Emilia-Romagna Region Research Articles

Negative impact of alluvial sediments on physical properties of agricultural soils affected by flooding in May 2023 in Emilia Romagna Region (Northern Italy)

Negative impact of alluvial sediments on physical properties of agricultural soils affected by flooding in May 2023 in Emilia Romagna Region (Northern Italy)

Scaling up integrated care: Can community hospitals be an answer? A multiple-case study from the Emilia-Romagna region in Italy

Integrated care is considered to be essential in improving care for people with chronic conditions who need continuous care. In 2022, the Italian Government asked all regions to build or renovate a massive number of community care facilities, employing European Next Generation funds, to be spent by 2026. Under the theoretical lens of the Structural Contingency Theory, the paper aims at aims at describing the contextual and organizational factors underlying the interconnection between integrated care and community hospitals. The study employs a multiple-case study design, relying both on quantitative and qualitative data, conducted in a 6 months-period. It investigated seven community hospitals belonging to a single Local Health Authority in Emilia-Romagna region in Italy. The choice of the empirical context was driven by Emilia-Romagna's long- and well-established tradition of community-based care. Overall, our analysis shows that community hospitals offers opportunities of integrated care, including better integration between care sectors, between primary care and specialist staff, between healthcare structures and their local community. The study confirms the value of the Structural Contingency Theory and its key message: implementation is not a mechanical step of the policy cycle and requires important adjustments to the planning phase according to environment and organizational factors.

Causes and Impacts of Flood Events in Emilia-Romagna (Italy) in May 2023

On 1–3 May 2023, severe hydro-meteorological events occurred in the Italian Emilia-Romagna region. Such events caused extensive flooding, landslides, isolation of many areas, evacuation of many families, and severe damage to infrastructure, agriculture, buildings, and essential services. Several municipalities were affected, thousands of civilians had to be evacuated, and losses of life occurred. The consequences beyond the recorded immediate impacts on infrastructure and life were impressive, and extended to the regional economy, specifically in the Fruit Valley, where, in addition to immediate yield losses, long-term damage to orchard production is expected due to persistent flooding. The civil and cultural building heritage has also been heavily affected, both in the countryside and in inhabited centers. Some of the damage, direct and indirect, caused by flooding on buildings will also see an evolution in the medium- to long-term that needs to be addressed. This paper analyzes the manifold aspects of such an atmospheric phenomenon and its impacts to understand the potential increasing occurrence of similar events in the climate change context.

Health burden and economic costs of vector-borne diseases in Italy: the AUSL Romagna case

Abstract Introduction Vector-borne diseases (VBDs) are a serious threat for global health, representing around 17% of communicable diseases and more than 700.000 deaths every year. In Europe, and especially in Italy, this is a subject of growing concern, due to the increase of VBDs outbreaks that need vector control plans. Objectives Evaluate the 2013-2022 trend of VBD outbreaks within the AUSL Romagna area (provinces of Ravenna, Rimini, and Forlì-Cesena, in Emilia-Romagna Region, Italy) and the economic impact caused by hospitalizations and local prevention/disinfestation treatments. Methods We used aggregated and anonymized data from 3 informative systems: communicable disease system (SMI) for VBD prevalence; hospital discharge records (SDO) for hospitalizations, with a contribution of the VBD-related Diagnosis Related Groups (DRG); municipality records regarding the cost of dedicated interventions for vector prevention and disinfestation, communicated to the Emilia-Romagna Region. Results For the area of interest, 479 cases of VBDs were notified from 2013 to 2022, with a slight increasing trend over the years. Through hospital SDOs, 252 cases were identified with a diagnosis of VBD, plus 283 with a VBD-related DRG, with a total expenditure of €9.587.777. The distribution was not uniform between the provinces, Ravenna having the highest expense. The municipality records highlighted expenses for €95.443 for prevention and control interventions against mosquitoes, with a very variable trend over the period considered. Forlì had the highest expense. Conclusions VBDs show a highly variable trend and distribution during time, also in relatively small, sub-regional areas. The Emilia-Romagna regional plan against arboviruses, annually updated, can contribute to reduce this specific health and economic burden, lowering transmission among the population and resulting hospital pressure, thanks to prevention and timely interventions. Key messages • The use of information systems enables monitoring of the impact of arboviruses, as well as the related cost for hospital care and local treatments. • Putting in place an effective and updated plan against arboviruses, like the Emilia-Romagna Region one, helps managing VBDs and mitigating economic costs.

