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The 4th National Report ex Art. 17 of the 92/43/EEC Directive in Italy (period 2013-2018) will try to fill a number of gaps still affecting the former versions of the Italian Reports, where territorial data were still missing for large parts of the country and the assessment was mostly based on the use of the expert opinion. Similar inconsistencies also emerged in other European countries (State of nature in the EU, EEA 2015). In order to reach this aim, a nationally shared protocol for monitoring the vegetation-based Annex I Habitats is currently under development. The most prominent issues addressed by the ongoing project are: i) fixing standardized, updated and scientifically grounded methodological tools, on the basis of the European guidelines (Evans & Arvela 2011, ETC-BD); ii) providing comparable data at national and European level; iii) harmonizing the territorially fragmented knowledge and iv) supporting nationally standardized measures for the conservation of terrestrial, brackish and freshwater Habitats. Promoted by the Italian Ministry for Environment (MATTM) and coordinated by the environmental agency ISPRA, the development of such a tool is being carried out by the Italian Society for Vegetation Science, with the support of a large team of experts. Open issues, such as the favourable reference values and the optimal thresholds for each considered parameter (range,area, structure and function), have to be dealt with, in a condition of large uncertainty. Due to its centrality in the assessment process, especially the concept of "typical species" should be developed with care, trying to combine the need for synthetic indicators with the great floristic diversity of the Italian Habitats. A clear definition of the parameters is crucial for a correct application of the monitoring protocol, to successfully contribute to the whole process of halting biodiversity loss in Europe.

The 4th National Report ex Art. 17 of the 92/43/EEC Directive in Italy (period 2013-2018) will try to fill a number of gaps still affecting the former versions of the Italian Reports, where territorial data were still missing for large parts of the country and the assessment was mostly based on the use of the expert opinion. Similar inconsistencies also emerged in other European countries (State of nature in the EU, EEA 2015). In order to reach this aim, a nationally shared protocol for monitoring the vegetation-based Annex I Habitats is currently under development. The most prominent issues addressed by the ongoing project are: i) fixing standardized, updated and scientifically grounded methodological tools, on the basis of the European guidelines (Evans & Arvela 2011, ETC-BD); ii) providing comparable data at national and European level; iii) harmonizing the territorially fragmented knowledge and iv) supporting nationally standardized measures for the conservation of terrestrial, brackish and freshwater Habitats. Promoted by the Italian Ministry for Environment (MATTM) and coordinated by the environmental agency ISPRA, the development of such a tool is being carried out by the Italian Society for Vegetation Science, with the support of a large team of experts. Open issues, such as the favourable reference values and the optimal thresholds for each considered parameter (range, area, structure and function), have to be dealt with, in a condition of large uncertainty. Due to its centrality in the assessment process, especially the concept of "typical species" should be developed with care, trying to combine the need for synthetic indicators with the great floristic diversity of the Italian Habitats. A clear definition of the parameters is crucial for a correct application of the monitoring protocol, to successfully contribute to the whole process of halting biodiversity loss in Europe.

The methodological foundations of the recently published Manual for Annex I Habitats monitoring in Italy, edited by the Italian Institute for Environmental Protection and Research (ISPRA) with the scientific support of the Italian Society for Vegetation Science (SISV), are here presented, discussed and related to the most consolidated and acknowledged scientific advances in the field of Vegetation science. The proposed methodologies aim at offering simple, yet effective, protocols and procedures towards a harmonized data collection, by way of standardized and shared technical tools, resulting in comparable evaluations of the conservation status of Annex I Habitats. The methodological framework was developed by experts including a large team of members of the SISV. Big efforts were deployed to provide indicators and parameters for biodiversity monitoring able to catch its complexity, yet simple enough to be easily measured. Diagnosis and syntaxonomical correspondences of Habitat types, sampling procedure, plot size, distribution mapping, typical species are among the principal issues here examined through a widely shared scientific discussion. The final product is a comprehensive Manual, which offers practical but scientifically sound methodological tools for an efficient and effective monitoring of Annex I Habitats. The importance of bridging across the science-policy interface is emphasized, in a general will to improve the impact of Vegetation science on conservation policy development in Europe.

