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Purpose: The aim of this experimental study was to investigate whether paper-and-pencil and computerized surveys administered in the school setting yield equivalent data quality indicators and risk behavior prevalence estimates. Methods: Data were drawn from the European School Survey Project on Alcohol and Other Drugs (ESPAD®) carried out in Italy to monitor drug, alcohol, tobacco use and other risk-behaviors among Italian high school students aged 15–19 years. A sub-sample of schools was recruited for the study (1673 pupils). For each school, two entire randomly selected courses (from the first to the fifth grade) participated and were assigned randomly to the self-administered paper-and-pencil (N = 811) or computerized survey (N = 862). Differences in data quality were assessed using the following indicators: questionnaire completeness (missing gender and/or 50% of missing answers) and internal consistency (repetitive extreme response patterns). Separate logistic regression models were used to estimate the mode effect on the reporting of each risk behavior, controlling for gender and age. Finally, the prevalence estimates of the experimental study were compared to the results of the national ESPAD® study. Results: The computerized administration mode produced a higher proportion of invalid questionnaires, but the prevalence estimates generated from responses to the paper-and-pencil and computerized surveys were generally equivalent. Nevertheless, comparing these results with those of the national ESPAD® study, some differences in the prevalence rates were found. Conclusions: The findings suggest that in a proctored school setting, the computerized survey mode yields almost the same results as the paper-and-pencil mode. However, because of the reliance on existing informatics facilities until when all schools in the country will be sufficiently equipped for the computerized data collection, they should be given the opportunity to choose between paper-and-pencil and computerized survey modes, in order to avoid a possible selection bias. [ABSTRACT FROM AUTHOR]

Radionuclide contamination is a serious health issue caused by nuclear experiments and plant accidents, as seen for the Chernobyl and Fukushima nuclear plants. Italy has been especially interested in northwestern alpine regions, as have several other nations. The aim of this work was to indagate 134Cs and 137Cs contamination in wild boars, which were considered bioindicators sampled in the Chisone/Germanasca Valley and the Pellice Valley districts (Piedmont, Italy) in two hunting seasons (2014 and 2016). In the 2014 season, only the livers of the animals (n = 48) were sampled, whereas in 2016, five different anatomical sampling sites were sampled for each animal (n = 16). The analyses were conducted in an accredited laboratory (Agenzia Regionale per la Protezione dell'Ambiente–ARPA) by the aid of an HPGe detector (Ortec) with a relative efficiency of 50%. In general, the contamination levels registered in 2014 were under the detection limit for 134Cs and low for 137Cs (Chisone/Germanasca valley: min: 0.0, max: 23.9 median 11.0 Bq/kg vs Pellice valley: min 0, max: 31.7, median: 9.6 Bq/kg) and no health concern can be supposed. In the first-year samples, the liver showed a negative correlation between age and contamination level. In the second year of sampling, low levels were confirmed (min: 3.1 Bq/kg, max: 113.3; median 17.7 Bq/kg). Multiple sampling from the same animal showed that the diaphragm (median = 27.7 Bq/kg) kidney (27.4) and tongue (27.6) were more contaminated than the liver (17.7) and spleen (15.3). Moreover, a linear mixed model revealed a negative organ-by-age interaction, meaning that interorgan differences in contamination level were greater in younger (5–11 months) than in older (18–36 months) animals. Different feeding habits can be the explanation. Our paper shows that muscle sites (diaphragm and tongue) can be useful for radionuclide pollution surveillance in wild boar populations and that younger animals show more interorgan variability in contamination levels than older animals. More investigations are needed to confirm this correlation and to fulfill the request for more data to achieve better risk assessment. [ABSTRACT FROM AUTHOR]

Understanding lay theories on the causes of economic inequality is the first step to comprehending why people tolerate, justify, or react against it. Accordingly, this paper aims to develop and validate with two cross-sectional studies the Attributions for Cross-Country Inequality Scale (ACIS), which assesses how people explain cross-country economic inequality–namely, the uneven distribution of income and wealth between poor and rich countries. After selecting and adapting items from existing scales of attributions for poverty and wealth, in Study 1, we tested the factorial structure of this initial pool of items in three countries with different levels of economic development and inequality, namely, Italy (n = 246), the UK (n = 248), and South Africa (n = 228). Three causal dimensions emerged from the Exploratory Factor Analysis: "rich countries" (blaming the systematic advantage of and exploitation by rich countries), "poor countries" (blaming the dispositional inadequacy and faults of poor countries), and "fate" (blaming destiny and luck). The retained items were administered in Study 2 to three new samples from Italy (n = 239), the UK (n = 249), and South Africa (n = 248). Confirmatory Factor Analysis (CFA) corroborated the factorial structure of the ACIS, and Multi-Group CFA supported configural and metric invariances of the scale across countries. In addition, we show internal consistency and construct validity of the scale: the scale correlates with relevant constructs (e.g., beliefs about cross-country inequality and ideological orientation) and attitudes toward relevant policies related to international redistribution and migration. Overall, the scale is a valid instrument to assess causal attribution for cross-national inequality and is reliable across countries. By focusing on resource distribution from an international perspective, this scale will allow researchers to broaden the discussion on economic inequality to a global level. [ABSTRACT FROM AUTHOR]

When the COVID-19 pandemic first emerged in early 2020, healthcare and bureaucratic systems worldwide were caught off guard and largely unprepared to deal with the scale and severity of the outbreak. In Italy, this led to a severe underreporting of infections during the first wave of the spread. The lack of accurate data is critical as it hampers the retrospective assessment of nonpharmacological interventions, the comparison with the following waves, and the estimation and validation of epidemiological models. In particular, during the first wave, reported cases of new infections were strikingly low if compared with their effects in terms of deaths, hospitalizations and intensive care admissions. In this paper, we observe that the hospital admissions during the second wave were very well explained by the convolution of the reported daily infections with an exponential kernel. By formulating the estimation of the actual infections during the first wave as an inverse problem, its solution by a regularization approach is proposed and validated. In this way, it was possible to compute corrected time series of daily infections for each age class. The new estimates are consistent with the serological survey published in June 2020 by the National Institute of Statistics (ISTAT) and can be used to speculate on the total number of infections occurring in Italy during 2020, which appears to be about double the number officially recorded. [ABSTRACT FROM AUTHOR]

Covid-19 outbreak led all organizations to reorganize their processes to prevent infection and contagion risk. All healthcare facilities, included penitentiary mental health services, had to redesign their processes to safely deliver care services. In this paper, the case of a Penitentiary Mental Health Division located in southern Italy is presented. Soft System Methodology and Business process management principles and techniques are adopted to analyse and redesign the detainees' mental health care process. The process, characterized by direct, close and prolonged contact with patients, exposes detainees and healthcare staff to a high Covid-19 infection risk. Through document analysis, interviews with the actors involved in the process and direct observation, the process's inefficiencies and criticalities are identified. The process is redesigned to make it compliant with Covid-19 prevention provisions and national penitentiary regulations and address the other criticalities. The proposed methodological approach–which innovatively combines Soft System Methodology and Business Process Management–constitutes a human-centered process-based redesign approach that can be used both in healthcare and other organizational settings. [ABSTRACT FROM AUTHOR]

Prospect Theory, proposed and developed by Kahneman and Tversky, demonstrated that people do not make rational decisions based on expected utility, but are instead biased by specific cognitive tendencies leading to neglect, under- or over- consider information, depending on the context of presentation. In this vein, the present paper focuses on whether and how individual decision-making attitudes are prone to change in the presence of globally challenging events. We ran three partial replications of the Kahneman and Tversky (1979) paper, focusing on a set of eight prospects, after a terror attack (Paris, November 2015, 134 subjects) and during the Covid-19 pandemic, both during the first lockdown in Italy (Spring 2020, 176 subjects) and after the first reopening (140 subjects). The results confirm patterns of choice characterizing uncertain times, as shown by previous literature. In particular, we note significant increase of risk aversion, both in the gain and in the loss domains, that consistently emerged in the three replications. Given the nature of our sample, and the heterogeneity between the three periods investigated, we suggest that the phenomenon we present can be explained stress-related effects on decision making rather than by other economic effects, such as the income effect. [ABSTRACT FROM AUTHOR]

