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The estimation of the slope (b -value) of the frequency–magnitude distribution of earthquakes is based on a formula derived by Aki decades ago, assuming a continuous exponential distribution. However, as the magnitude is usually provided with a limited resolution, its distribution is not continuous but discrete. In the literature, this problem was initially solved by an empirical correction (due to Utsu) to the minimum magnitude, and later by providing an exact formula such as that by Tinti and Mulargia, based on the geometric distribution theory. A recent paper by van der Elst showed that the b -value can be estimated also by considering the magnitude differences (which are proven to follow an exponential discrete Laplace distribution) and that in this case the estimator is more resilient to the incompleteness of the magnitude data set. In this work, we provide the complete theoretical formulation including (i) the derivation of the means and standard deviations of the discrete exponential and Laplace distributions; (ii) the estimators of the decay parameter of the discrete exponential and trimmed Laplace distributions and (iii) the corresponding formulas for the parameter b. We deduce (iv) the standard 1 σ intervals for the estimated b. Moreover, we are able (v) to quantify the error associated with the Utsu minimum-magnitude correction. Furthermore, we have discussed the formulas to produce statistically independent magnitude differences. We tested extensively the b -value estimators on simulated synthetic data sets including complete catalogues as well as catalogues affected by a strong incompleteness degree such as aftershock sequences where the incompleteness is made to vary from one event to the next. We have also analysed the real aftershock sequence of the 30/10/2016 Norcia (central Italy) to integrate the finding of the simulations. To judge the performance of the various estimators we have introduced an index p that can be seen as a non-parametric extension of the Student's t index. The main outcomes of this paper are that (1) the b -value estimators devised for continuous magnitude data are not adequate for binned magnitudes, (2) for complete data sets, estimators based on magnitudes and on magnitude differences provide substantially equivalent results, (3) for incomplete magnitude data sets, estimators based on magnitude differences provide better results and (4) for incomplete aftershock sequences there is no evidence that methods based on positive magnitude differences are superior than other methods using differences. This conclusion is further confirmed by our analysis of the above-mentioned Norcia seismic sequence. This last finding contrasts with the van der Elst's claim that the so called |${{b}_ + }$| method is the most adequate to treat real aftershock sequences. [ABSTRACT FROM AUTHOR]

In this paper, we gather and take stock of the results produced by the Operational Earthquake Forecasting (OEF) system in Italy, during its first 10 yr of operativity. The system is run in real-time: every midnight and after each M L 3.5+ event, it produces the weekly forecast of earthquakes expected by an ensemble model in each cell of a spatial grid covering the entire Italian territory. To evaluate the performance skill of the OEF-Italy forecasts, we consider here standard tests of the Collaboratory for the Study of Earthquake Predictability, which have been opportunely adapted to the case of the overlapped weekly OEF forecasts; then we also adopt new performance measures borrowed from other research fields, like meteorology, specific to validate alarm-based systems by a binary criterion (forecast: yes/no; occurrence: yes/no). Our final aim is to: (i) investigate possible weaknesses and room for improvements in the OEF-Italy stochastic modelling, (ii) provide performance measures that could be helpful for stakeholders who act through a boolean logic (making an action or not) and (iii) highlight possible features in the Italian tectonic seismic activity. [ABSTRACT FROM AUTHOR]

Estimation of local seismic response plays a key role in assessing local seismic hazard and particularly in the design of shaking scenarios. Modelling local seismic response involves knowing of the shear wave velocity (VS) and quality factor (QS) profiles for the site in question. The many techniques that have been developed to assess VS in surface deposits produce reliable measurements of VS , but these rarely correspond to direct measurements of QS. The latter is often considered through damping measures from laboratory tests on small-scale soil samples, which can provide information primarily on intrinsic attenuation, neglecting the contribution of scattering effects. In this paper, using seismic recordings obtained at the surface and in boreholes at 100 m depth, we estimate an average value of QS of some characteristic alluvial deposits of the Po Plain (northern Italy). Data come from a microseismic network which sampled an almost uniform lithology in the central Po Plain and consisted of three surface and four borehole stations with an interstation distance of about 2 km. The average value of QS of the shallowest 100 m of the sedimentary strata, Q S ,100, is estimated by considering: (1) the high-frequency attenuation of seismic waves due to propagation through the corresponding stratigraphy and (2) the interference between incident and surface-reflected waves observed at borehole stations. We parametrize the first through |$\Delta k_{0_{ {100}}}$|⁠ , the difference between the values of the spectral decay parameter kappa (k) estimated at the surface and at the boreholes depth, respectively. We use the second in order to compute V S ,100, the time-averaged VS referred to the uppermost 100 m stratigraphy. We obtain: |$\Delta k_{0_{ {100}}} = (11 \pm 3)\,$|  ms, |${V_{S,100}} \, =\, (309\, \pm \, 11)\,$| m s−1 and |${Q_{S,100}} \, =\, 31 \pm 10$|⁠. At the surface, the estimated values of the site-specific kappa, k 0, are found to range from 75 to 79 ms. As expected, these results are in good agreement with studies performed in other sites characterized by sandy or clayey lithologies, and can be usefully used in site response analysis at sites where the rigidity is mainly controlled by lithostatic pressure. [ABSTRACT FROM AUTHOR]

In this paper we deal with statistical features of earthquakes, seeking possible correlations between the Gutenberg–Richter magnitude distribution and the short-term clustering in an area of the Central Apennines, Italy, where significant seismicity with earthquakes exceeding magnitude 6.0 has been repeatedly observed from 1990 to the present. For this purpose, a recently developed version of the ETAS model, incorporating a 3-D spatial triggering kernel, has been adopted. Our analysis has been carried out representing the b -value and the probability of independence of events on six vertical cross-sections suitably related to the seismic structures that are considered responsible of the seismicity observed in the study area. The results of the statistical analysis of the seismicity in the study area have shown a clear distinction between the western normal low-angle fault system, characterized by eastward dip and the eastern normal fault systems, with westward dip. In the former (Etrurian Fault System ; EFS) we found seismicity with a high b -value and high probability of independence, that is a scarce capacity of producing clusters and strong aftershock sequences. The eastern fault systems of our study area are distinguishable in two main distinct systems, which generated two strong seismic sequences in 1997 and 2016–2017. In the former (Colfiorito) sequence the seismicity showed a very low b -value and a modest probability of independence, while in the latter (Central Italy) sequence the b -value was significantly higher and the probability of independence had extremely low values (manifesting a high level of clustering). The much higher b -value of the EFS than the other extensional sources could be caused by its peculiar seismotectonic role of discontinuity at the base of the normal active faulting, and its reduced capacity of accumulating stress. This circumstance may be interpreted by a difference in the rheological properties of these fault systems, possibly also in relation to their present status in the earthquake cycle and the presence of strong aftershock sequences. [ABSTRACT FROM AUTHOR]

Legal medical doctors (LMDs) expertise encompasses a wide range of responsibilities. Work-related stress amongst LMDs is an extremely relevant factor, which affects the quality of LMDs life and work. Whilst it is a better-known problem abroad, this issue is poorly debated in Italy, as demonstrated by this literature analysis. The aim of this paper is to better understand the main sources of stress in the practice of legal medicine in Italy, highlighting the need for systematic psychological support. The risks of work-related stress for the social and health professions are well known in literature. In Italy, however, due to a series of complex circumstances and cultural and research delays, forensic practitioners often seem to be excluded from these kinds of complex issues. The authors, after a series of considerations drawn from a review of the literature and from experience in the forensic and medical field, point out how work in this area entails risks for workers, on par with all others belonging to the helping and social-health professions. They conclude their contribution with a series of proposals for appropriate protocols to cope with such problems for workers in the forensic and medical field. Key points Work-related risks for the social and health professionals are widely recognized in the literature. Although legal medical doctors are often thought to be safe from these types of issues, significant risks exist for this category as well. It is important to create appropriate protocols to address outcomes for legal medical doctors. [ABSTRACT FROM AUTHOR]