A partire dall’entrata in vigore della Direttiva 92/43/EEC, la sorveglianza dello stato di conservazione degli habitat elencati nell’Allegato I ed il relativo monitoraggio periodico a intervalli di sei anni sono diventati un obbligo per tutti i paesi membri dell’UE, in base a quanto previsto negli Articoli 11 e 17. Nel 2011 è stato pubblicato un documento che fornisce le linee guida di riferimento europee per il monitoraggio di habitat e specie (Evans & Arvela 2011). Su questa base metodologica, la Società Italiana di Scienza della Vegetazione (SISV), avvalendosi di un ampio gruppo di soci esperti, ha avviato un dibattito interno su principi, criteri, parametri e strumenti per il monitoraggio degli habitat di Allegato I e dei tipi di vegetazione in essi rappresentati. Il progetto è stato promosso dal Ministero dell’Ambiente e della Tutela del Territorio e del Mare e coordinato dall’Istituto Superiore per la Protezione e la Ricerca Ambientale, e si trova al momento in una fase prossima alla conclusione. A partire dalla documentazione già prodotta a livello nazionale per gli habitat italiani (Biondi et al., 2009, 2012, 2014; Genovesi et al., 2014), diversi aspetti critici sono stati esaminati attraverso una discussione scientifica ampiamente condivisa. In particolare, sono stati affrontati: gli aspetti legati alla scelta di strumenti adeguati per valutare i parametri area, struttura e funzione, prospettive future; il concetto di "specie tipica"; i metodi di campionamento habitat-specifici appropriati. Il protocollo sviluppato si pone come uno strumento pratico ed efficace, scientificamente valido e in linea con gli standard metodologici internazionali. Il suo utilizzo permetterà una raccolta armonizzata di dati su scala nazionale, rendendo possibile una valutazione comparata dello stato di conservazione di ciascun habitat.

The methodological foundations of the recently published Manual for Annex I Habitats monitoring in Italy, edited by the Italian Institute for Environmental Protection and Research (ISPRA) with the scientific support of the Italian Society for Vegetation Science (SISV), are here presented, discussed and related to the most consolidated and acknowledged scientific advances in the field of Vegetation science. The proposed methodologies aim at offering simple, yet effective, protocols and procedures towards a harmonized data collection, by way of standardized and shared technical tools, resulting in comparable evaluations of the conservation status of Annex I Habitats. The methodological framework was developed by experts including a large team of members of the SISV. Big efforts were deployed to provide indicators and parameters for biodiversity monitoring able to catch its complexity, yet simple enough to be easily measured. Diagnosis and syntaxonomical correspondences of Habitat types, sampling procedure, plot size, distribution mapping, typical species are among the principal issues here examined through a widely shared scientific discussion. The final product is a comprehensive Manual, which offers practical but scientifically sound methodological tools for an efficient and effective monitoring of Annex I Habitats. The importance of bridging across the science-policy interface is emphasized, in a general will to improve the impact of Vegetation science on conservation policy development in Europe.

European tradition on vegetation classification provides an extraordinary legacy for understanding biodiversity. However, this classification lacks explicit data on vegetation attributes, especially if we extend national or regional concepts to a continental perspective. An additional effort for evaluating and characterizing European vegetation types is therefore needed, and the data contained in vegeta­ tion databases are probably the main tool for these purposes. The Braun­Blanquet project is an initiative of the European Vegetation Survey for characterizing veg­ etation alliances across Europe. By analyzing more than 500,000 vegetation plots from 22 European countries, we developed a framework consisting of: (1) evaluat­ ing the consistency and robustness of alliances using the information provided by vegetation plot databases, (2) calibrating assignment rules for classifying, at least partially, the plots not assigned to alliances and (3) characterizing vegeta­ tion types by providing lists of diagnostic species and major distributional pat­ terns. The Braun­Blanquet project represents the first attempt for extrapolating European vegetation information into a comprehensive definition of vegetation types. Furthermore, the outputs of the project are expected to improve biodiver­sity assessment and the conservation management of natural habitats. As a study case, we illustrate how our framework can be used to characterize different forest types across Europe.