During the COVID-19 pandemic, science has been prominently featured in institutional communication and political agendas as never before. Governments substantially relied on scientific experts to analyze pandemic trends, develop anti-COVID-19 vaccines and adopt containment strategies. In this paper, we analyze speeches by three political leaders–Boris Johnson (Prime Minister, UK), Sergio Mattarella (President of the Republic, Italy), and Ursula von der Leyen (President, European Commission)–between February 20, 2020, and February 20, 2022, to identify how science was addressed and framed. The results of the quantitative and qualitative exploration of the speeches highlight three main ways in which political leaders view science: a national pride narrative–i.e., science as an instrument and indicator of national pride and international standing of the country; an ethical narrative–i.e., science as an agent of social growth; an integration narrative–i.e., science as a driving force of both European integration and stronger collaboration between knowledge production and industry. The predominant narrative varies in relation to the political leaders' different institutional contexts and roles. [ABSTRACT FROM AUTHOR]

Long bone breakage for bone marrow recovery is a commonly observed practice in Middle Palaeolithic contexts, regardless of the climatic conditions. While lithic technology is largely used to define cultural patterns in human groups, despite dedicating research by zooarchaeologists, for now butchering techniques rarely allowed the identification of clear traditions, notably for ancient Palaeolithic periods. In this paper, we test the hypothesis of butchery traditions among Neandertal groupsusing the bone assemblages from three sites in southwestern Europe. These sites are located in southeastern France and northern Italy and are dated to the Late Middle Palaeolithic: Abri du Maras (Marine Isotopic Stages (MIS) 4–3, Ardèche), Saint-Marcel (MIS 3, Ardèche), and Riparo Tagliente (MIS 4–3, Verona). The detection of culturally-induced patterns of bone breakage involves differentiating them from intuitively generated patterns. To tackle this issue, we used a zooarchaeological approach focusing on the percussion marks produced during the bone breakage process. Statistical analyses as the chi-square test of independence were employed to verify if percussion mark locations were randomly distributed, and if these distributions were different from the intuitive ones. For femurs and humeri, our results demonstrate that Neandertal groups occupying the Abri du Maras (levels 4.1 and 4.2) and the Saint-Marcel Cave (levels g and h) sites in France applied butchery traditions to recover yellow marrow. However, the traditions developed at each site were different. On the contrary, in Riparo Tagliente, in Italy, several groups or individuals of a same group did not share the same butchery traditions over time. Regarding the Abri du Maras and Saint Marcel Cave assemblages, our research demonstrates that Neandertal groups applied intense standardized bone breakage, far from the intuitive practice observed experimentally and related to bone density and/or skeletal morphology. These standardized patterns, which are systematic and counter-intuitive, can be interpreted as culturally induced for the Abri du Maras and Saint Marcel Cave. The diversity of Neandertal traditions should be considered by taking into account the butchery, in particular the practice of bone marrow extraction, and not only technological behaviours and types of tool kits. [ABSTRACT FROM AUTHOR]

MammoWave is a microwave imaging device for breast lesion detection, employing two antennas which rotate azimuthally (horizontally) around the breast. The antennas operate in the 1-9 GHz band and are set in free space, i.e., pivotally, no matching liquid is required. Microwave images, subsequently obtained through the application of Huygens Principle, are intensity maps, representing the homogeneity of the dielectric properties of the breast tissues under test. In this paper, MammoWave is used to realise tissues dielectric differences and localise lesions by segmenting microwave images adaptively employing pulse coupled neural network (PCNN). Subsequently, a non-parametric thresholding technique is modelled to differentiate between breasts having no radiological finding (NF) or benign (BF) and breasts with malignant finding (MF). Resultant findings verify that automated breast lesion localization with microwave imaging matches the gold standard achieving 81.82% sensitivity in MF detection. The proposed method is tested on microwave images acquired from a feasibility study performed in Foligno Hospital, Italy. This study is based on 61 breasts from 35 patients; performance may vary with larger number of datasets and will be subsequently investigated. [ABSTRACT FROM AUTHOR]

The last year of Covid-19 pandemic has been characterized by the continuous chase between the vaccination campaign and the appearance of new variants that puts further obstacles to the possibility of eradicating the virus and returning to normality in a short period. In the present paper we develop a deterministic compartmental model to describe the evolution of the Covid-19 in Italy as a combined effect of vaccination campaign, new variant spreading and mobility restrictions. Particular attention is given to the mechanism of waning immunity, appropriately timed with respect to the effective progress of the vaccination campaign in Italy. We perform a retrospective analysis in order to explore the role that different mechanisms, such as behavioral changes, variation of the population mobility, seasonal variability of the virus infectivity, and spreading of new variants have had in shaping the epidemiological curve. We find that, in the large time window considered, the most relevant mechanism is the seasonal variation in the stability of the virus, followed by the awareness mechanism, that induces individuals to increase/relax self-protective measures when the number of active cases increases/decreases. The appearance of the Delta variant and the mobility variations have had instead only marginal effects. In absence of vaccines the emerging scenario would have been dramatic with a percentage difference in the number of total infections and total deaths, in both cases, larger than fifty per cent. The model also predicts the appearance of a more contagious variant (the Omicron variant) and its becoming dominant in January 2022. [ABSTRACT FROM AUTHOR]

COVID-19 has got us to face a new situation where, for the lack of ready-to-use vaccines, it is necessary to support vaccination with complex non-pharmaceutical strategies. In this paper, we provide a novel Mixed Integer Nonlinear Programming formulation for fine-grained optimal intervention planning (i.e., at the level of the single day) against newborn epidemics like COVID-19, where a modified SIR model accounting for heterogeneous population classes, social distancing and several types of vaccines (each with its efficacy and delayed effects), allows us to plan an optimal mixed strategy (both pharmaceutical and non-pharmaceutical) that takes into account both the vaccine availability in limited batches at selected time instants and the need for second doses while keeping hospitalizations and intensive care occupancy below a threshold and requiring that new infections die out at the end of the planning horizon. In order to show the effectiveness of the proposed formulation, we analyze a case study for Italy with realistic parameters. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has been characterized by a social media "infodemic": an overabundance of information whose authenticity may not always be guaranteed. With the potential to lead individuals to harmful decisions for the society, this infodemic represents a severe threat to information security, public health and democracy. In this paper, we assess the interplay between the infodemic and specific aspects of the pandemic, such as the number of cases, the strictness of containment measures, and the news media coverage. We perform a comparative study on three countries that employed different managements of the COVID-19 pandemic in 2020—namely Italy, the United Kingdom, and New Zealand. We first analyze the three countries from an epidemiological perspective to characterize the impact of the pandemic and the strictness of the restrictions adopted. Then, we collect a total of 6 million posts from Facebook to describe user news consumption behaviors with respect to the reliability of such posts. Finally, we quantify the relationship between the number of posts published in each of the three countries and the number of confirmed cases, the strictness of the restrictions adopted, and the online news media coverage about the pandemic. Our results show that posts referring to reliable sources are consistently predominant in the news circulation, and that users engage more with reliable posts rather than with posts referring to questionable sources. Furthermore, our modelling results suggest that factors related to the epidemiological and informational ecosystems can serve as proxies to assess the evolution of the infodemic. [ABSTRACT FROM AUTHOR]

Introduction: REsilience and Activities for every DaY (READY) is an Acceptance and Commitment Therapy-based group resilience-training program that has preliminary empirical support in promoting quality of life and other psychosocial outcomes in people with multiple sclerosis (PwMS). Consistent with the Medical Research Council framework for developing and evaluating complex interventions, we conducted a pilot randomized controlled trial (RCT), followed by a phase III RCT. The present paper describes the phase III RCT protocol. Methods and analysis: This is a multi-centre cluster RCT comparing READY with a group relaxation program (1:1 ratio) in 240 PwMS from eight centres in Italy (trial registration: isrctn.org Identifier: ISRCTN67194859). Both interventions are composed of 7 weekly sessions plus a booster session five weeks later. Resilience (primary outcome), mood, health-related quality of life, well-being and psychological flexibility will be assessed at baseline, after the booster session, and at three and six month follow-ups. If face-to-face group meetings are interrupted because of COVID-19 related-issues, participants will be invited to complete their intervention via teleconferencing. Relevant COVID-19 information will be collected and the COVID-19 Peritraumatic Distress scale will be administered (ancillary study) at baseline and 3-month follow-up. Analysis will be by intention-to-treat to show superiority of READY over relaxation. Longitudinal changes will be compared between the two arms using repeated-measures, hierarchical generalized linear mixed models. Conclusion: It is expected that his study will contribute to the body of evidence on the efficacy and effectiveness of READY by comparing it with an active group intervention in frontline MS rehabilitation and clinical settings. Results will be disseminated in peer-reviewed journals and at other relevant conferences. [ABSTRACT FROM AUTHOR]