Etizolam is a benzodiazepine (BZD). Etizolam is structurally different from BZDs as a thiophene replaces the benzene ring and a triazole ring is fused to the diazepine ring, but etizolam's pharmacological profile is similar. Etizolam has been used to treat anxiety and panic disorders, to reduce depressive and somatization symptoms and to induce muscle relaxation. Etizolam is used recreationally due to its reinforcing and sedative effects. Etizolam is available in tablet or powder form or administered on blotter paper that can be placed on the tongue for oral absorption. Etizolam metabolizes into two major metabolites: α-hydroxyetizolam and 8-hydroxyetizolam, and all three compounds can be detected in different biological specimens using various common analytical techniques such as immunoassay, chromatography and mass spectrometry. Etizolam is a controlled drug in many countries around the globe but is approved for medical use in some countries, such as Japan, South Korea and Italy. This work is a collation and review of available literature on etizolam to help improve the fundamental understanding of its toxicology, outline best analytical practice, and aid interpretation of toxicology results. [ABSTRACT FROM AUTHOR]

This paper aims at analysing the causes and effects of increasing financial accumulation by Italian firms, within a radical Institutional theoretical framework. It will be argued that financialisation can be imputed to the fact that the biggest Italian companies aim to increase their profits through speculation after the cycle of class struggle of the 1970s. It will also be shown that financial accumulation has contributed to the reduction of economic growth and to the increase of income inequalities. Since very few research studies have dealt with the Italian case, this paper fills a gap. [ABSTRACT FROM AUTHOR]

Background The dissemination of scientific data on coronavirus disease 2019 (COVID-19) continually builds but, in April 2020, could not keep up with the spread of the disease. Through technology, surgeons in Italy and the UK, representing both peak and pre-peak infective time zones, were able to communicate so that the urgent lessons on the huge expected demands of care learned in Italy could be brought to the UK in advance. This paper specifically discusses the issues related to paediatric surgery, currently under-reported in the literature. Methods The aim of this paper is to conjoin experience from the field to provide a framework for a safe assessment and treatment of paediatric patients by adopting a systemic approach aimed at reducing the risk of contamination. We reviewed the processes and good practices that were undertaken in contexts of emergency such as in Italy and the UK and then adapted them within the Systems Engineering Initiative for Patient Safety (SEIPS) framework to provide an assessment of how to reorganize the services in order to cope with an unexpected situation. The SEIPS model is the adopted theoretical framework, which allows to analyse the system in its main components with a human factors and ergonomics (HFE) perspective. Results The results introduce some of the good practices and recommendations developed during the emergency in the surgical scenario with a focus on the paediatric patients. They represent the lessons learned from the combination of the little existing evidence of literature and the experience from surgical teams who responded in an impromptu and unrehearsed way. Conclusions Lessons learned from the frontline 'on the fly' during COVID-19 emergency should be consolidated and taken into the future. In order to prepare proactively for the next phases and get ahead of the curve of these hospital accesses, there is a need for a risk assessment of the new clinical pathways with a multidisciplinary approach centred on HFE with the adoption of the SEIPS model and an involvement of all the surgical teams. [ABSTRACT FROM AUTHOR]

Following the M w 3.9 earthquake that occurred in the Ischia island (Naples, southern Italy) on 21 August 2017, the local monitoring seismic network was significantly improved in terms of both number of stations and instrumentation performance. Due to the huge amount of collected seismic ambient noise data, in this paper we present a first 3-D shear wave velocity model of the island retrieved from the inversion of horizontal-to-vertical spectral ratio curves by fixing the shear wave velocities (Vs) and modifying the thicknesses to get the corresponding 1-D Vs models. We are confident about the robustness of the attained models since the inversion process provided a good convergence towards the best-fitting solutions. Then, a first 3-D velocity model was obtained by contouring all the 1-D models obtained for the selected seismic stations to highlight possible lateral variations of the layer thicknesses and to reconstruct the morphology of the deeper interface characterized by a high-impedance contrast. A good correspondence between the 3-D Vs model and the geological features of the island was observed, especially in the northern sector where most of the stations are installed. In particular, the top of the high-impedance contrast interface appears deeper in the northern coastal areas and shallower in the central sector. This result agrees with the structural settings of the island likely due to the resurgence of Mount Epomeo. [ABSTRACT FROM AUTHOR]

Companies' strategies of domestic and international location of production and of externalisation/outsourcing are linked to their effects on labour fragmentation and, in general, to strategies towards labour. The paper starts with a theoretical analysis on the strategies of transnational companies and their impact on labour. An application to the Fabbrica Italiana Automobili Torino (FIAT) company follows. After a brief history of the company and of the Italian industrial relations system, the paper concentrates on four post-World War II periods: 1950–68, 1969–80, 1981–2003 and 2004–16. In each period, the above key strategies are highlighted and considered in relation to industrial relations in the same period. Other strategies are mentioned as appropriate. The analysis of each period focuses on the linkages between the three sets of strategies in a multidisciplinary context. The methodology centres on a detailed analysis of a historical case and on the interplay of strategic behaviour by both the company and labour. In terms of empirical material, we use a variety of historical and multidisciplinary secondary sources, data from FIAT's historical archives and a series of informal interviews with FIAT experts. We conclude that there is historical evidence of a pattern of strategic moves and countermoves by both FIAT and its labour force and Trade Unions, with effects on labour fragmentation and labour relations. [ABSTRACT FROM AUTHOR]

In the wake of the Covid-19 pandemic, public private partnerships (PPP) can prove useful to close the healthcare investment gap and accelerate long-term recovery, by matching public and private money. Despite their extensive application in the delivery of major infrastructure projects globally, their performance remains contested. Drawing on a unique set of data of PPP contracts for healthcare investments in Italy, the paper explores the antecedents (namely, policies, institutions, and contracts), that have influenced the capacity of PPP contracts to deliver performance, measured in terms of value for money (VfM), and contract stability. Results show that although explicit policy goals have a clear contribution, VfM can benefit from competent central PPP institutions, which should play a hands-on role in the planning, design, and project management activities. At the same time, centralised PPP units, if not combined with local competent authorities and strong governance mechanisms, may increase the risk of contract renegotiation. [ABSTRACT FROM AUTHOR]

The sustainability of the Italian government debt has been under close scrutiny since the launch of the Euro Area, and even more so after the Global Financial Crisis. The Covid-19 crisis in 2020 has depressed the Italian economy further and negatively affected the government budget. Despite the rebound in 2021, the state of the economy and government debt in Italy remain precarious. Building on Pasinetti's work, this paper examines the sustainability of the Italian government debt through a medium-scale, stock-flow consistent, structural macroeconometric model. The model has been coded and calibrated using the R package Bimets developed by the Bank of Italy. Our findings show that the Italian government debt is unlikely to enter a sustainable trajectory in the next few years. While the Next Generation EU and the other fiscal and monetary measures are helping the Italian economy to recover, in the coming years, a greater effort on the part of the European authorities—including an intervention of the ECB in controlling the yield curve—seems necessary to stabilize the debt to GDP ratio in Italy. [ABSTRACT FROM AUTHOR]

In the face of the complexities of problem-solving, experts are gaining centrality in policymaking (Weiss, 1979). At the same time, they are increasingly challenged in their legitimacy, which is not only technical but also political. Challenges to the legitimacy of experts suggest that other types of legitimacy are important for policymaking. Issues of legitimacy are particularly important for sound policymaking when the authority of experts and the value of evidence are contested and when the debate over policy solutions is particularly conflictual and ideological. In this paper, I use three exploratory cases of the use of expertise in education policy in Italy to show how policymakers design different advisory committees to enhance different types of legitimacy (epistemic, bureaucratic, and political). The findings suggest that while policymakers design advisory committees primarily to meet their legitimacy needs, the legitimacy of a decision requires different types of sources to generate consent and to allow for the impact of expertise. [ABSTRACT FROM AUTHOR]

