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Background: Moderate hypofractionated radiotherapy is a treatment option for the cure of localized prostate cancer (PCa) patients based on the results of randomized prospective trials, but there is a clinical concern about the relatively short length of follow-up, and real-world results on outcome and toxicity based on cutting-edge techniques are lacking. The objective of this study is to present the long-term results of a large multicentric series. Materials and methods: We retrospectively evaluated 1325 PCa patients treated with daily volumetric image-guided hypofractionated radiotherapy between 2007 and 2020 in 16 Centers. For survival endpoints, we used Kaplan–Meier survival curves and fitted univariate and multivariable Cox's proportional hazards regression models to study the association between the clinical variables and each survival type. Results: At the end of the follow-up, 11 patients died from PCa. The 15-year values of cancer-specific survival (CSS) and biochemical relapse-free survival (b-RFS) were 98.5% (95%CI 97.3–99.6%) and 85.5% (95%CI 81.9–89.4%), respectively. The multivariate analysis showed that baseline PSA, Gleason score, and the use of androgen deprivation therapy were significant variables for all the outcomes. Acute gastrointestinal (GI) and genitourinary (GU) toxicities of grade ≥ 2 were 7.0% and 16.98%, respectively. The 15-year late grade ≥ 2 GI and GU toxicities were 5% (95%CI 4–6%) and 6% (95%CI 4–8%), respectively. Conclusion: Real-world long-term results of this multicentric study on cutting-edge techniques for the cure of localized PCa demonstrated an excellent biochemical-free survival rate of 85.5% at 15 years, and very low rates of ≥ G3 late GU and GI toxicity (1.6% and 0.9% respectively), strengthening the results of the available published trials. [ABSTRACT FROM AUTHOR]

Land systems combine land use and land cover, considering that their changes have important consequences for the local environment and human well-being and are pervasive factors of regional and global environmental change. More specifically, land consumption (LC), due to the occupation of originally agricultural, natural, or semi-natural areas, implies a progressive loss of key environmental resources and ecosystem services (ESs), reducing the individual well-being. Furthermore, policy makers need data on the benefits of public goods in monetary terms to support well-being-oriented decision-making. This work seeks to demonstrate that life satisfaction approach (LSA) can be applied to a practical assessment goal with the intention to give a monetary value to the LC and consequently to a loss of important ESs. The Italian case study is investigated with the help of a national survey database reporting the subjective well-being index (SWBI) subsequently grouped by regions. The overall intent is to make explicit to the policymakers that biodiversity and ESs are valuable to society and that their further degradation will result in irreversible damages to local communities. Using nationally representative data from the Multi-Purpose Survey on Italian Families in Italy over 2012–2016, results suggest that the national average annual income willingness to accept (WTA) related to consumed land is equal to −0.0827 €/m2 on average, while the social cost for LC and the loss of related ESs affects 0.01% of the Italian GDP per year. Finally, the possibility of estimating and comparing the WTA with the land market values brings the method presented here closer to cost-based estimates overcoming the limitations of contingent valuation methods. [ABSTRACT FROM AUTHOR]

Occupant behavior is among the main causes for the mismatch between simulated and in-use energy performance of buildings. One of the strategies considered capable of reducing user's behavior induced energy consumption, while increasing indoor environmental quality is the application of Building Automation and Control Systems (BACS). In this study, three building user's profiles have been considered depending on their energy consumption. The energy savings due to BACS class increase have been calculated, and a cost–benefit analysis (CBA) has been performed to evaluate the feasibility of different scenarios. Additional co-benefits perceived by the individuals have been accounted for in the form of willingness-to-pay (WTP). The methodology is applied to two case studies: a nearly zero-energy building (NZEB) rural single-family house and a recently renovated dwelling in an apartment block. The results show that the main reductions are achieved by the users' behavior alone, and the adoption of BACS is economically feasible only when an incentive program is in place, and the WTP is repeated as a recurrent co-benefit over the years. In particular, relying only on energy reduction due to higher BACS class introduction is not economically desirable. The greatest savings are achieved by the behavioral change of the user when coupled with BACS, supporting their potential role in improving user's energy literacy. Finally, incentive schemes are necessary to reduce the investment costs of such projects, being these the most influential variables in the feasibility of BACS applications. [ABSTRACT FROM AUTHOR]