Novel Covid-19 has had a huge impact on the world's population since December 2019. The very rapid spreading of the virus worldwide, with its heavy toll of death and overload of the healthcare systems, induced the scientific community to focus on understanding, monitoring and foreseeing the epidemic evolution, weighing up the impact of different containment measures. An immense literature was produced in few months. Many papers were focused on predicting the peak features through a variety of different models. In the present paper, combining the surveillance data-set with data on mobility and testing, we develop a deterministic compartment model aimed at performing a retrospective analysis to understand the main modifications occurred to the characteristic parameters that regulate the epidemic spreading. We find that, besides self-protective behaviors, a reduction of susceptibility should have occurred in order to explain the fast descent of the epidemic after the peak. A sensitivity analysis of the basic reproduction number, in response to variations of the epidemiological parameters that can be influenced by policy-makers, shows the primary importance of a rigid isolation procedure for the diagnosed cases, combined with an intensive effort in performing extended testing campaigns. Future scenarios depend on the ability to protect the population from the injection of new cases from abroad, and to pursue in applying rigid self-protective measures. [ABSTRACT FROM AUTHOR]

The spread of COVID-19 implied a large and fast increase of demand for intensive care services. To face this increase in demand, health care systems need to adapt their response by increasing hospital beds, intensive care unit (ICU) capacity and by (re-)deploying doctors and other personnel. This paper proposes a forecast approach based on the Vector Error Correction model for the daily counts of hospitalized patients with symptoms and of patients in ICU, using publicly available data on the current COVID-19 outbreak in Italy, Switzerland and Spain. The level of analysis is the local government managing the health care system response, which corresponds to regions for Italy. The one-week-ahead forecasts are validated with out-of-sample data over successive weeks; they are found to provide timely and robust prediction of ICU capacity needs in Lombardy, the most-affected Italian region, starting from the sample of the first 2 weeks of data. The same methodology is successfully validated on other Italian regions, Switzerland and Spain. This approach may be used in other countries/regions/provinces to help adapt the health care system response to COVID-19 (or other similar disease); for this purpose, the open-source software code to produce the forecasts is provided with the paper. [ABSTRACT FROM AUTHOR]

Introduction: This paper describes how mortality among hospitalised COVID-19 patients changed during the first three waves of the epidemic in Italy. Methods: This prospective cohort study used the Kaplan-Meier method to analyse the time-dependent probability of death of all of the patients admitted to a COVID-19 referral centre in Milan, Italy, during the three consecutive periods of: 21 February-31 July 2020 (first wave, W1), 1 August 2020–31 January 2021 (second wave, W2), and 1 February-30 April 2021 (third wave, W3). Cox models were used to examine the association between death and the period of admission after adjusting for age, biological sex, the time from symptom onset to admission, disease severity upon admission, obesity, and the comorbidity burden. Results: Of the 2,023 COVID-19 patients admitted to our hospital during the study period, 553 (27.3%) were admitted during W1, 838 (41.5%) during W2, and 632 (31.2%) during W3. The crude mortality rate during W1, W2 and W3 was respectively 21.3%, 23.7% and 15.8%. After adjusting for potential confounders, hospitalisation during W2 or W3 was independently associated with a significantly lower risk of death than hospitalisation during W1 (adjusted hazard ratios [AHRs]: 0.75, 95% confidence interval [CI] 0.59–0.95, and 0.58, 95% CI 0.44–0.77). Among the patients aged >75 years, there was no significant difference in the probability of death during the three waves (AHRs during W2 and W3 vs W1: 0.93, 95% CI 0.65–1.33, and 0.88, 95% CI 0.59–1.32), whereas those presenting with critical disease during W2 and W3 were at significantly lower risk of dying than those admitted during W1 (AHRs 0.61, 95% CI 0.43–0.88, and 0.44, 95% CI 0.28–0.70). Conclusions: Hospitalisation during W2 and W3 was associated with a reduced risk of COVID-19 death in comparison with W1, but there was no difference in survival probability in patients aged >75 years. [ABSTRACT FROM AUTHOR]

This paper investigates gender issues in Ph.D. entrepreneurship. The empirical analysis is based on data from a questionnaire survey run in 2014–15 in Italy. We analyse how Ph.D. students perceive the institutional entrepreneurial environment, the drivers and the factors hindering entrepreneurship and gender-equality among faculties at the parent institution. We find evidence of a gender bias in Ph.D. entrepreneurship and that the perception about the factors either hampering or supporting entrepreneurship is deeply different between sexes. The academic environment can have a fundamental impact on students' decisions to start new ventures and on the probability that they will abandon their entrepreneurial intentions. Female student entrepreneurs particularly benefit from the opportunity to engage with a gender-balanced work environment. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic is bringing disruptive effects on the healthcare systems, economy and social life of countries all over the world. Even though the elder portion of the population is the most severely affected by the COVID-19 disease, the counter-measures introduced so far by governments took into little account the age structure, with restrictions that act uniformly on the population irrespectively of age. In this paper, we introduce a SIRD model with age classes for studying the impact on the epidemic evolution of lockdown policies applied heterogeneously on the different age groups of the population. The proposed model is then applied to age-stratified COVID-19 Italian data. The simulation results suggest that control measures focused to specific age groups may bring benefits in terms of reduction of the overall mortality rate. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 epidemic in Italy has severely affected people aged more than 80, especially socially isolated. Aim of this paper is to assess whether a social and health program reduced mortality associated to the epidemic. Methods: An observational retrospective cohort analysis of deaths recorded among >80 years in three Italian cities has been carried out to compare death rate of the general population and "Long Live the Elderly!" (LLE) program. Parametric and non-parametric tests have been performed to assess differences of means between the two populations. A multivariable analysis to assess the impact of covariates on weekly mortality has been carried out by setting up a linear mixed model. Results: The total number of services delivered to the LLE population (including phone calls and home visits) was 34,528, 1 every 20 day per person on average, one every 15 days during March and April. From January to April 2019, the same population received one service every 41 days on average, without differences between January-February and March-April. The January-April 2020 cumulative crude death rate was 34.8‰ (9,718 deaths out of 279,249 individuals; CI95%: 34.1–35.5) and 28.9‰ (166 deaths out of 5,727 individuals; CI95%:24.7–33.7) for the general population and the LLE sample respectively. The general population weekly death rate increased after the 11th calendar week that was not the case among the LLE program participants (p<0.001). The Standardized Mortality Ratio was 0.83; (CI95%: 0.71–0.97). Mortality adjusted for age, gender, COVID-19 weekly incidence and prevalence of people living in nursing homes was lower in the LLE program than in the general population (p<0.001). Conclusions: LLE program is likely to limit mortality associated with COVID-19. Further studies are needed to establish whether it is due to the impact of social care that allows a better clients' adherence to the recommendations of physical distancing or to an improved surveillance of older adults that prevents negative outcomes associated with COVID-19. [ABSTRACT FROM AUTHOR]

The global impact of coronavirus disease 2019 (COVID-19) is unprecedented, and many control and prevention measures have been implemented to test for and trace COVID-19. However, invisible-spreaders, who are associated with nucleic acid detection and asymptomatic infections, have received insufficient attention in the current COVID-19 control efforts. In this paper, we analyze the time series infection data for Italy, Germany, Brazil, India and Sweden since the first wave outbreak to address the following issues through a series of experiments. We conclude that: 1) As of June 1, 2020, the proportion of invisible-spreaders is close to 0.4% in Sweden, 0.8% in early Italy and Germany, and 0.4% in the middle and late stages. However, in Brazil and India, the proportion still shows a gradual upward trend; 2) During the spread of this pandemic, even a slight increase in the proportion of invisible-spreaders could have large implications for the health of the community; and 3) On resuming work, the pandemic intervention measures will be relaxed, and invisible-spreaders will cause a new round of outbreaks. [ABSTRACT FROM AUTHOR]