SUMMARY: We estimate the b-value parameter of the Gutenberg–Richter law for earthquake magnitudes in the early stage of the Costa Marchigiana (Italy) seismic sequence, starting on 2022 November 9, with an ML 5.7 event in the Adriatic sea. In particular, we estimate both the completeness magnitude Mc and the b-value within the first 4 and 7 d after the initial strong event in the sequence. Our work represents a practical example of b-value estimation in 'true' real time, that is, during the seismic sequence, and its possible interpretation in terms of short-term forecasting. We highlight some critical issues to consider both in estimating/intepreting the b-value, and in evaluating the real time estimation of Mc. These issues are mainly due to the fact that preliminary catalogues available in real time are quite different from the revised ones, which are usually delivered after a few months. The criticalities are linked to the raw data recorded at an early-stage, an unreliable evaluation of the Mc with statistical approaches, the Short Term Aftershock Incompleteness entailed after the initial strong event, and the magnitude binning. Our results show that real time estimation of the b-value can give insights into the evolution of an ongoing seismic sequence, when attention is paid to data quality and quantity. [ABSTRACT FROM AUTHOR]

Background: Healthcare associated foodborne outbreaks (HA-FBO) can result from exposure to contaminated food in premises where highly vulnerable patients are cared, including hospitals and nursery homes. The probability of developing severe foodborne diseases such as invasive listeriosis is much higher for susceptible populations. There is limited knowledge on the data on food exposures that could be used to investigate HAFBOs. There is also lack of data relating to specific policies in the health facilities aimed to prevent the administration of potentially risky foods, possibly bringing them from home. Methods: This study was in the framework of One Health EJP Project NOVA. A semistructured questionnaire was administered to 4 general hospitals, 1 specialist clinic and 3 nursing homes located in the Abruzzo and Molise regions, Italy. The questionnaire included 25 questions in 3 sections (I. General organization of the catering service; II. Food menu data; III. Food from home). Results: In most facilities (75%) external catering companies used inhouse kitchens. Trace-back of food to individual patients was possible in 5 premises out of 8 (62.5%), but only in 1 nursery home out of 3 (33.3%). Data were collected in electronic format (hospitals) or paper (nursery homes) and stored 1-12 months. Food at risk of Listeria monocytogenes were not excluded from the menus, such as pre-sliced cooked meat products (served in 4 out of 8 premises, 50%), smoked fish (20%), soft cheese (20%). The consumption of food brought from home was possible in ‘‘special occasions’’, mostly in the nursery homes (66.6%). Conclusions: In case of HA-FBO it could be difficult to trace back the food particularly in the nursery homes where food data are not individually collected and usually on paper. More studies are needed in order to understand the effective exposure to foodborne pathogens, given that some types of foods considered by EFSA as at high risk of microbial contamination are commonly served. Key messages: · Served food could not be traced back to the patient mostly in nursery homes. · Foods at risk of Listeria monocytogenes contamination are commonly served to patients and residents. [ABSTRACT FROM AUTHOR]

This paper discusses the Marshallian Industrial District as it was rediscovered and further developed by Italian economists before tracing the main changes in the market and institutional context in the wake of globalization. It then focuses on some of the main transformations that have taken place in the Italian districts since the 1990s. After highlighting the important role still played by the districts in the Italian economy, the paper develops a framework for the evolutionary processes of the Marshallian Industrial District that would allow reproduction of the district in a manner suited to the era of globalisation. [ABSTRACT FROM AUTHOR]

We study the financial and real effects of political risk shocks for Italy, Spain, Ireland, Portugal and Greece between 2008 and 2019. We build an instrument for these shocks using the changes of the sovereign yield spread around political and policy dates, and estimate their effects in the context of local projection. We show that adverse political risk shocks have negative effects on domestic financial markets and in some countries generate spillovers on the spreads of other eurozone economies. Moreover, in Italy populism-related political risk shocks have a larger effect on financial markets and they harm the real economy. [ABSTRACT FROM AUTHOR]

This paper deals with the Italian recession in a theoretical framework which combines Marxian and Kaldorian elements. The interpretation proposed of the slow rate of growth of the Italian economy in the last decades is based on the view that the implementation of a liberal agenda (mainly in the form of increasing labour market deregulation and increasing taxation on labour) has generated increasing income inequality and the reduction of the growth rate. The basic idea, derived from Kaldor, is that the decline of labour share, the increasing precariousness and measures of fiscal consolidation have reduced domestic demand with negative effects on the level of employment and the growth of labour productivity. Moreover, the increase in public debt involves increasing taxation (mainly on labour), which, in turn, contributes to the reduction of the rate of growth of labour productivity via the deterioration of the quality of the workforce. [ABSTRACT FROM AUTHOR]

In traditional tight integration of high-rate GNSS and strong motion sensors, an appropriate process variance is crucial for obtaining accurate broad-band coseismic deformations. In this paper, instead of using a subjectively empirical value, we present an approach for determining the process variance adaptively based on the adaptive Kalman filter for real-time use. The performance of the approach was validated by the colocated stations collected during the 2010 M w 7.2 earthquake in El-Mayor, 2016 M w 7.8 earthquake in New Zealand and 2016 M w 6.5 earthquake in central Italy. The results show that this method complements the advantages of GNSS and strong motion accelerometers and can provide more accurate coseismic waveforms especially during the strong shaking period, due to the ability of the method to adjust the process variance in real time according to the actual status of the station. In addition, this method is also free from the influence of the baseline shift. Testing of the new method for the integration of strong motion and multi-GNSS indicates that multi-GNSS has an obvious improvement in the precision while single GPS has a poor observation condition. [ABSTRACT FROM AUTHOR]

Environmental health literacy (EHL) is a rather recent concept that applies health literacy skills to environmental issues. Research in this field is still at the beginning, and there is currently no existing tool in the literature designed to comprehensively assess individual general EHL among university students. The aim of our study is to fill this gap through the validation of the Environmental Health Literacy Index (EHLI) in such a target group. We adapted a previously administered survey, originally completed by 4778 university students from various Italian universities. Starting from the original questionnaire, our methodology involved a three-round item selection process, followed by a comprehensive evaluation of the instrument's psychometric properties. The EHLI consists of 13 Likert-type items, covering three primary domains of health literacy: functional (six items), interactive (three items), and critical (four items). The Cronbach's alpha coefficient is 0.808 for the global scale, while it stands at 0.888 for the functional, 0.795 for the critical, and 0.471 for the interactive components. The area under the receiver operating characteristic curve reached a value of 0.643. Spearman correlation analysis revealed a significant yet slight correlation between EHLI and both functional health literacy score and the extent of pro-environmental behaviors adoption. Our study serves as an important initial step in developing a tool able to evaluate the EHL of university-aged individuals. Further research efforts may improve the questionnaire's validity and completeness, as well as to explore its applicability to different age groups. [ABSTRACT FROM AUTHOR]

The aim of this study was to describe the goals, activities, and methods of EUMOVE project in developing a set of resources targeting both primary and secondary schools that allow the entire educational community to promote healthy lifestyles (HL). The EUMOVE project is an Erasmus+ program based in the Creating Active Schools (CAS) framework. The project lasted 3 years and was developed by 14 academic and non-governmental institutions from Spain, Portugal, France, Italy, and the UK. EUMOVE was divided into three phases. In the first phase, several work packages were carried out aimed to ensure the coordination/management of the project activities. In the second phase, seven educational resources strengthened by rigorous scientific research were developed to promote HL from schools. During the last phase, all the resources were disseminated through scientific seminars, workshops with families and teachers, and the online promotion by the non-governmental institutions of each country. The EUMOVE project developed and promoted a smartphone APP, video/activity repository of physically active lessons, active break virtual platform, learning units, and parent/teachers/school-leaders' guidelines to promote physical activity, active commuting, active school playgrounds, healthy diet, and sleep habits. To our knowledge, EUMOVE is the first European project to provide a set of practical tools based on scientific evidence to help schools or future school-wide interventions implement a paradigm shift based on the CAS framework for the promotion of HL. Future research will need to investigate the implementation, effectiveness, and scalability of this proposal. [ABSTRACT FROM AUTHOR]