In recent years, the scientific community has made significant efforts in order to create geo­referenced vegetation databases (Global Index of Vegetation Plot Databases). These databases are useful to carry out assessments of the state of bio­ diversity, conservation of species and habitats, dispersion of alien species and as a support for the planning of land and protected areas. In this context, Italy has given birth to its own project called VegItaly, coordinated by the Italian Society of Vegetation Science and conducted by several research groups, in order to develop a uniform database for the entire country. Within this framework we have created a georeferenced database of phytosociological relevés of forest vegetation. This work was conducted in three main steps: digitalizing published phytosociological relevés, georeferencing them using indications on their location and topographical features, and updating species nomenclature according to the more recent checklist. In this way, we obtained a database of 5593 georeferenced relevés for insular and penin­ sular Italy. This database was then used to identify and map the main forest com­ munities in the study area. For the classification process we used a finite mixture model that is particularly suitable to this purpose since it is able to integrate in the classificatory process species composition, environmental variables and the spatial distribution of the relevés. The application of this method led to the identification of 20 forest communities that represent the remarkable biological diversity in pen­ insular and insular Italy. This variability is characterized by the presence of central temperate European communities, sub­Mediterranean ones with marked Balkan influences and typically Mediterranean ones. The final step was mapping the poten­ tial distribution of these forest communities using only the environmental variables and validating the map by means of the georeferenced relevés. Results indicate the sub­Mediterranean forest communities being characterized by a lower classification accuracy with respect to the other two macro­typologies. Despite the intrinsic limi­ tations of natural potential vegetation mapping, we believe that our approach can produce maps useful for small­scale landscape planning and nature conservation activities, being based on a replicable and standardized procedure that could be ap­ plied when georeferenced relevés are available.

Linee guida per il monitoraggio dell'habitat 5230*

ASSO Project (Adolescents Surveillance System and Obesity prevention) is a study financed by the Italian Ministry of Health, aimed at developing an innovative web-based system for a standardized collection of data on food consumptions, lifestyles and body size in the adolescents attending high schools. One of the main objectives of the project is to develop user-friendly and cost-effective tools to create a web-based software. A Systematic Literature Review (SLR) on the most valid dietary and physical activity/fitness assessment methods used in the target population has been perfomed. The implementation of the software is being done by using JAVA and the data archive system is based on MySQL database, and a website of the project is being built up (http://www.assoproject.info). The following tools were delivered: informative letter on the project and informed consent of the parents; Standard Operating Procedure (SOP); questionnaires and forms to be embedded within the software. In particular, the questionnaires for the collection of food habits and lifestyle data include an ASSO-PIQ (Personal Information Questionnaire), an ASSOPASAQ (Physical Activity, Smoke and Alcohol Questionnaire) and an ASSO-FHQ (Food Habits Questionnaire). For the food consumption data collection, an ASSO-FFQ (Food Frequency Questionnaire) has been developed on the basis of a SLR on the different European valid and reproducible assessment methods. Even for the fitness measurement tests, a SLR has been carried out on the most valid techniques, in order to develop an ASSO-FTB (Fitness Tests Battery). The teachers will report anthropometric measures (weight, height and waist circumference) and results of the fitness tests on an ASSO-WHFF (Weight, Height and Fitness Form). The delivered ASSO-toolkit will be agreed by the Italian National Research Institute on Food and Nutrition (INRAN), to support the project with a high scientific quality. The establishment of a well-defined surveillance system will help to better understand public health problems related to life habits of the adolescents. It can be an example of good practice delivering a web-based surveillance instrument that allows a cost-effective, timely, updatable and potentially permanent collection of data.