The Covid-19 pandemic has highlighted the importance of citizens' behaviors in the containment of the virus. Individuals might change their intention to adhere to public health prescriptions depending on various personal characteristics, including their own emotional status, which has been recognized to be a crucial psychological factor in orienting people's adherence to public health recommendation during emergency settings. In particular, it is crucial to support citizens' alliance with authorities and feeling of trust: public engagement is a concept that refers to the general involvement of citizens into public affairs which is generally considered an effective approach to enhance citizens' understanding of their crucial role in public affairs. However, so far there is no agreement on the metrics and indexes that should be used to measures public engagement during a health crisis. The aim of this paper is to validate a psychometric scale (PHEs-E), which intends to measure the readiness of individuals to adhere to the prescribed behavioral change to contain the emergency. Data were collected throughout the pandemic in Italy: in particular, five independent samples were recruited starting from March 2020 to March 2021. Results showed that the proposed measure has good psychometric characteristics. A general linear model was computed to assess the differences of public engagement across the different data points and among citizens with different sociodemographic characteristics. Correlations with other psychological constructs (i.e. Anxiety, Depression and Self-Efficacy) were also tested, showing that more engaged citizens have a lower level of anxiety and depression, and a higher self-efficacy. This study's findings indicate that individuals' characteristics may differentiate citizens' motivation to engage in public health behavioral recommendation to prevent the COVID-19 contagion. However the scale could be useful to perform a psychological monitoring of psychological readiness to engage in public health strategies to face critical events and settings. [ABSTRACT FROM AUTHOR]

Cremation 168 from the second half of the 8th century BCE (Pithekoussai's necropolis, Ischia Island, Italy), better known as the Tomb of Nestor's Cup, is widely considered as one of the most intriguing discoveries in the Mediterranean Pre-Classic archaeology. A drinking cup, from which the Tomb's name derives, bears one of the earliest surviving examples of written Greek, representing the oldest Homeric poetry ever recovered. According to previous osteological analyses, the Cup is associated with the cremated remains of a juvenile, aged approximately 10–14 years at death. Since then, a vast body of literature has attempted to explain the unique association between the exceptionality of the grave good complex, the symposiac and erotic evocation of the Nestor's Cup inscription with the young age of the individual buried with it. This paper reconsiders previous assessments of the remains by combining gross morphology with qualitative histology and histomorphometric analyses of the burnt bone fragments. This work reveals the commingled nature of the bone assemblage, identifying for the first time, more than one human individual mixed with faunal remains. These outcomes dramatically change previous reconstructions of the cremation deposit, rewriting the answer to the question: who was buried with Nestor's Cup?. [ABSTRACT FROM AUTHOR]

Scientific evidence plays an important role in the therapeutic decision-making process. What happens when physicians are forced to make therapeutic decisions under uncertainty? The absence of scientific guidelines at the beginning of a pandemic due to an unknown virus, such as COVID-19, could influence the perceived legitimacy of the application of non-evidence-based therapeutic approaches. This paper reports on a test of this hypothesis, in which we administered an ad hoc questionnaire to a sample of 64 Italian physicians during the first wave of the COVID-19 pandemic in Italy (April 2020). The questionnaire statements regarding the legitimacy of off-label or experimental drugs were framed according to three different scenarios (Normality, Emergency and COVID-19). Furthermore, as the perception of internal bodily sensations (i.e., interoception) modulates the decision-making process, we tested participants' interoceptive sensibility using the Multidimensional Assessment of Interoceptive Awareness (MAIA). The results showed that participants were more inclined to legitimate non-evidence-based therapeutic approaches in the COVID-19 and Emergency scenarios than the Normality scenario. We also found that scores on the MAIA Trusting subscale positively predicted this difference. Our findings demonstrate that uncertain medical scenarios, involving a dramatic increase in patient volume and acuity, can increase risk-taking in therapeutic decision-making. Furthermore, individual characteristics of health care providers, such as interoceptive ability, should be taken into account when constructing models to prevent the breakdown of healthcare systems in cases of severe emergency. [ABSTRACT FROM AUTHOR]

Notable cross-country differences exist in the diffusion of the Covid-19 and in its lethality. Contact patterns in populations, and in particular intergenerational contacts, have been argued to be responsible for the most vulnerable, the elderly, getting infected more often and thus driving up mortality in some context, like in the southern European one. This paper asks a simple question: is it between whom contacts occur that matters or is it simply how many contacts people have? Due to the high number of confounding factors, it is extremely difficult to empirically assess the impact of single network features separately. This is why we rely on a simulation exercise in which we counterfactually manipulate single aspects of countries' age distribution and network structures. We disentangle the contributions of the kind and of the number of contacts while holding constant the age structure. More precisely, we isolate the respective effects of inter-age contact patterns, degree distribution and clustering on the virus propagation across age groups. We use survey data on face-to-face contacts for Great Britain, Italy, and Germany, to reconstruct networks that mirror empirical contact patterns in these three countries. It turns out that the number of social contacts (degree distribution) largely accounts for the higher infection rates of the elderly in the Italian context, while differences in inter-age contacts patterns are only responsible for minor differences. This suggests that policies specifically targeting inter-age contacts would be little effective. [ABSTRACT FROM AUTHOR]

Introduction: Placenta accreta spectrum (PAS) is a rare but potentially life-threatening event due to massive hemorrhage. Placenta previa and previous cesarean section are major risk factors for PAS. Italy holds one of the highest rates of primary and repeated cesarean section in Europe; nonetheless, there is a paucity of high-quality Italian data on PAS. The aim of this paper was to estimate the prevalence of PAS in Italy and to evaluate its associated factors, ante- and intra-partum management, and perinatal outcomes. Also, since severe morbidity and mortality in Italy show a North-South gradient, we assessed and compared perinatal outcomes of women with PAS according to the geographical area of delivery. Material and methods: This was a prospective population-based study using the Italian Obstetric Surveillance System (ItOSS) and including all women aged 15–50 years with a diagnosis of PAS between September 2014 and August 2016. Six Italian regions were involved in the study project, covering 49% of the national births. Cases were prospectively reported by a trained clinician for each participating maternity unit by electronic data collection forms. The background population comprised all women who delivered in the participating regions during the study period. Results: A cohort of 384 women with PAS was identified from a source population of 458 995 maternities for a prevalence of 0.84/1000 (95% CI, 0.75–0.92). Antenatal suspicion was present in 50% of patients, who showed reduced rates of blood transfusion compared to unsuspected patients (65.6% versus 79.7%, P = 0.003). Analyses by geographical area showed higher rates of both concomitant placenta previa and prior CS (62.1% vs 28.7%, P<0.0001) and antenatal suspicion (61.7% vs 28.7%, P<0.0001) in women in Southern compared to Northern Italy. Also, these women had lower rates of hemorrhage ≥2000 mL (29.6% vs 51.2%, P<0.0001), blood transfusion (64.5% vs 87.5%, P = 0.001), and severe maternal morbidity (5.0% vs 11.1%, P = 0.036). Delivery in a referral center for PAS occurred in 71.9% of these patients. Conclusions: Antenatal suspicion of PAS is associated with improved maternal outcomes, also among high-risk women with both placenta previa and prior CS, likely because of their referral to specialized centers for PAS management. [ABSTRACT FROM AUTHOR]

The novel coronavirus (COVID-19) that was first reported at the end of 2019 has impacted almost every aspect of life as we know it. This paper focuses on the incidence of the disease in Italy and Spain—two of the first and most affected European countries. Using two simple mathematical epidemiological models—the Susceptible-Infectious-Recovered model and the log-linear regression model, we model the daily and cumulative incidence of COVID-19 in the two countries during the early stage of the outbreak, and compute estimates for basic measures of the infectiousness of the disease including the basic reproduction number, growth rate, and doubling time. Estimates of the basic reproduction number were found to be larger than 1 in both countries, with values being between 2 and 3 for Italy, and 2.5 and 4 for Spain. Estimates were also computed for the more dynamic effective reproduction number, which showed that since the first cases were confirmed in the respective countries the severity has generally been decreasing. The predictive ability of the log-linear regression model was found to give a better fit and simple estimates of the daily incidence for both countries were computed. [ABSTRACT FROM AUTHOR]