The joint inversion of multiple data sets encompasses the advantages of different geophysical methods but may yield to conflicting solutions. Global search methods have been recently developed to address the issue of local minima found by derivative-based methods, to analyse the data compatibility and to find the set of trade-off solutions, since they are not unique. In this paper, we examine two evolutionary algorithms to solve the joint inversion of electrical and electromagnetic data. These nature-inspired metaheuristics also adopt the principle of Pareto optimality in order to identify the result among the feasible solutions and then infer the data compatibility. Since the joint inversion is characterized by more than one objective, we implemented the algorithm multi-objective particle swarm optimization (MOPSO) to jointly interpret time-domain electromagnetic data and vertical electrical sounding. We first tested MOPSO on a synthetic model. The performance of MOPSO was directly compared with that of a multi-objective genetic algorithm, the non-dominated sorting genetic algorithm (NSGA-III), which has often been adopted in geophysics. The adoption of MOPSO and NSGA-III enabled avoiding both simplification into a single-objective problem and the use of a weighting factor between the objectives. We tested the two methods on real data sets collected in the northwest of Italy. The results obtained from MOPSO and NSGA-III were highly comparable to each other and largely consistent with literature findings. The MOPSO performed a rigorous selection of the best trade-off solutions and its convergence was faster than NSGA-III. The analysis of the Pareto Front reported data incompatibility, which is very common for real data due to different resolutions, sensitivities and depth of investigations. Notwithstanding this, the multi-objective optimizers provided a complementary interpretation of the data, ensuring significant advantages with respect to the separate optimizations we carried out using the single-objective particle swarm optimization algorithm. [ABSTRACT FROM AUTHOR]

Background: Lower levels of sun exposure in childhood have been suggested to be associated with increased risk of multiple sclerosis (MS). In this paper we extend previous work, using two novel analytical strategies.Methods: Data collected in the Environmental risk factors In MS (EnvIMS) study, a case-control study with MS cases and population-based controls from Canada, Italy and Norway, were used. Participants reported on sun exposure behaviours for 5-year age intervals from birth; we focused on the first three age intervals (≤15 years). We compared two life course epidemiology conceptual models, the critical period and the accumulation model. We also used latent class analysis to estimate MS risk for different latent sun exposure behaviour groups.Results: The analyses included 2251 cases and 4028 controls. The accumulation model was found to be the best model, which demonstrated a nearly 50% increased risk of MS comparing lowest reported summer sun exposure with highest [risk ratio (RR) = 1.47 (1.24, 1.74)]. The latent sun exposure behaviour group, characterized by low sun exposure during summer and winter and high sun protection use, had the highest risk of MS; a 76% increased risk as compared with the group with high sun exposure and low sun protection use [RR = 1.76 (1.27, 2.46)].Conclusions: Our analyses provide novel insights into the link between sun exposure and MS. We demonstrate that more time indoors during childhood and early adolescence is linked with MS risk, and that sun protection behaviours in those who spend most time indoors may play a key role in increasing risk. [ABSTRACT FROM AUTHOR]

The annual meeting of the European Association of Cardiovascular Imaging, EuroEcho-Imaging, was held in Milan, Italy, in December 2018. In the present paper, we report a summary of the 'Highlights' session. [ABSTRACT FROM AUTHOR]

This paper estimates the causal relationship of supply of art on domestic tourist flows. To this aim, we use aggregate bilateral data on tourist flows and various data on museums in the twenty Italian regions. To solve the potential endogeneity of the supply of museums, we use three different empirical strategies: we use a fixed effects model controlling for bilateral macro-area dummies, we compute the degree of selection on unobservables relative to observables which would be necessary to drive the result to zero and, finally, we adopt a two-stage least squares approach that uses a measure of historical patronage, the number of noble families, as an instrument for the number of museums. For each empirical strategy, there is strong evidence of a positive effect of the number of 'net-museums' on bilateral tourist flows. [ABSTRACT FROM AUTHOR]

This paper investigates the impact of the public smoking ban which came into effect in Italy in January 2005 on individual smoking behaviour. Current empirical evidence supports the existence of a negative effect of the Italian ban on smoking prevalence and consumption in the general population. Our analysis shows that the apparent success of the ban is due to the fact that existing results do not take into account seasonal differences in smoking behaviour. Using quarterly data from the 1999/2000 and 2004/2005 Italian Health Surveys and adopting a difference-in-difference approach that nets out monthly variation in smoking rates, we show that the Italian smoking ban had no impact on smoking behaviour for the population as a whole but only on some subgroups. This result notwithstanding, we find that the smoking ban increased the overall well-being of non-smokers. [ABSTRACT FROM AUTHOR]

This article aims to estimate fiscal multipliers in Italy by assessing the effect of an increase in government expenditure and taxes on the Gross Domestic Product (GDP). By applying structural vector autoregressive modelling to Italian quarterly data for the 1995–2019 period, I show that expansionary fiscal policies produce positive effects on the GDP level. Estimated spending multipliers are higher than 1, and when government investment and consumption are compared, findings show that government investment has a larger effect on GDP than government consumption. Estimated tax multipliers are lower than 1, and tax-based policies are less effective in stimulating GDP than expenditure-based fiscal plans. My findings strongly support the Keynesian perspective and indicate that Italy should increase public investments considerably in order to foster economic growth. [ABSTRACT FROM AUTHOR]

Background Primary hyperoxaluria (PH) is a rare, severe genetic disorder, characterized by increased urinary excretion of calcium oxalate, which is responsible for kidney damage and systemic clinical manifestations. Since the year 2020, a new molecule, lumasiran, based on RNA interference (RNAi) technology, has been added to the traditional therapeutic approach. The aim of this analysis was to define the baseline characteristics of a PH1 pediatric population treated with lumasiran in a compassionate-use program setting, and to evaluate the medium-term efficacy of this drug in the routine clinical setting. Methods A retrospective observational analysis was conducted in nine pediatric patients (male:female 5:4; median age at lumasiran start 1.9 years, range 0–14.1). Data concerning oxalate concentration in plasma and urine, kidney stones events, ultrasound and kidney function were collected during the study period (follow-up, mean ± standard deviation: 15.3 ± 5 months). Results In this analysis, a reduction in the urinary oxalate to creatinine ratio (reduction range within the sixth month of treatment from 25.8% to 69.6%, median 51.2%) as well as plasma oxalate concentration under the limit of supersaturation of oxalate in all the patients. Only one patient presented new stone events; kidney ultrasonographic findings related to nephrocalcinosis remained stable in eight out of nine patients. Glomerular filtration rate remained stable during treatment. No adverse events related to lumasiran were noted. Conclusion Data from this analysis support the efficacy and safety of lumasiran in a pediatric clinical setting, especially if administrated in early life. [ABSTRACT FROM AUTHOR]