The challenges currently facing the EU in the energy sector include increasing import dependence, limited diversification, high and volatile energy prices, decarbonization, and slow progress in energy efficiency. EU energy policy has provided a wide range of measures to achieve an integrated energy market and sustainability of the building sector. Various incentives and financial instruments have been promoted and financed by governments to help consumers in energy retrofit processes. These include direct investments and fiscal, financial, and market instruments. Public measures have been widely studied but private initiatives have not. In this study, the energy-efficiency mortgage (EEM) is investigated as a credit scheme to attract young people to a real estate market for sustainable buildings, characterized by high sale prices. A choice experiment (CE) was modelled to investigate the preferences of potential young buyers of a new home. The results of this exploratory survey showed an appreciation of the purchase of new A-rated properties according to the Energy Performance Certificate, compared to those that need to be retrofitted or not retrofitted. Consumers like the option of a home energy efficiency renovation being fully managed by a third party (i.e., following the one-stop shop model). The key appeal of energy efficiency for consumers ranges from its ability to support better energy management, to better property value management. The EEM seems to be a promising tool to stimulate investments in energy efficiency and to promote the accessibility and affordability of housing in the sustainable housing market. The results of this study can help private financial institutions to propose appropriate credit plans, which limit the risk of default by the borrower. They can also help public incentive policymakers to propose complementary instruments to EEM. [ABSTRACT FROM AUTHOR]

In the ongoing context of climate change, there is an increasing need to support decision-making processes in the domain of landscape planning and management. Suitable evaluation techniques are needed to take into account the interests of actors and stakeholders in shared policy decisions. An important methodological contribution to the field is given by the Multicriteria Decision Analysis (MCDA), due to its ability to combine multiple aspects of a decision problem with the values and opinions expressed by different Decision Makers. The present paper develops the "Group Analytic Hierarchy Process Sorting II method" (GAHPSort II), which aims to sort a group of municipalities included in the UNESCO site "Vineyard Landscape of Piedmont: Langhe-Roero, and Monferrato" (Italy) according to the economic attractiveness of the landscape. Extending the previous versions AHPSort I, AHPSort II and GAHPSort, the GAHPSort II optimizes multi-stakeholder evaluations on large databases by reducing the number of comparisons. Moreover, the GAHPSort II method is proposed as a novel spatial decision support system because it combines a set of economic indicators for landscape and GIS methods for aiding the Decision Makers to better understand the case study and to support the definition and localization of policies and strategies of landscape planning and management. [ABSTRACT FROM AUTHOR]

Background: Elderly breast cancer patients are frequently affected by significant comorbidities that make sophisticated radiotherapy treatments particularly challenging. Aims: We dosimetrically analyzed two different simple free-breathing external beam radiotherapy (EBRT) techniques for the hypofractionated treatment of the left breast in elderly patients with a low compliance, to compare target coverage, and heart and left anterior descending coronary artery (LADCA) sparing. Methods: We developed radiation plans for 24 elderly patients using 3D conformal (3DCRT) field-in-field tangential technique and intensity-modulated (IMRT) tangential beam technique. Dose-Volume-Histograms (DVHs) were used to provide a quantitative comparison between plans. Results: The median breast volume was 645 cm3. IMRT and 3DCRT plans comparison demonstrated no significant differences in terms of organ sparing for the heart. Regarding LADCA, mean dose (10.3 ± 9.5 Gy vs 11.9 ± 9.6 Gy, p = 0.0003), maximum dose (26.1 ± 16.1 Gy vs 29.1 ± 16.1 Gy, p = 0.004) and V17 Gy (21.5% ± 26.9% vs 25.0% ± 27.2%, p = 0.002) significantly decreased using IMRT compared with 3DCRT. IMRT plans showed a better target coverage compared with 3DCRT (0.91 ± 0.05 vs 0.93 ± 0.04, p = 0.05). Discussion: Comparing the two different EBRT techniques, we demonstrated few, although substantial, dosimetric differences in terms of doses to the organs at risk characterized by a statistically significant dose reduction of LADCA in the IMRT plans. Conclusions: Elderly patients with a low compliance to treatment might benefit from 3DCRT with field-in-field tangential arrangement or from a simple IMRT approach. IMRT should be preferred. [ABSTRACT FROM AUTHOR]