Understanding how marine taxa will respond to near-future climate changes is one of the main challenges for management of coastal ecosystem services. Ecological studies that investigate relationships between the environment and shell properties of commercially important marine species are commonly restricted to latitudinal gradients or small-scale laboratory experiments. This paper aimed to explore the variations in shell features and growth of the edible bivalve Chamelea gallina from the Holocene sedimentary succession to present-day thanatocoenosis of the Po Plain-Adriatic Sea system (Italy). Comparing the Holocene sub-fossil record to modern thanatocoenoses allowed obtaining an insight of shell variations dynamics on a millennial temporal scale. Five shoreface-related assemblages rich in C. gallina were considered: two from the Middle Holocene, when regional sea surface temperatures were higher than today, representing a possible analogue for the near-future global warming, one from the Late Holocene and two from the present-day. We investigated shell biometry and skeletal properties in relation to the valve length of C. gallina. Juveniles were found to be more porous than adults in all horizons. This suggested that C. gallina promoted an accelerated shell accretion with a higher porosity and lower density at the expense of mechanically fragile shells. A positive correlation between sea surface temperature and both micro-density and bulk density were found, with modern specimens being less dense, likely due to lower aragonite saturation state at lower temperature, which could ultimately increase the energetic costs of shell formation. Since no variation was observed in shell CaCO3 polymorphism (100% aragonite) or in compositional parameters among the analyzed horizons, the observed dynamics in skeletal parameters are likely not driven by a diagenetic recrystallization of the shell mineral phase. This study contributes to understand the response of C. gallina to climate-driven environmental shifts and offers insights for assessing anthropogenic impacts on this economic relevant species. [ABSTRACT FROM AUTHOR]

There is evidence that adoption of non-pharmaceutical containment measures (NPMs) may have had a major impact on Covid-19 epidemic dynamics, and mitigated its effect on healthcare system. Optimal timing of implementation of these measures however is not known. In Italy, a national lockdown was decided on March 11th 2020 and ended 4th of May. At that time, cumulative incidence (CI) was different in Italian regions which ranged from <5 cases/100,000 to >11 cases/100,000 inhabitants. In this paper, we aim to evaluate how level of incidence in different regions at the time of implementation of NPMs affected CI and had an impact on the healthcare system in terms of ICU bed occupancy and mortality rates. We used regional daily new COVID-19 diagnosed cases as well number of people hospitalized in ICU and number of deaths for period February 24-May 11 from all the 19 Italian regions and two autonomous provinces. For each region we calculated: temporal daily trend of cumulative cases of Covid-19/100,000 inhabitants, daily trend of ICU bed occupancy and mortality rate at the end of period. We found that the epidemic curves show similar trends for all regions and all tend to flatten between 11–32 days. However, after 2 months, regions with lower CI at lockdown remained at substantially lower CI (<265 cases/100,000), had a peak of percentage of cases hospitalized in ICU which did not exceed 79.4% and a mortality<0.27/1,000. On the other hand, in regions with higher incidence at lockdown, CI reached 382–921 cases/100,000, the peak of percentage of cases hospitalized in ICU and mortality rate reached 270%, and 1.5/1,000, respectively. Our data suggests that level of CI at the moment of lockdown is important to control the subsequent spread of infection so NPMs should be adopted very early during the course of Covid-19 epidemic, in order to mitigate the impact on the healthcare system and to reduce related mortality. [ABSTRACT FROM AUTHOR]

The Late Mesolithic in Southern Europe is dated to the 7th and the first part of the 6th millennia BCE and is marked by profound changes which are mostly evident in the technical know-how and tool-kit of the last hunter-fisher-gatherer societies. The significance of this phase also relates to the fact that it precedes the Early Neolithic, another period of major transformations of human societies. Nonetheless, the Late Mesolithic still remains a poorly known age in this area. A burial discovered at Mondeval de Sora (Northern Italy) in 1987, represents a unique window into this period. In this paper, we provide a detailed analysis of more than 50 lithic and osseous artifacts associated with this burial. We highlight important contextual data regarding the techno-economic dimension and the notion of personal burial possessions. Based on the association and location of some items, we propose a new interpretation of the social status of this individual and the possible impact of technological innovation on the social organization and symbolic sphere of Late Mesolithic groups. [ABSTRACT FROM AUTHOR]

Introduction: Although Italy's NHS is funded through general taxation, the private sector plays an important role in health service provision and financing. The aim of this paper was to identify the sociodemographic and health service organizational factors associated with the propensity to seek specialist care in the private sector. Materials and methods: Data were retrieved from the national Istat survey "Health conditions and use of health services" carried out in 2012–2013. We selected adults with a specialty visit in the previous 12 months in the four most frequent medical specialties: ophthalmology, cardiology, obstetrics/gynecology and orthopedics. The study outcome was the choice to use a private service. In order to investigate the determinants of private use, we adopted the socio-behavioral model by Andersen and Newman, making a distinction between sociodemographic and healthcare organizational factors. The associations with the outcome were analyzed using chi-squared test, t-test and multivariable logistic regression analysis. Results and discussion: Use of private care varied widely, from 26.3% for cardiology to 53.6% for obstetrics/gynecology. Females, patients with higher educational levels and patients with higher self-reported economic resources sought more frequently private healthcare for all specialties; younger patients and employed patients were more likely to seek private care for ophthalmic conditions. Exemption from copayment for public services reduced more than half the propensity to seek private care. Trust in this healthcare service was the main reason for private users (52.5%) followed by waiting time (26.7%) and physician choice (20.1%). Conclusion: The attitude of the population to use private services for specialist visits is linked both to sociodemographic and health services organizational factors: the former are unmodifiable while the latter are susceptible to managerial and health policy actions. In a public-financed, universal coverage system, policy makers may act upon the organizational factors that make private health facilities more attractive in order to reduce private care use. [ABSTRACT FROM AUTHOR]

Xylella fastidiosa pauca ST53 is the bacterium responsible for the Olive Quick Decline Syndrome that has killed millions of olive trees in Southern Italy. A recent work demonstrates that a rational integration of vector and transmission control measures, into a strategy based on chemical and physical control means, can manage Xylella fastidiosa invasion and impact below an acceptable economic threshold. In the present study, we propose a biological alternative to the chemical control action, which involves the predetermined use of an available natural enemy of Philaenus spumarius, i.e., Zelus renardii, for adult vector population and infection biocontrol. The paper combines two different approaches: a laboratory experiment to test the predation dynamics of Zelus renardii on Philaenus spumarius and its attitude as candidate for an inundation strategy; a simulated experiment of inundation, to preliminary test the efficacy of such strategy, before eventually proceeding to an in-field experimentation. With this double-fold approach we show that an inundation strategy with Zelus renardii has the potential to furnish an efficient and "green" solution to Xylella fastidiosa invasion, with a reduction of the pathogen incidence below 10%. The biocontrol model presented here could be promising for containing the impact and spread of Xylella fastidiosa, after an in-field validation of the inundation technique. Saving the fruit orchard, the production and the industry in susceptible areas could thus become an attainable goal, within comfortable parameters for sustainability, environmental safety, and effective plant health protection in organic orchard management. [ABSTRACT FROM AUTHOR]

The paper discusses results of an interdisciplinary research project integrating lead isotope, chemical, and archaeological analysis of 20 early metal objects from central Italy. The aim of the research was to develop robust provenance hypotheses for 4th and 3rd millennia BC metals from an important, yet hitherto neglected, metallurgical district in prehistoric Europe, displaying precocious copper mining and smelting, as well as socially significant uses of metals in 'Rinaldone-style' burials. All major (and most minor) ore bodies from Tuscany and neighbouring regions were characterised chemically and isotopically, and 20 Copper Age axe-heads, daggers and halberds were sampled and analysed. The objects were also reassessed archaeologically, paying special attention to find context, typology, and chronology. This multi-pronged approach has allowed us to challenge received wisdom concerning the local character of early metal production and exchange in the region. The research has shown that most objects were likely manufactured in west-central Italy using copper from Southern Tuscany and, quite possibly, the Apuanian Alps. A few objects, however, display isotopic and chemical signatures compatible with the Western Alpine and, in one case, French ore deposits. This shows that the Copper Age communities of west-central Italy participated in superregional exchange networks tying together the middle/upper Tyrrhenian region, the western Alps, and perhaps the French Midi. These networks were largely independent from other metal displacement circuits in operation at the time, which embraced the north-Alpine region and the south-eastern Alps, respectively. [ABSTRACT FROM AUTHOR]