Background: Medically unexplained symptoms (MUS) are common in primary care and are one of the most challenging clinical encounters for general practitioners (GPs).Objective: To assess GPs' clinical experience with MUS and its relationship with their gender, age and length of practice.Methods: Four hundred and thirty-three Italian GPs were invited to complete a questionnaire encompassing the following MUS-related features: workload, cognitive and emotional responses, management strategies, attitudes towards psychological interventions, sources of education and educational needs.Results: A total of 347 GPs (80.1%) participated in the study. About seven out of ten physicians spent 'much' or 'very much' time and energy for MUS during their daily practice. Fear of neglecting a medical disease was the most frequent (59.1%) response to MUS. Providing reassurance and support (73.8%) and listening to the patient (69.2%) were the most frequent management strategies. More than half of GPs rated psychological interventions as 'much' or 'very much' useful for MUS. However, only a third of GPs were well informed about the role of psychologists in MUS management. The main sources of education about MUS were scientific papers and continuing medical education courses. Most of GPs (77.5%) needed further education about MUS. GPs' younger age and lower length of practice were significantly associated with negative emotional responses to MUS.Conclusion: The introduction of guidelines for MUS in Italian primary care settings would promote a collaborative clinical approach to MUS and more formal training on this topic. [ABSTRACT FROM AUTHOR]

Advancements in genomics have significant implications for public health, making citizens' education vital for informed decision-making. Based on two literature reviews' findings and a survey conducted with experts from the Italian Network of Genomics in Public Health, we conducted a pilot survey on Italian citizens' attitudes, knowledge and educational needs toward genetic testing and omics sciences. Our results demonstrate a widespread interest in genetic testing and uncertainties regarding associated risks, with 99% of participants acknowledging insufficient knowledge of genetic testing. There is an urgent need for educational tools to improve citizens' literacy and engagement in this rapidly evolving field. [ABSTRACT FROM AUTHOR]

Background Disability does not simply affect the health status of the individual who directly experiences that condition, but it has important consequences on the health and well-being of the other family members as well. Focusing on Italy, an extremely interesting test-bed due to its strong familialist welfare regime, we show significant spillover effects of children's disability on parental health and well-being. Methods We use data from a nationally representative household survey on almost 13 000 mothers and fathers and adopt a multivariate regression setting providing evidence that the disability of a child is negatively associated with parents' health and life satisfaction. Results Parents of a disabled child report lower levels of general and mental health, as well as lower levels of well-being compared with parents with a healthy child. Strong heterogeneity by gender and socio-economic characteristics is observed, with mothers being more affected by the disability status of the child than fathers. The estimated coefficients suggest that education remains an important protective factor even for parents of a disabled child. Conclusion This study claims and documents that child disability is an overlooked source of health disadvantage for parents. Such disadvantage is especially relevant for mothers and lower-educated parents, evidence that suggests the importance of taking an intersectional approach to study health disparities. [ABSTRACT FROM AUTHOR]

Background Molecular-driven oncology allows oncologists to identify treatments that match a cancer's genomic profile. Clinical trials are promoted as an effective modality to deliver a molecularly matched treatment. We explore the role of geographical accessibility in Italy, and its impact on patient access to clinical trials. Material and Methods We retrospectively reviewed molecular data from a single-institutional case series of patients receiving next-generation sequencing testing between March 2019 and July 2020. Actionable alterations were defined as the ones with at least one matched treatment on Clinicaltrials.gov at the time of genomic report signature. We then calculated the hypothetical distance to travel to reach the nearest assigned clinical trial. Results We identified 159 patients eligible for analysis. One hundred and one could be potentially assigned to a clinical trial in Italy, and the median distance that patients needed to travel to reach the closest location with a suitable clinical trial was 76 km (interquartile range = 127.46 km). Geographical distribution of clinical trials in Italy found to be heterogeneous, with Milan and Naples being the areas with a higher concentration. We then found that the probability of having a clinical trial close to a patient's hometown increased over time, according to registered studies between 2015 and 2020. Conclusions The median distance to be travelled to the nearest trial was generally acceptable for patients, and trials availability is increasing. Nevertheless, many areas are still lacking trials, so efforts are required to increase and homogenize the possibilities to be enrolled in clinical trials for Italian patients with cancer. [ABSTRACT FROM AUTHOR]

Stimulated by the recent advances in computational tools for the simulation of seismic wave propagation problems in realistic geological configurations, this paper presents a 3D physicsbased numerical analysis of near-source ground motion during the MW 6.0 2012 May 29 earthquake in the Po Plain, Northern Italy. To reproduce with sufficient accuracy some of the most peculiar features of the near-source strong-motion records and of the spatial variability of damage distribution, this study required a sequence of investigations, starting from the analysis of a wide set of near-source records, to the calibration of an improved kinematic seismic source model, up to the development of a 3D numerical model of the portion of the Po Plain interested by the earthquake. The latter includes the basin geometry, characterized by sediment thickness sharply varying from few tens of metres to some kilometres. The spatial resolution of the numerical model is suitable to propagate frequencies up to about 1.5 Hz. Numerical simulations were performed using the open-source high-performance code SPEED, based on the Discontinuous Galerkin Spectral Elements method. The 3D numerical model, coupled with the updated slip distribution along the rupturing fault, proved successful to reproduce with good agreement, measured through quantitative goodness-of-fit criteria, the most relevant features of the observed ground motion. These include: (i) the large fault normal velocity peaks at the near-source stations driven by updip directivity effects; (ii) the small-scale variability at short distance from the source, resulting in the out-of-phase motion at stations separated by only 3 km distance; (iii) the propagation of prominent trains of surface waves, especially in the Northern direction; (iv) the map of earthquake-induced ground uplift with maximum values of about 10 cm, in substantial agreement with geodetic measurements and (v) the two-lobed pattern of the peak ground velocity map, well correlated with the distribution of macroseismic intensity. [ABSTRACT FROM AUTHOR]

Background There are still many unknowns about COVID-19. We do not know its exact mortality rate nor the speed through which it spreads across communities. This lack of evidence complicates the design of appropriate response policies. Methods We source daily death registry data for 4100 municipalities in Italy's north and match them to Census data. We augment the dataset with municipality-level data on a host of co-factors of COVID-19 mortality, which we exploit in a differences-in-differences regression model to analyze COVID-19-induced mortality. Results We find that COVID-19 killed more than 0.15% of the local population during the first wave of the epidemic. We also show that official statistics vastly underreport this death toll, by about 60%. Next, we uncover the dramatic effects of the epidemic on nursing home residents in the outbreak epicenter: in municipalities with a high share of the elderly living in nursing homes, COVID-19 mortality was about twice as high as in those with no nursing home intown. Conclusions A pro-active approach in managing the epidemic is key to reduce COVID-19 mortality. Authorities should ramp-up testing capacity and increase contact-tracing abilities. Adequate protective equipment should be provided to nursing home residents and staff. [ABSTRACT FROM AUTHOR]

Background: After rising for years, vaccination rates in Italy fell until 2015 because of unfounded safety concerns, abetted by some government and court actions. Public education and a 2017 law on mandatory vaccination have boosted rates since then. So far only a few papers have examined the correlation between beliefs and attitudes towards vaccines and the level of trust in the scientific community regarding vaccinations in the general population. Methods: Data were extracted from the Italian section of the last two editions of the European Social Survey (ESS), the first carried out between September and November 2017, the latter between December 2018 and March 2019. A descriptive analysis was conducted using survey data. In the two editions respectively 2,626 and 2,745 persons were interviewed. The main outcomes assessed was comparing the two surveys, so as to highlight the key changes in public opinion on vaccines. Results: In the 2017 edition, 19% of the respondents believed in the harmfulness of vaccines, out of them 29% did not even have trust in the scientific community while those confident in the safety of vaccines were 50%. In the 2019 survey, the proportion of those who believed vaccines to be harmful fell to 15%, the undecided rose to 15%, those opposed to the idea that vaccines are harmful became 63%, not responding people were 8%. Correspondingly, trust in the scientific community about vaccines has increased from 57% in the first survey to 70% in the last one. Conclusions: The scientific community and research bodies in the last years, in support of the Ministry of Health, have made a huge effort in the public debate on vaccines. This might play a role in increasing the public confidence in the safety of vaccines and the adherence to vaccination campaigns, changing the climate with regard to vaccination in general. Key messages: Italians changed their opinions on vaccines between two ESS surveys. The scientific community had a relevant role in the public debate on vaccines. [ABSTRACT FROM AUTHOR]