Mining activities can contribute to sustainable development, focusing on economic, environmental, and community aspects. To this purpose, it appears essential to investigate the spatial dimension of mining operations to have a clear picture of the full range of impacts in terms of both opportunities and constrains. The paper illustrates the construction of a geodatabase for supporting planning and management of mining activities in Piedmont Region (Northern Italy). In the geodatabase, all the quarries located in the area are represented at a regional scale, distinguishing by active and inactive sites that have been further divided according to the main categories of extracted materials, namely aggregates, industrial minerals, and ornamental stones. The article discusses how the regional mining mapping can offer an integrated and interdisciplinary representation of the territory under analysis, thus supporting the decision-making processes in the context of the activities related to the Strategic Environmental Assessment of the planning of mining operations. [ABSTRACT FROM AUTHOR]

Aims: To retrospectively evaluate the outcome of stereotactic body radiation therapy (SBRT) in the treatment of elderly patients affected by isolated body metastasis from different primitive tumors.Methods: 70 patients with isolated body metastasis were treated. Median age at diagnosis was 75 years (IQR 69-80). The most common SBRT fractionation scheme was 5 × 7 Gy (total dose 35 Gy). The primary endpoints were Local Control (LC) and Toxicity. Secondary endpoints were Overall Survival (OS) and Disease-Specific Survival (DSS). Response to radiotherapy was assessed according to RECIST criteria v1.1. Toxicity was registered according to Common Terminology Criteria for Adverse Events (CTCAE) v 4.0. We performed survival analysis with the Kaplan-Meier method. The correlation between time actuarial incidence and clinical parameters was studied.Results: Median follow-up was 26.5 months. 44 patients (62.8%) were alive at the time of analysis, while 22 (31.4%) died because of the disease. Local control at 2 and 3 years was 87%. The 2-year OS and DSS were 84 and 71%, respectively, while the 3-year values were 57 and 62%. PFS at 2 and 3 years was 41 and 25%, respectively. On univariate analysis, KPS ≥ 90 is statistically correlated with improved OS and DSS (p < 0.05). Acute toxicity of grade ≥ 2 occurred in 4 (5.7%) patients, while late toxicity ≥ 2 was recorded in 6 (8.6%) patients.Conclusions: Ablative Radiotherapy represents a safe, effective, and minimally invasive treatment modality for elderly oligometastatic patients who are judged unfit for systemic therapy. [ABSTRACT FROM AUTHOR]

In this paper we deal with an urban and territorial planning problem by applying the Non Additive Robust Ordinal Regression (NAROR). NAROR is a recent extension of the Robust Ordinal Regression family of Multiple Criteria Decision Aiding methods to the Choquet integral preference model which permits to represent interaction between considered criteria through the use of a set of non-additive weights called capacity or fuzzy measure. The use of NAROR permits the Decision Maker (DM) to give preference information in terms of preferences between pairs of alternatives with which she is familiar, and relative importance and interaction of considered criteria. The basic idea of NAROR is to consider the whole set of capacities that are compatible with the preference information given by the DM. In fact, the recommendation supplied by NAROR is expressed in terms of necessary preferences, in case an alternative is preferred to another for all compatible capacities, and of possible preferences, in case an alternative is preferred to another for at least one compatible capacity. In the considered case study, several sites for the location of a landfill are analyzed and compared through the use of the NAROR on the basis of different criteria, such as presence of population, hydrogeological risk, interferences on transport infrastructures and economic cost. This paper is the first application of NAROR to a real-world problem, even if not already with real DMs, but with a panel of experts simulating the decision process. [ABSTRACT FROM AUTHOR]

It is well known that the incorporation of the intergenerational equity objective has turned the traditional Cost-Benefit Analysis (CBA) approach into an obsolete tool for the evaluation of certain types of projects, particularly those exhibiting many environmental externalities and those whose effects extend throughout a long period of time. Two main changes are taking place in CBA in order to adapt this methodology to the sustainable development paradigm: (a) the development of new tools for the economic valuation of environmental externalities that were traditionally left out of the analysis; and (b) an in-depth revision of the theoretical foundations underlying the traditional approaches to discounting, since the repercussions of decisions that are presently being debated will extend to a distant future (in some cases for centuries), whereas in the classical CBA, we deal with few decades at best. This paper aims at investigating the discounting operation in CBA, trying to summarize the main approaches available in the literature, with specific reference to the tools which allow future generations to be included in the analysis. In order to support the theoretical explanation, a real case study is analysed concerning the evaluation of a waste incinerator that has been constructed in the Province of Turin (Italy). [ABSTRACT FROM AUTHOR]