Industrial robots are a strategic future technology and an important part of the development of artificial intelligence, and they are a necessary means for the intelligent transformation of manufacturing industry. Based on global industrial robot trade data from 1998 to 2017, this paper applies the dynamic complex network analysis method to reveal the spatial and temporal variation characteristics and trade status evolution of the global industrial robot trade network. The results show that the global industrial robot network density has steadily increased, and the industrial robot trade has been characterized by ‘diversification’. The number of major industrial robot exporters in the world is increasing, and the import market is increasingly diversified. The export market structure is relatively tight, the centrality of the global industrial robot trade network shows a downward trend, and the dissimilarity of the ‘core-edge’ clusters decreases year by year. The trade status of ‘catch-up’ countries represented by China has rapidly increased. However, Japan, Germany, and Italy are still in the central position of the industrial robot trade. Moreover, trade of the ‘catch-up’ countries’ is dominated by imports, and exports of industrial robot products are insufficient. Finally, policy suggestions are provided according to the results. [ABSTRACT FROM AUTHOR]

Ecoregionalization is the process by which a territory is classified in similar areas according to specific environmental and climatic factors. The climate and the environment strongly influence the presence and distribution of vectors responsible for significant human and animal diseases worldwide. In this paper, we developed a map of the eco-climatic regions of Italy adopting a data-driven spatial clustering approach using recent and detailed spatial data on climatic and environmental factors. We selected seven variables, relevant for a broad set of human and animal vector-borne diseases (VBDs): standard deviation of altitude, mean daytime land surface temperature, mean amplitude and peak timing of the annual cycle of land surface temperature, mean and amplitude of the annual cycle of greenness value, and daily mean amount of rainfall. Principal Component Analysis followed by multivariate geographic clustering using the k-medoids technique were used to group the pixels with similar characteristics into different ecoregions, and at different spatial resolutions (250 m, 1 km and 2 km). We showed that the spatial structure of ecoregions is generally maintained at different spatial resolutions and we compared the resulting ecoregion maps with two datasets related to Bluetongue vectors and West Nile Disease (WND) outbreaks in Italy. The known characteristics of Culicoides imicola habitat were well captured by 2/22 specific ecoregions (at 250 m resolution). Culicoides obsoletus/scoticus occupy all sampled ecoregions, according to its known widespread distribution across the peninsula. WND outbreak locations strongly cluster in 4/22 ecoregions, dominated by human influenced landscape, with intense cultivations and complex irrigation network. This approach could be a supportive tool in case of VBDs, defining pixel-based areas that are conducive environment for VBD spread, indicating where surveillance and prevention measures could be prioritized in Italy. Also, ecoregions suitable to specific VBDs vectors could inform entomological surveillance strategies. [ABSTRACT FROM AUTHOR]

Domestication of wild cattle, sheep, and pigs began a process of body size diminution. In most of Western Europe this process continued across prehistory and was not reversed until the Roman period. However, in Italy, an increase in livestock body size occurred during the Iron Age, earlier than the Western provinces. In order to better understand the nature and timing of this early increase in animal size, this paper presents a detailed regional study of taxonomic abundance and biometric data from zooarchaeological assemblages recovered from the Po and Venetian–Friulian Plains in northern Italy. Our results demonstrate a high level of regionality in the choice of species exploited, with husbandry systems focused on different domesticates, as well as regional differences in animal size. However, despite significant variation in species frequencies, settlement structure, and epigraphic tradition, all areas with sufficient data demonstrate similar significant changes in livestock body size. Cattle and sheep increased incrementally in size prior to the Roman conquest in all regions considered; surprisingly, pigs continued to decrease in size throughout later prehistory. The incremental pace and pan-regional character of the size change in cattle and sheep suggests an internally motivated phenomenon rather than herd replacement with a new larger population, as might follow colonisation or conquest. The divergence in size trends for bovids and suids suggests a noteworthy change in cattle and sheep herding practices during the Iron Age or final centuries of the Bronze Age, in contrast with greater continuity in pig management. Our analysis provides a thorough zooarchaeological synthesis for northern Italy and, for the first time, demonstrates that both cattle and sheep increased in size outside of Roman territory well before the conquest of this area. This study offers a basis for future chemical analyses (DNA, isotopes), which will further investigate the cause(s) of livestock size changes in northern Italy. [ABSTRACT FROM AUTHOR]

The monitoring of seasonal influenza yearly epidemics remains one of the main activity of national syndromic surveillance systems. The development of internet-based surveillance tools has brought an innovative approach to seasonal influenza surveillance by directly involving self-selected volunteers among the general population reporting their health status on a weekly basis throughout the flu season. In this paper, we explore how Influweb, an internet-based monitoring system for influenza surveillance, deployed in Italy since 2008 has performed during three years from 2012 to 2015 in comparison with data collected during the same period by the Italian sentinel doctors surveillance system. [ABSTRACT FROM AUTHOR]

Background: Primary biliary cirrhosis (PBC) is a chronic liver disease characterized by intrahepatic bile-duct destruction, cholestasis, and fibrosis. It can lead to cirrhosis and eventually liver failure. PBC also shows some regional differences with respect to incidence and prevalence that are becoming more pronounced each year. Recently, researchers have paid more attention to PBC. To evaluate the development of PBC research during the past 11 years, we determined the quantity and quality of articles on this subject. We also compared the contributions of scientists from the US, UK, Japan, Italy, Germany, and China. Methods: The English-language papers covering PBC published in journals from 2000 through 2010 were retrieved from the PubMed database. We recorded the number of papers published each year, analyzed the publication type, and calculated the accumulated, average impact factors (IFs) and citations from every country. The quantity and quality of articles on PBC were compared by country. We also contrasted the level of PBC research in China and other countries. Results: The total number of articles did not significantly increase during the past 11 years. The number of articles from the US exceeded those from any other country; the publications from the US also had the highest IFs and the most citations. Four other countries showed complex trends with respect to the quantity and quality of articles about PBC. Conclusion: The researchers from the US have contributed the most to the development of PBC research. They currently represent the highest level of research. Some high-level studies, such as RCTs, meta-analyses, and in-depth basic studies should be launched. The gap between China and the advanced level is still enormous. Chinese investigators still have a long way to go. [ABSTRACT FROM AUTHOR]

Background: The limited availability of prevalence data based on a representative sample of the general population, and the limited number of diseases considered in studies about co-morbidity are the critical factors in study of autoimmune diseases. This paper describes the prevalence of 12 autoimmune diseases in a representative sample of the general population in the South of Sardinia, Italy, and tests the hypothesis of an overall association among these diseases. Methods: Data were obtained from 21 GPs. The sample included 25,885 people. Prevalence data were expressed with 95% Poisson C.I. The hypothesis of an overall association between autoimmune diseases was tested by evaluating the cooccurrence within individuals. Results: Prevalence per 100,000 are: 552 rheumatoid arthritis, 124 ulcerative colitis, 15 Crohn's disease, 464 type 1 diabetes, 81 systemic lupus erythematosus, 124 celiac disease, 35 myasthenia gravis, 939 psoriasis/psoriatic arthritis, 35 systemic sclerosis, 224 multiple sclerosis, 31 Sjogren's syndrome, and 2,619 autoimmune thyroiditis . An overall association between autoimmune disorders was highlighted. Conclusions: The comparisons with prevalence reported in current literature do not show outlier values, except possibly for a few diseases like celiac disease and myasthenia gravis. People already affected by a first autoimmune disease have a higher probability of being affected by a second autoimmune disorder. In the present study, the sample size, together with the low overall prevalence of autoimmune diseases in the population, did not allow us to examine which diseases are most frequently associated with other autoimmune diseases. However, this paper makes available an adequate control population for future clinical studies aimed at exploring the co-morbidity of specific pairs of autoimmune diseases. [ABSTRACT FROM AUTHOR]