Aims: The role of the serotonin transporter gene (SLC6A4) in alcohol dependence (AD) is still unclear. In this paper, we have evaluated the association of the SLC6A4 gene polymorphisms 5-HTTLPR and rs25531 in AD and assessed the polymorphic patterns both in alcoholics and in healthy people of an Italian population. Methods: Genotyping of the 5-HTTLPR (L/S) and rs25531 (A/G) polymorphisms of the SLC6A4 gene was performed on 403 alcoholics outpatients and 427 blood donors. Results: Comparing AD and control populations and taking into account statistical correction for multiple testing,we found no statistically significant differences for 5-HTTLPR (L/S) and rs25531 polymorphisms in terms of either genotypes or alleles frequencies. By univariate ANOVA, a statistically significant difference was found in the onset of AD: the mean age of onset resulted to be of 25.4 years in males in respect to 28.1 in females. In particular in males, the early AD onset was different, in a statistically significant manner, depending on the presence of at least one S or Lg allele (24.6 years) in respect to La homozygotes (27.5 years) (P = 0.03). Conclusions: These findings suggest that genetic factors contribute, together with gender and age, to the onset differences in alcohol-dependent phenotypes. [ABSTRACT FROM AUTHOR]

STUDY QUESTION: Is it possible to replicate the genetic association of single nucleotide polymorphisms (SNPs) rs 13394619, rs4141819, rs7739264, rs 17694933 and rs 10859871 in five genetic loci previously identified as associated with endometriosis in an Italian Caucasian population? SUMMARY ANSWER: SNP rs 10859871 near the vezatin (VEZT) gene was found to be significantly associated with endometriosis in general while SNPs rs 17694933 and rs4141819 were associated with Stage III/IV and ovarian disease, respectively. WHAT IS KNOWN ALREADY: Endometriosis represents a complex disease in which the phenotypic manifestations are influenced by both genetic and environmental factors. Recent genome-wide association studies (GWASs) have allowed to identify some SNPs associated with the predisposition to the disease. A meta-analysis published in 2014 combined results from GWAS and replication studies showing that of the nine loci found to be associated with the disease in at least one of the studies, six (rs7521902, rs 1270667, rs 13394619, rs7739264, rs 1537377 and rs 10859871) remained genome-wide significant while two others (rs 1250248 and rs4141819) showed borderline genome-wide significant association with more severe disease. STUDY DESIGN, SIZE, DURATION: Allele frequencies of selected SNPs (rs13394619, rs4141819, rs7739264, rs17694933 and rs 10859871) were investigated in 305 women with laparoscopically proven endometriosis, 285 laparoscopic controls and 2425 healthy, blood donor controls from the general population. A meta-analysis with previous data was also conducted. PARTICIPANTS/MATERIALS, SETTING, METHODS: A total of 590 women who underwent endoscopic surgery were enrolled in the study and a blood sample was collected. After DNA extraction, genotype was obtained using Taq-Man pre-designed assay. Genotype data from healthy blood donor women were obtained from an existing genotype bank. MAIN RESULTS AND THE ROLE OF CHANCE: A statistically significant association with endometriosis was found for SNP rs 10859871, close to the VEZT gene, compared with both general population [odds ratio (OR) = 1.43, 95% confidence interval (CI): 1.20- 1.71, P = 6.9 x 10-5] and laparoscopic controls (OR = 1.58, 95% CI: 1.24-2.02, P = 2.1 x 10-4). Meta-analysis with previous data confirmed the rs 10859871 SNP as that with the strongest evidence for association with endometriosis (OR= 1.19, 95% CI: 1.15-1.24, P= 7.9 x 10-20). A further meta-analysis conducted using data from Stage III-IV endometriosis resulted in stronger genome-wide significant effect sizes for four out of the five SNPs tested. LIMITATIONS, REASONS FOR CAUTION: The inability to confirm all previous demonstrated associations considering all stages of endometriosis maybe due to a lack of statistical power and differences in the definition of cases included. WIDER implications of the findings: The associations with the SNPs identified so far have been obtained with a relatively small sample size supporting a limited heterogeneity across the various datasets. This represents an important advance in the identification of genetic markers of this disease. STUDY FINDING/COMPETING INTEREST(S): No funding to declare. The authors have no competing financial interests in relation to the content of this research paper. [ABSTRACT FROM AUTHOR]

The M ∼ 7 1915 Fucino (Central Italy) earthquake represents one of the most destructive seismic events ever occurred in the Italian Peninsula. Several seismogenic faults have been proposed in the past decades as the source of the earthquake by means of different approaches and techniques that lead to a variety of speculations about the source mechanism and the fault location, often contrasting with one another. The 1915 earthquake produced a remarkable data set of 73 coseismic hydrological changes in the near and intermediate field that consist in variation of the flow of streams and springs, liquefaction, rise of water temperature and turbidity. In this paper, we study the coseismic water level changes induced by the 1915 earthquake in the near field to provide convincing clues on the geometry of the earthquake causative fault. We model the coseismic strain field induced by seventeen individual faults proposed through different approaches, and compare its pattern with the distribution of streamflow changes. We find: (i) clues on the most probable geometry of the earthquake causative fault. Best fits between modelled deformation and observed data are displayed by sources (derived by geological or seismological data) that share several distinctive features, as they are ∼135°-striking, SW-dipping, 25–30-km-long normal faults located along the eastern side of the Fucino basin. These data point to the Serrone Fault and the Parasano Fault as the most likely causative structures and support the hypothesis that the coseismic ruptures observed in the field represented primary surface faulting. On the contrary, our calculations show that the Pescina Fault and the Ventrino Fault are secondary faults from the perspective of the hydrological response. Finally, one of the best scoring potential sources (from geological data) is a multifaulting system that considers the presence, in the central-western part of the basin, of fault splays synthetic and antithetic to the main seismogenic structures; therefore, we infer for these splays a possible active involvement in a 1915-like seismogenic process; (ii) evidence against a number of seismogenic structures that were previously associated with the earthquake. In particular, the plots of coseismic strain induced by sources uniquely derived by macroseismic or geodetic data prove to be inconsistent with the polarities of the hydrological signatures. Also, sources mainly characterized by reverse faulting and/or by right-lateral strike-slip component are discarded and (iii) as a final remark, we maintain that the study of the hydrological signatures of earthquake strain can offer an alternative tool in the investigation of the historical seismicity, to estimate the focal mechanism of major earthquakes capable of giving rise to a consistent data set of hydrological data. [ABSTRACT FROM AUTHOR]

Italy was the first large epicentre of the COVID-19 pandemic in the Western world. Since the country has not had any serious experience with this kind of disease in recent decades, its response has been indicative of a first reaction to an (un)known and (un)expected event. At the same time, the Italian experience is an emblematic case of how a lack of specific preparedness measures drives a country to deal with this kind of crisis through a process in which the existing characteristics of the policy and political system, with all their pros and cons, prevail. This means that the existing country characteristics that affects policy design, state capacity, institutional arrangements and political games forge the process and content of the response. Based on this observation, this paper analyses the policy dynamics of the first four months of management of the COVID-19 outbreak in Italy, focusing on how the health and economic responses were designed and implemented. [ABSTRACT FROM AUTHOR]