The current standard of care (SoC) for chronic hepatitis C, i.e. the combination of a pegylated-interferon (PEG-IFN) with ribavirin (RBV), may activate underlying autoimmune conditions. Particularly, interferon (IFN) has been known to induce or exacerbate autoimmune hepatitis (AIH) and primary biliary cirrhosis (PBC) in hepatitis C virus patients. We describe a severe, acute-onset antimitochondrial antibody (AMA)-M2 positive AIH appearing during the last weeks of SoC in a woman with chronic hepatitis C and no previous history of autoimmunity, and resolving on protracted steroids. In this context, the relevance of the characterization of the immunoglobulin isotype of portal plasma cells for a more appropriate diagnosis of autoimmune liver diseases can be emphasized.

Eosinophilic gastroenteritis is a rare condition of unknown etiology characterized by eosinophilic infiltration of the bowel. Corticosteroids are the mainstay of EG therapy. Although rare, steroid-resistant EG could be a life-threatening condition with tissue destructive evolution. Associations of eosinophilic gastroenteritis with systemic lupus erythematosus have rarely been reported. In this report we describe a case of successful IVIG treatment in a patient with systemic lupus erythematosus and steroid-refractory eosinophilic gastroenteritis. Eosinophilic gastroenteritis is a rare condition of unknown etiology characterized by eosinophilic infiltration of the bowel. Corticosteroids are the mainstay of EG therapy. Although rare, steroid-resistant EG could be a life-threatening condition with tissue destructive evolution. Associations of eosinophilic gastroenteritis with systemic lupus erythematosus have rarely been reported. In this report we describe a case of successful IVIG treatment in a patient with systemic lupus erythematosus and steroid-refractory eosinophilic gastroenteritis.

A major problem in assessing the likelihood of survival of patients with hepatocellular carcinoma (HCC) arises from a lack of models capable of predicting outcome accurately.To compare the ability of the Italian score (CLIP), the French classification (GRETCH) and the Barcelona (BCLC) staging system in predicting survival in patients with HCC.We included 406 consecutive patients with cirrhosis and HCC. Seventy-eight per cent of patients had hepatitis C. Independent predictors of survival were identified using the Cox model.One-hundred and seventy-eight patients were treated, while 228 were untreated. The observed mortality was 60.1% in treated patients and 84.9% in untreated patients. Among treated patients, albumin, bilirubin and performance status were the only independent variables significantly associated with survival. Mortality was independently predicted by bilirubin, alpha-fetoprotein and portal vein thrombosis in untreated patients. CLIP achieved the best discriminative capacity in the entire HCC cohort and in the advanced untreatable cases, while BCLC was the ablest in predicting survival in treated patients.Overall predictive ability of BCLC, CLIP and GRETCH staging systems was not satisfactory, and was not uniform for treated patients and untreated patients. None of the scoring systems provided confident prediction of survival in individual patients.

European tradition on vegetation classification provides an extraordinary legacy for understanding biodiversity. However, this classification lacks explicit data on vegetation attributes, especially if we extend national or regional concepts to a continental perspective. An additional effort for evaluating and characterizing European vegetation types is therefore needed, and the data contained in vegetation databases are probably the main tool for these purposes. The Braun-Blanquet project is an initiative of the European Vegetation Survey for characterizing vegetation alliances across Europe. By analyzing more than 500, 000 vegetation plots from 22 European countries, we developed a framework consisting of: (1) evaluating the consistency and robustness of alliances using the information provided by vegetation plot databases, (2) calibrating assignment rules for classifying, at least partially, the plots not assigned to alliances and (3) characterizing vegetation types by providing lists of diagnostic species and major distributional patterns. The Braun-Blanquet project represents the first attempt for extrapolating European vegetation information into a comprehensive definition of vegetation types. Furthermore, the outputs of the project are expected to improve biodiversity assessment and the conservation management of natural habitats. As a study case, we illustrate how our framework can be used to characterize different forest types across Europe.