Background: Antimicrobials are the most commonly prescribed drugs. Many studies have evaluated antibiotic prescriptions in the paediatric outpatient but few studies describing the real antibiotic consumption in Italian children’s hospitals have been published. Point-prevalence survey (PPS) has been shown to be a simple, feasible and reliable standardized method for antimicrobials surveillance in children and neonates admitted to the hospital. In this paper, we presented data from a PPS on antimicrobial prescriptions carried out in 7 large Italian paediatric institutions. Methods: A 1-day PPS on antibiotic use in hospitalized neonates and children was performed in Italy between October and December 2012 as part of the Antibiotic Resistance and Prescribing in European Children project (ARPEC). Seven institutions in seven Italian cities were involved. The survey included all admitted patients less than 18 years of age present in the ward at 8:00 am on the day of the survey, who had at least one on-going antibiotic prescription. For all patients data about age, weight, underlying disease, antimicrobial agent, dose and indication for treatment were collected. Results: The PPS was performed in 61 wards within 7 Italian institutions. A total of 899 patients were eligible and 349 (38.9%) had an on-going prescription for one or more antibiotics, with variable rates among the hospitals (25.7% - 53.8%). We describe antibiotic prescriptions separately in neonates (<30 days old) and children (> = 30 days to <18 years old). In the neonatal cohort, 62.8% received antibiotics for prophylaxis and only 37.2% on those on antibiotics were treated for infection. Penicillins and aminoglycosides were the most prescribed antibiotic classes. In the paediatric cohort, 64.4% of patients were receiving antibiotics for treatment of infections and 35.5% for prophylaxis. Third generation cephalosporins and penicillin plus inhibitors were the top two antibiotic classes. The main reason for prescribing antibiotic therapy in children was lower respiratory tract infections (LRTI), followed by febrile neutropenia/fever in oncologic patients, while, in neonates, sepsis was the most common indication for treatment. Focusing on prescriptions for LRTI, 43.3% of patients were treated with 3rd generation cephalosporins, followed by macrolides (26.9%), quinolones (16.4%) and carbapenems (14.9%) and 50.1% of LRTI cases were receiving more than one antibiotic. For neutropenic fever/fever in oncologic patients, the preferred antibiotics were penicillins with inhibitors (47.8%), followed by carbapenems (34.8%), aminoglycosides (26.1%) and glycopeptides (26.1%). Overall, the 60.9% of patients were treated with a combination therapy. Conclusions: Our study provides insight on the Italian situation in terms of antibiotic prescriptions in hospitalized neonates and children. An over-use of third generation cephalosporins both for prophylaxis and treatment was the most worrisome finding. A misuse and abuse of carbapenems and quinolones was also noted. Antibiotic stewardship programs should immediately identify feasible targets to monitor and modify the prescription patterns in children’s hospital, also considering the continuous and alarming emergence of MDR bacteria. [ABSTRACT FROM AUTHOR]

Objective: The aim of this paper was to evaluate socio-economic factors associated to poor primary care utilization by studying two specific subjects: the hospital readmission rate, and the use of the Emergency Department (ED) for non-urgent visits. Methods: The study was carried out by the analysis of administrative database for hospital readmission and with a specific survey for non-urgent ED use. Results: Among the 416,698 sampled admissions, 6.39% (95% CI, 6.32–6.47) of re-admissions have been registered; the distribution shows a high frequency of events in the age 65–84 years group, and in the intermediate care hospitals (51.97%; 95%CI 51.37–52.57). The regression model has shown the significant role played by age, type of structure (geriatric acute care), and deprivation index of the area of residence on the readmission, however, after adjusting for the intensity of primary care, the role of deprivation was no more significant. Non-urgent ED visits accounted for the 12.10%, (95%CI 9.38–15.27) of the total number of respondents to the questionnaire (N = 504). The likelihood of performing a non-urgent ED visit was higher among patients aged <65 years (OR 3.2, 95%CI 1.3–7.8 p = 0.008), while it was lower among those perceiving as urgent their health problem (OR 0.50, 95%CI 0.30–0.90). Conclusions: In the Italian context repeated readmissions and ED utilization are linked to different trajectories, besides the increasing age and comorbidity of patients are the factors that are related to repeated admissions, the self-perceived trust in diagnostic technologies is an important risk factor in determining ED visits. Better use of public national health care service is mandatory, since its correct utilization is associated to increasing equity and better health care utilization. [ABSTRACT FROM AUTHOR]

Background: Since antibiotic resistance has become a worldwide public health concern and is in part related to physicians’ lack of knowledge, it is essential to focus our attention on healthcare profession students. The present study aims at evaluating the knowledge and attitudes of the School of Medicine’s students towards antibiotic usage and antibiotic resistance. Methods: In December 2013, a cross sectional study was conducted amongst medical, dental, nursing and other health care profession students of the School of Medicine at the University of Torino. Students of all the academic years took part in this study. Questionnaires were submitted during regular lectures (only students who attended courses on one specific day were surveyed) and the data collected was analyzed using StataMP11 statistical software. Results: Overall, 1,050 students were interviewed. The response rate was 100%. Around 20% of the sample stated that antibiotics are appropriate for viral infections and 15% of the students that they stop taking those drugs when symptoms decrease. Results of the multivariate analyses showed that females were more likely than males to take antibiotics only when prescribed (OR 1.43, 95% CI 1.04–1.98). Interestingly, students with a relative working in a health-related field, as well as those who took at least one course of antibiotics in the last year, had a lower probability of taking those drugs only under prescription (OR = 0.69 95% CI: 0.49–0.97 and OR = 0.38 95% CI: 0.27–0.53, respectively). Conclusion: The present paper shows how healthcare profession students do not practice what they know. Since those students will be a behavioral model for citizens and patients, it is important to generate more awareness around this issue throughout their studies. It would be advisable to introduce a specific course and training on antibiotics in the core curriculum of the School of Medicine. [ABSTRACT FROM AUTHOR]

In this paper we present an analysis of the behavior of Italian Twitter users during national political elections. We monitor the volumes of the tweets related to the leaders of the various political parties and we compare them to the elections results. Furthermore, we study the topics that are associated with the co-occurrence of two politicians in the same tweet. We cannot conclude, from a simple statistical analysis of tweet volume and their time evolution, that it is possible to precisely predict the election outcome (or at least not in our case of study that was characterized by a “too-close-to-call” scenario). On the other hand, we found that the volume of tweets and their change in time provide a very good proxy of the final results. We present this analysis both at a national level and at smaller levels, ranging from the regions composing the country to macro-areas (North, Center, South). [ABSTRACT FROM AUTHOR]

Background: Italy has a population of 60 million and a universal coverage single-payer healthcare system, which mandates collection of healthcare administrative data in a uniform fashion throughout the country. On the other hand, organization of the health system takes place at the regional level, and local initiatives generate natural experiments. This is happening in particular in primary care, due to the need to face the growing burden of chronic diseases. Health services research can compare and evaluate local initiatives on the basis of the common healthcare administrative data.However reliability of such data in this context needs to be assessed, especially when comparing different regions of the country. In this paper we investigated the validity of healthcare administrative databases to compute indicators of compliance with standards of care for diabetes, ischaemic heart disease (IHD) and heart failure (HF). Methods: We compared indicators estimated from healthcare administrative data collected by Local Health Authorities in five Italian regions with corresponding estimates from clinical data collected by General Practitioners (GPs). Four indicators of diagnostic follow-up (two for diabetes, one for IHD and one for HF) and four indicators of appropriate therapy (two each for IHD and HF) were considered. Results: Agreement between the two data sources was very good, except for indicators of laboratory diagnostic follow-up in one region and for the indicator of bioimaging diagnostic follow-up in all regions, where measurement with administrative data underestimated quality. Conclusion: According to evidence presented in this study, estimating compliance with standards of care for diabetes, ischaemic heart disease and heart failure from healthcare databases is likely to produce reliable results, even though completeness of data on diagnostic procedures should be assessed first. Performing studies comparing regions using such indicators as outcomes is a promising development with potential to improve quality governance in the Italian healthcare system. [ABSTRACT FROM AUTHOR]

The introduction of Levallois technology in Europe marked the transition from the Lower to the early Middle Paleolithic. This new method of flake production was accompanied by significant behavioral changes in hominin populations. The emergence of this technological advance is considered homogeneous in the European archaeological record at the Marine isotopic stage (MIS) 9/MIS 8 boundary. In this paper we report a series of combined electron spin resonance/U-series dates on mammal bones and teeth recovered from the lower units of San Bernardino Cave (Italy) and the technological analyses of the lithic assemblages. The San Bernardino Cave has yielded the earliest evidence of Levallois production on the Italian Peninsula recovered to date. In addition to our results and the review of the archaeological record, we describe the chronological and geographical differences between European territories and diversities in terms of technological developments. The belated emergence of Levallois technology in Italy compared to western Europe corresponds to the late Italian Neanderthal speciation event. The new radiometric dates and the technological analyses of San Bernardino Cave raise the issue of the different roles of glacial refugia in the peopling and the spread of innovative flaking strategies in Europe during the late Middle Pleistocene. [ABSTRACT FROM AUTHOR]