Background Missed opportunities constitute a main driver of suboptimal seasonal influenza vaccination (SIV) coverage in older adults. Vaccine co-administration is a way to reduce these missed opportunities. In this study, we quantified missed opportunities for SIV, identified some of their socio-structural correlates and documented SIV co-administration patterns. Methods In this registry-based retrospective cohort study, we verified the SIV status of all subjects aged ≥65 years who received at least one dose of coronavirus disease 2019 (COVID-19), pneumococcal or herpes zoster vaccines during the 2022/23 influenza season. The frequency of concomitant same-day administration of SIV with other target vaccines was also assessed. Results Among 41 112, 5482 and 3432 older adults who received ≥1 dose of COVID-19, pneumococcal and herpes zoster vaccines, missed opportunities for SIV accounted for 23.3%, 5.0% and 13.2%, respectively. Younger, male and foreign-born individuals were generally more prone to missing SIV. The co-administration of SIV with other recommended vaccines was relatively low, being 11.0%, 53.1% and 17.1% in COVID-19, pneumococcal and herpes zoster cohorts, respectively. Conclusions A sizeable proportion of older adults who received other recommended vaccines during the last influenza season did not receive SIV. This share of missed opportunities, which are subject to some social inequalities, may be addressed by increasing vaccine co-administration rates and implementing tailored health promotion interventions. [ABSTRACT FROM AUTHOR]

Background The European Union has used Healthy Life Years (HLY) as an indicator to monitor the health of its aging populations. Scholarly and popular interest in HLY across countries has grown, particularly regarding the ranking of countries. It is important to note that HLY is based on self-assessments of activity limitations, raising the possibility that it might be influenced by differences in health reporting behaviours between populations, a phenomenon known as differential item functioning (DIF). Methods We estimated DIF-adjusted HLY at age 50 for Belgium, France, Germany, Greece, Italy, the Netherlands, Spain, and Sweden to determine the extent to which differences in HLY might be influenced by reporting heterogeneity across countries. We used anchoring vignettes, taken from the 2004 Survey of Health, Ageing and Retirement in Europe, to estimate DIF-adjusted prevalence rates of activity limitations measured by the Global Activity Limitations Indicator (GALI). The Sullivan method was used to calculate DIF-adjusted HLY. Results Changes in HLY before and after adjustment ranged from a 1.20-year decrease for men in Italy to a 1.61-year increase for women in Spain. Adjustment for DIF produced changes in the rankings of the countries by HLY, with upward and downward movements of up to three positions. Conclusion Our results show that DIF is likely to affect HLY estimates, thereby posing a challenge to the validity of comparisons of HLY across European countries. The findings suggest that HLY should be used to monitor population health status within a country, rather than to make comparisons across countries. [ABSTRACT FROM AUTHOR]

Background Sex differences for cardiovascular (CV) risk and outcomes in chronic kidney disease (CKD) patients not on dialysis have been scarcely or never investigated. We therefore studied this important aspect in a cohort of CKD stage 2–5 in the south of Italy. Methods We tested the relationship between sex and fatal and non-fatal major CV events in a cohort of 759 stage 2–5 CKD patients followed up for a median time of 36 months. Results Out of 759 patients, 455 were males (60%) and the remaining 304 patients were females (40%). During the follow-up, 42 patients died, and 118 had fatal and non-fatal CV events. On univariate Cox regression analyses, the male sex failed to be associated with all-cause mortality but was strongly related to the incidence rate of fatal and non-fatal major CV events [hazard ratio (HR) 1.75, 95% confidence interval (CI) 1.18–2.60, P  = .006]. Data adjustment for a series of major potential confounders did not materially affect the strength of this relationship (HR 1.78, 95% CI 1.03–3.09). Further analysis testing the effect of age on major CV outcomes by sex showed an effect modification by this risk factor on the same outcome (P  = .037) because the HR of male versus female CV events increased progressively with aging. Conclusion Male patients in stage G2–5 CKD had a higher risk for CV events compared with female patients. Age was shown to be a risk modifier for the association between sex and CV events and this risk increased linearly across a wide age spectrum in CKD patients. [ABSTRACT FROM AUTHOR]

Background Main aim was to describe youth smoking prevalence in Italy over the last two decades, and to provide recent trends in knowledge, attitudes towards smoking, awareness of anti-tobacco mass media campaigns, second-hand smoke (SHS) exposure and access to cigarettes. Methods Figures from three surveillance systems, with 12 representative cross-sectional surveys (about 43 000 participants): European School Survey Project on Alcohol and Other Drugs, 15–16-year-old students, 1995–2015; Health Behaviour in School-aged Children, 11-, 13-, 15-year-old students, 2002–14 and Global Youth Tobacco Survey, 13–15-year-old students, 2010, 2014. Results Among 11- and 13-year-old students, daily and non-daily smokers decreased by 30–50% from 2002 to 2014. Among 15–16-year-old adolescents, ever smokers significantly decreased by 10% in the period 1995–2015, whereas current and daily smokers have been stalling or even increased. Appeal of smoking increased in 2014 compared to 2010, perception of SHS as harmful, and awareness of recent anti-tobacco mass media campaigns decreased. Moreover, a significant 30% reduction in reporting retailers did not refuse to sell cigarettes to adolescents and a decrease in reporting to buy cigarettes were reported. Conclusions Policies enforced in Italy over the last 20 years slightly reduced ever smokers, but did not decrease current and daily smokers in 15–16-year-old adolescents, and determined an impact among younger adolescents. Stricter rules on youth tobacco access reduced ease of access to cigarettes, but did not affect adolescents' tobacco use. Stronger tobacco control measures are urgently needed in order to determine a steeper decline in smoking prevalence in adolescents. [ABSTRACT FROM AUTHOR]

Background Progression of chronic kidney disease (CKD) has proven to be faster in men than in women. Whether the same holds true for cardiovascular risk remains ill-defined. Methods We conducted a pooled analysis of four cohort studies from 40 nephrology clinics in Italy including patients with CKD [estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 or higher if proteinuria >0.15 g/day]. The aim was to compare multivariable-adjusted risk (hazard ratio, 95% confidence interval) of a composite cardiovascular endpoint (cardiovascular death and non-fatal myocardial infarction, congestive heart failure, stroke, revascularization, peripheral vascular disease and non-traumatic amputation) in women (n  = 1192) versus men (n  = 1635). Results At baseline, women had slightly higher systolic blood pressure (SBP) as compared with men (139 ± 19 vs 138 ± 18 mmHg, P  = .049), lower eGFR (33.4 vs 35.7 mL/min/1.73 m2, P  = .001) and lower urine protein excretion (0.30 g/day vs 0.45 g/day in men, P  < .001). Women did not differ from men in age and prevalence of diabetes, while having a lower prevalence of cardiovascular disease, left ventricular hypertrophy and smoking habit. During a median follow-up of 4.0 years, 517 fatal and non-fatal cardiovascular events were registered (199 in women and 318 in men). The adjusted risk of cardiovascular events was lower in women (0.73, 0.60–0.89, P  = .002) than in men; however, the cardiovascular risk advantage of women progressively diminished as SBP (as continuous variable) increased (P for interaction = .021). Similar results were obtained when considering SBP categories: when compared with men, women had lower cardiovascular risk for SBP <130 mmHg (0.50, 0.31–0.80, P  = .004) and SBP 130–140 mmHg (0.72, 0.53–0.99, P  = .038), while no difference was observed for SBP >140 mmHg (0.85, 0.64–1.11, P  = .232). Conclusions Higher BP levels abolish the cardiovascular protection seen in female vs male patients with overt CKD. This finding supports the need for higher awareness of hypertensive burden in women with CKD. [ABSTRACT FROM AUTHOR]