Game-based learning (GBL) refers to different learning methodologies based on the use of games as part of educational strategy in training processes. GBL represents an effective and innovative learning methodology and, in recent years, there has been an increasing interest in the beneficial aspects of using games as learning tools. In fact, in the literature several studies show the effectiveness of these training methodologies in promoting the acquisition of knowledge and skills, both for children and for adults, in a number of areas. In the health sector, GBL strategies are used to support training courses for medical and nursing students. Research literature describes educational programs, for undergraduate and graduate students, which use game-based techniques (especially game-based simulations and role playing) for the acquisition of specific skills in medical and nursing education. The use of game based strategies to support educational programs in the field of continuing medical education is more recent and less frequent. Another recent use of GBL is in health education and health promotion. The purpose of this paper is to explore the most recent and relevant game-based learning methods used in the field of education and training in the health sector. The classification of the different types of games used in specific health contexts will be illustrated, with particular emphasis both on the aspects related to their effectiveness for the acquisition of specific skills, knowledge and competences, and the assessment methodologies.

The purpose of this paper is to describe a computer based triage system which is to be implemented at the Emergency Department of obstetrics and gynecology at the University Hospital "P. Giaccone" in Palermo. Within the hospital there is no existing system of obstetric and gynecologic triage. The number of admissions to the obstetric-gynecologic ward is not high, but the triage system could facilitate and improve the process of patient care planning, by classifying patients who enter the ward. The use of the system will help obstetricians to follow a protocol for the classification of patients, guiding them through an analysis of the parameters needed to assign the appropriate priority to patients. Obstetricians and gynecologists will be trained to use the triage system. We will implement a blended training model. Specifically, there will be an initial training period in which different training methodologies and techniques will be used: active didactic strategies will be introduced/provided, and e-learning and face-to-face learning programs will be integrated. The initial phase of the blended training program will be followed by a phase of training on the job, in which both obstetricians and the gynecologists will be trained directly in their own workplace both on the use of the triage system and on the use of treatment and intervention modalities for specific cases. At the end of the training process the effectiveness of the training model will be measured by evaluating the knowledge and skills acquired for using the triage system, and its impact on improving patient care.

The constant updating of professional knowledge is both an opportunity and an obligation for medical practitioners. In order to ensure a satisfactory level of professional training in Italy, as in other countries, the CME programme was introduced some years ago. Depending on which training models were adopted for CME there was a difference in the level of satisfaction and, in particular, a difference in the level of effectiveness as regards increased knowledge, skills and performance on the part of the health care professionals; evaluation has now begun of the impact of training courses on the quality of treatment and care provided by the National Health Service. This article aims to analyze the most recent training models used in the field of CME, and to assess the principal features which determine their effectiveness. The most commonly used training activities in the last few years have been of a residential nature. However, recent observations have suggested that these types of training activities have proved to be relatively ineffective in modifying professional practices, as they are based on passive types of teaching methods. The last few years have also seen an increase in the number of courses based on distance or blended education. Some experimental training courses have been held which require the participation and active involvement of health care professionals right from the planning phase, with the identification of their training needs. These training courses also envisage a high degree of interactivity and active didactic strategies. Other experimental models which are particularly effective envisage the adoption of complex training paths which develop over a long period of time and which are based on the integrated use of different training techniques, some of which attempt to exploit the well recognized potentials and benefits of ICT for learning purposes. A further element which is becoming particularly important in the planning and carrying out of CME courses is the definition of evaluation systems which provide information about the adequacy of a training project in terms of its impact on improving professional performance and health care.