Batrachochytrium dendrobatidis is considered a main driver of the worldwide declines and extinctions of amphibian populations. Nonetheless, fundamental questions about its epidemiology, including whether it acts mainly as a “lone killer” or in conjunction with other factors, remain largely open. In this paper we analysed contemporary and historical samples of the endangered Apennine yellow-bellied toad (Bombina pachypus) along the Italian peninsula, in order to assess the presence of the pathogen and its spreading dynamics. Once common throughout its range, B. pachypus started to decline after the mid-1990s in the northern and central regions, whereas no declines have been observed so far in the southern region. We show that Batrachochytrium dendrobatidis is currently widespread along the entire peninsula, and that this was already so at least as early as the late 1970s, that is, well before the beginning of the observed declines. This temporal mismatch between pathogen occurrence and host decline, as well as the spatial pattern of the declines, suggests that the pathogen has not acted as a “lone killer”, but in conjunction with other factors. Among the potentially interacting factors, we identified two as the most probable, genetic diversity of host populations and recent climate changes. We discuss the plausibility of this scenario and its implications on the conservation of B. pachypus populations. [ABSTRACT FROM AUTHOR]

Introduction: Malnutrition is a clinical condition due to the imbalance among needs, intake and use of nutrients, leading to the increase of morbidity and mortality, and to the impairment of quality of life. Even in industrialized countries undernutrition is becoming an alarming phenomenon, especially involving elderly institutionalized subjects. A multicentric study called PIMAI (Project Iatrogenic MAlnutrition in Italy), was carried out in Italy over 2005. The aims of this study were to determine the prevalence of malnutrition in hospitals and in nursing care homes (NH), to assess the level of nutritional attention and to measure the perceived quality in food and nutritional care. This paper represents a preliminary analysis of data collected in a NH included in the PIMAI project. Materials and methods: A total of 100 subjects (29 males and 71 females, aged 80.2±10 years), were recruited from January to June 2005 at the Clinical Rehabilitation Institute “Villa delle Querce” in Nemi (Rome), among patients in the NH facility. All the participants underwent a multidimensional geriatric evaluation (considering nutritional, clinical, functional and cognitive parameters), and a survey on “perceived quality” of nutritional care. Results and discussion: According to nutritional status defined by the Mini Nutritional Assessment®, data analysis showed a high prevalence of malnutrition (36%) especially related to advanced age, chewing, cognitive and functional impairments. Patients seemed to consider nutrition to be important for their health; on the other hand, they were not thoroughly satisfied with the quality of food. Particularly, it was observed scarce attention to nutritional status from medical and nursing staff. Conclusions: Our study confirms the need to pay greater attention to nutritional status in elderly institutionalized subjects. Medical and nursing teams need to be aware of the importance to perform an evaluation of nutritional status in these subset of subjects. [ABSTRACT FROM AUTHOR]

In recent years, the preservation of biodiversity has become an important issue. Despite much public discussion, however, current practices in the food industry seldom take account of its potential economic importance: on the contrary, the introduction of industrialized agriculture practices over large areas has often resulted in a dramatic reduction in biodiversity. In this paper, we report on the remarkable degree of biodiversity in the wine yeast populations naturally present in a small area of Sicily (Italy) where traditional (non-industrial) winery practices are still in place. Out of more than 900 Saccharomyces yeast isolates recovered from late spontaneous fermentations, we detected at least 209 strains. Most interestingly, when evaluated at the fermentation and technological level, a number of isolates were found to be superior to industrial yeast strains. Out of a selected group, isolates from two strains were used for experimental fermentations in a winery environment and the quality of the wines produced was assessed at the technological, quality and sensory levels. Given that the characteristics of the wines produced were found to be industrially appealing, the study demonstrated the economic potential of preserving the patrimony of Sicilian yeast biodiversity and highlighted the importance of maintaining traditional wine making practices. [ABSTRACT FROM AUTHOR]

Background: Monoclonal antibodies directed against the epidermal growth factor receptor (EGFR) have been approved for the treatment of patients with metastatic colorectal carcinoma (mCRC) that do not carry KRAS mutations. Therefore, KRAS testing has become mandatory to chose the most appropriate therapy for these patients. Methodology/Principal Findings: In order to guarantee the possibility for mCRC patients to receive an high quality KRAS testing in every Italian region, the Italian Association of Medical Oncology (AIOM) and the Italian Society of Pathology and Cytopathology -Italian division of the International Academy of Pathology (SIAPEC-IAP) started a program to improve KRAS testing. AIOM and SIAPEC identified a large panel of Italian medical oncologists, pathologists and molecular biologists that outlined guidelines for KRAS testing in mCRC patients. These guidelines include specific information on the target patient population, the biological material for molecular analysis, the extraction of DNA, and the methods for the mutational analysis that are summarized in this paper. Following the publication of the guidelines, the scientific societies started an external quality assessment scheme for KRAS testing. Five CRC specimens with known KRAS mutation status were sent to the 59 centers that participated to the program. The samples were validated by three referral laboratories. The participating laboratories were allowed to use their own preferred method for DNA extraction and mutational analysis and were asked to report the results within 4 weeks. The limit to pass the quality assessment was set at 100% of true responses. In the first round, only two centers did not pass (3%). The two centers were offered to participate to a second round and both centers failed again to pass. Conclusions: The results of this first Italian quality assessment for KRAS testing suggest that KRAS mutational analysis is performed with good quality in the majority of Italian centers. [ABSTRACT FROM AUTHOR]

Viewing a face with averted gaze results in a spatial shift of attention in the corresponding direction, a phenomenon defined as gaze-mediated orienting. In the present paper, we investigated whether this effect is influenced by social factors. Across three experiments, White and Black participants were presented with faces of White and Black individuals. A modified spatial cueing paradigm was used in which a peripheral target stimulus requiring a discrimination response was preceded by a noninformative gaze cue. Results showed that Black participants shifted attention to the averted gaze of both ingroup and outgroup faces, whereas White participants selectively shifted attention only in response to individuals of their same group. Interestingly, the modulatory effect of social factors was context-dependent and emerged only when group membership was situationally salient to participants. It was hypothesized that differences in the relative social status of the two groups might account for the observed asymmetry between White and Black participants. A final experiment ruled out an alternative explanation based on differences in perceptual familiarity with the face stimuli. Overall, these findings strengthen the idea that gaze-mediated orienting is a socially-connoted phenomenon. [ABSTRACT FROM AUTHOR]

Aim: The aim of this paper is to describe the time spent to activate oncological non-profit clinical trials promoted in Italy by the National Cancer Institute of Naples, following the implementation of recent European laws. Methodology: Data about the process of activation of 5 non-profit multicentre clinical trials were prospectively collected through a web-based system. The impact of European guidelines was assessed by comparing the efficiency of the process between applications started before and after the decree introducing in Italy the Clinical Trial Application form (MD-CTA). Outcomes of the descriptive analyses were the time to EC opinion, the time to administrative agreement signature after a positive EC opinion, and the cumulative percentage of submissions that came to closure (either positive or negative) within four subsequent time cohorts. Principal Findings: From March 2007 to October 2009, 202 applications were submitted to 107 centres. Forty-four (59%) applications of those submitted before were successful, compared to 71 (55%) of those submitted after MD-CTA. Most of the failures were due to missing EC response (27% and 22%) or administrative reasons (10% and 16%, before and after, respectively); very few (4% and 7%) were due to EC refusal. The impact of the MD-CTA on time to EC opinion looked positive (median 4.1 vs 2.4 months, before and after, respectively) but a subgroup analysis revealed that the impact was limited to a comparison biased by the selection of EC. After a positive EC opinion, there was no difference before and after MD-CTA in the time to administrative agreement signature (median 3.6 and 3.8 months, respectively). A trend to shortening time to closure of the whole submission process over the time was evident, with 58% of the applications coming to closure within 6 months from submission in the most recent cohort. Conclusions: In our experience there is reassuring evidence of a trend toward shortening the time spent to activate nonprofit clinical trials in Italy, but the whole process still remains inefficient. Efforts should be made to improve the process, also focusing on administrative procedures. [ABSTRACT FROM AUTHOR]