Sustainable Forest Management (SFM) is a key objective of the European Forest Strategy. One of the most important aspects to be considered to achieve this fundamental goal is the implementation of Sustainable Forest Operations (SFOs). This study aims to investigate how and to what extent forest logging and silvicultural treatments affect soil physicochemical properties in the context of Mediterranean forestry by summarizing the results of 55 field studies, performed within the development of Master's and PhD theses, carried out in Italy over the last 15 years. In order to define reliable and scalable conclusions, and going beyond the typical case-study approach, we applied a data synthesis under the meta-analytic framework summarizing the results of the studies analyzed. The results show that disturbance triggered by the silvicultural treatments (meant as an alteration of canopy cover as a consequence of the removal of some trees) is much lower than that caused by forest logging, in particular passage of forest vehicles and woody loads. Furthermore, as expected, a clear relationship was observed between the impacts on soil physicochemical properties and biological impacts. Based on our results we recommend that ground-based extraction on slopes steeper than 20 per cent should be limited, extending the applications of skyline systems or winch-assisted extraction. Interestingly, different conditions of terrain roughness showed variable effects on the magnitude of impacts, suggesting the need for future dedicated studies on this topic. The application of machineries specifically developed for the forestry sector showed better performance than lower levels of mechanizations, confirming what was reported in previous literature on the topic. However, the major finding from this study clearly shows that the way in which extraction is carried out is the major factor causing soil disturbance. [ABSTRACT FROM AUTHOR]

Background This study aimed to compare the cost-effectiveness of coronavirus disease 2019 (COVID-19) mass testing, carried out in November 2020 in the Italian Bolzano/Südtirol province, to scenarios without mass testing in terms of hospitalizations averted and quality-adjusted life-year (QALYs) saved. Methods We applied branching processes to estimate the effective reproduction number (Rt) and model scenarios with and without mass testing, assuming Rt = 0.9 and Rt = 0.95. We applied a bottom-up approach to estimate the costs of mass testing, with a mixture of bottom‐up and top‐down methodologies to estimate hospitalizations averted and incremental costs in case of non-intervention. Lastly, we estimated the incremental cost-effectiveness ratio (ICER), denoted by screening and related social costs, and hospitalization costs averted per outcome derived, hospitalizations averted and QALYs saved. Results The ICERs per QALY were €24 249 under Rt = 0.9 and €4604 under Rt = 0.95, considering the official and estimated data on disease spread. The cost-effectiveness acceptability curves show that for the Rt = 0.9 scenario, at the maximum threshold willingness to pay the value of €40 000, mass testing has an 80% probability of being cost-effective compared to no mass testing. Under the worst scenario (Rt = 0.95), at the willingness to pay threshold, mass testing has an almost 100% probability of being cost-effective. Conclusions We provide evidence on the cost-effectiveness and potential impact of mass COVID-19 testing on a local healthcare system and community. Although the intervention is shown to be cost-effective, we believe the initiative should be carried out when there is initial rapid local disease transmission with a high Rt, as shown in our model. [ABSTRACT FROM AUTHOR]

Background Untimely social interventions prolong hospitalizations, suggesting discharge planning should begin early. This study aimed to create a tool to identify, already in Emergency department, patients at risk of complex discharge for social reasons. Methods We developed the Risk Assessment of Complex Discharge Index (RACDI). In Emergency department, we administered RACDI to patients destined to hospitalization. We calculated sensitivity and specificity of RACDI in identifying patients who need a social intervention. RACDI was compared with simplified BRASS. A multivariable logistic regression explored social intervention predictors (P -value < 0.05). Results RACDI was administered to 296 patients. There were significant associations between classes of risk defined by RACDI or by simplified BRASS and social intervention. The sensitivity of RACDI and simplified BRASS was, respectively, 0.59 and 0.43; the specificity 0.81 and 0.83. Chances of social intervention were higher for patients at high risk with RACDI (adjOR:3.13, 95% CI: 1.23–8.00, P  = 0.017). Conclusions The reduced items and mostly dichotomous answers made RACDI a tool easy to be used in daily practice. RACDI helps in classifying patients needing discharge planning for social care and is a starting point to standardize the evaluation of social context early in hospitalization. Further work is needed to overcome limitations and assess additional outcomes. [ABSTRACT FROM AUTHOR]

We provide new results from a controlled-source seismic experiment on the deepest part of the Val Sesia crust–mantle section of the Ivrea–Verbano zone (IVZ) in the Italian Alps. The IVZ is a tilted, almost complete section through the continental crust and exposes gabbros and peridotites in the structurally deepest level, coinciding with high-resolution gravity anomalies imaging the Ivrea geophysical body. The seismic experiment SEIZE (SEismic imaging of the Ivrea ZonE) was conducted along two crossing profiles: an NNE-SSW profile of ∼11 km length and an E-W profile of ∼16 km length. 432 vibration points were recorded with 110 receivers resulting in 24   392 traveltime picks. Inversion methods using Markov chain Monte Carlo techniques have been used to derive an isotropic 3-D P -wave velocity model based on first break traveltimes (refracted phases) from controlled source seismic data. Resulting seismic P -wave velocities (Vp) range from 4.5 to 7.5 km s−1, with an expected general trend of increasing velocities with depth. A sharp velocity change from low Vp in the West to high Vp in the East marks the Insubric Zone (ISZ), the Europe–Adria plate boundary. The most prominent feature of the 3-D tomography model is a high-velocity body (Vp increases from 6 to 7.5 km s−1) that broadens downwards. Its pointy shape peaks the surface East of Balmuccia at a location coincident with the exposed Balmuccia peridotite. Considering rock physics, high-resolution gravity and other geophysical data, we interpret this high-velocity body as dominantly composed of peridotite. The dimension of this seismically imaged peridotite material is far bigger than interpreted from geological cross-sections and requires a revision of previous models. The interpretation of ultramafic bodies in the IVZ as fragments of mantle peridotites interfingered in the crust during pre-Permian accretion is not supported by the new data. Instead, we revive a model that the contact between the Balmuccia peridotite and the Permian mafic magmas might represent a fossil continental crust–mantle transition zone. [ABSTRACT FROM AUTHOR]

We present the results from a fully unconstrained moment tensor inversion of induced seismic events in a complex and high seismic hazard region (Val d'Agri basin, Southern Italy). The study area hosts two well-documented cases of induced microseismicity linked to (i) a wastewater injection well of a giant oilfield (the largest in onshore Europe), and (ii) severe seasonal level changes of an artificial lake. In order to gather information on the non-double-couple components of the source and to better understand the rupture mechanisms, we analyse seismic events recorded during daily injection tests in the disposal well. The computed moment tensors have significant non-double-couple components that correlate with the well-head injection pressure. The injection parameters strongly influence the rupture mechanism that can be interpreted as due to the opening/closing of a fracture network inside a fault zone of a pre-existing thrust fault. For the case of the reservoir-induced seismicity, no direct correlations are observed with the loading/unloading of the reservoir. [ABSTRACT FROM AUTHOR]

The Every Earthquake a Precursor According to Scale (EEPAS) forecasting model is a space–time point-process model based on the precursory scale increase (⁠|$\psi $|) phenomenon and associated predictive scaling relations. It has been previously applied to New Zealand, California and Japan earthquakes with target magnitude thresholds varying from about 5–7. In all previous application, computations were done using the computer code implemented in Fortran language by the model authors. In this work, we applied it to Italy using a suite of computing codes completely rewritten in Matlab. We first compared the two software codes to ensure the convergence and adequate coincidence between the estimated model parameters for a simple region capable of being analysed by both software codes. Then, using the rewritten codes, we optimized the parameters for a different and more complex polygon of analysis using the Homogenized Instrumental Seismic Catalogue data from 1990 to 2011. We then perform a pseudo-prospective forecasting experiment of Italian earthquakes from 2012 to 2021 with M w ≥ 5.0 and compare the forecasting skill of EEPAS with those obtained by other time independent (Spatially Uniform Poisson, Spatially Variable Poisson and PPE: Proximity to Past Earthquakes) and time dependent [Epidemic Type Aftershock Sequence (ETAS)] forecasting models using the information gain per active cell. The preference goes to the ETAS model for short time intervals (3 months) and to the EEPAS model for longer time intervals (6 months to 10 yr). [ABSTRACT FROM AUTHOR]