Cross-sectoral interventions to promote health-supportive urban environments

Abstract Background As dealing with the complexity of urban living conditions becomes more and more evident and urgent, it is fundamental to promote cross-sectoral interventions that allow cities to become more inclusive and supportive of health. The Emilia-Romagna region, Italy, has promoted a participatory initiative to structurally integrate health into urban planning tools, identifying a framework of tailored urban indicators linked to locally perceived population health issues. Methods Through internal discussion and systematic literature research, a set of urban planners, epidemiologists, and public health experts from regional offices, local health services, universities, and environmental protection agencies identified the urban and health dimensions most suitable for embedding population health into city planning. The result was summarised in a preliminary working paper, which included a matrix of associations between urban features and health dimensions framed according to the DPSEEA framework. Its applicability was then tested in a participatory process (March-May 2024) involving urban planners and public health departments of 7 different sized municipalities. Results A group of epidemiologists identified local-level computable indicators for the health dimensions already included in the matrix or added at request. Each municipality focused on specific topics based on local priorities: 3 groups assessing their already-approved urban plans and looking for computable urban indicators; the others integrating their under-construction plans with local health indicators. Conclusions The need for professional contamination and cross-sectoral interventions is significant. Epidemiological support is pivotal in integrating different professional languages and reading health data. The outputs of this experience will contribute to a technical document outlining how to incorporate health promotion into urban planning tools and practice while actively considering the local context. Key messages • Although the development of a common vocabulary can be difficult, multidisciplinary collaboration is essential in promoting a model for integrating health promotion into urban planning. • Local municipalities’ involvement in the experimentation can improve the model’s applicability by taking into account territorial specificities.

Isolation of Shewanella algae from blue crabs (Callinectes sapidus) in Northwestern Adriatic Sea

Abstract Blue crab (Callinectes sapidus) is one of the last reported invasive species that have colonized the Italian coasts, in particular the lagoons of the northern Adriatic Sea. Their massive presence is compromising shellfish farming, causing a serious economic crisis among the valley populations. To limit the economic damage, blue crabs have been introduced as human food in the Italian markets. This study aimed to evaluate the microbiological contamination of blue crab as potential risk to human health. From July 2023 to April 2024, 72 blue crabs were collected in coastal lagoons and 5-6 nm from the coast of the Emilia Romagna Region. Microbiological analysis revealed Shewanella algae as one of the most commonly identified microorganisms (18/72, 25%). Shewanella was isolated on Chromagar Vibrio™ and TCBS after an enrichment step in Alkaline Saline Peptone Water. Colony morphology, Gram stain, and biochemical tests (oxidase, catalase) sustained Shewanella identification, later confirmed by MALDI-TOF MS (MALDI Biotyper® Sirius, Bruker Daltonics). S. algae is a Gram-negative, rod-shaped, aerobic microorganism widely distributed in seawater, freshwater, and soil. In humans, it is considered an opportunistic pathogen, especially in people with impaired immune systems. Shewanellosis has been strongly associated with seawater exposure and typically arises in hot months. Clinical manifestations include skin and soft tissue infections, otitis media, keratitis, biliary tract infections, vertebral discitis, and bloodstream infections. Notably, in the last years, S. algae infections have increased globally, even in healthy young people. The present study suggests blue crabs as a potential source of S. algae throughout the year. The increasing identification of S. algae in marine waters worldwide, as well as in marine-derived foods like blue crabs, underscores the growing importance of S. algae as an emerging pathogen and its impact on public health. Key messages • Shewanella algae is an opportunistic pathogen, increasingly isolated in marine water and seafood. • Blue crab is an invasive species that has recently conolonised the Italian coasts.

The association between surgical complications and compliance to the World Health Organization Surgical Safety Checklist: A retrospective analysis of hospital records.

The World Health Organization Surgical Safety Checklist (SSC), now used by healthcare providers worldwide, has proved to be useful in the improvement of patients' health through the reduction of mortality and morbidity after surgery. In the Emilia-Romagna region in Italy the SSC is accompanied by a document that registers any non-conformity (NC) identified during SSC completion. This study aimed to investigate the association between surgical complications and checklist compliance, in terms of incompleteness and presence of NCs, using data from the Modena Local Health Unit (LHU). We used data from surgeries performed in the Modena LHU between 2018 and 2022, with their SSC and related NC document. We estimated relative risks (RRs) of complications fitting three modified Poisson regression models. Model 1 included checklist incompleteness and NC presence, Model 2 adjusted Model 1 for patients' sex and age group, and Model 3 adjusted Model 2 for the other potential confounders. We also performed a sensitivity analysis estimating the same three models including death outcomes as complications. We found an increased risk of complications for both checklist incompleteness (unadjusted RR [uRR]= 2.04; 95% confidence interval [CI]: 1.17 to 3.54) and presence of NCs (uRR = 2.35; 95% CI: 1.71 to 3.22). Results were consistent after adjustment and in the sensitivity analysis. Improving checklist compliance can reduce the risk of surgical complications. In particular, NCs are a risk factor that must be further investigated to better understand their relationship with complications. We believe that NCs data recording is helpful for both researchers in the scope of surgical complications, and healthcare professionals in the operating room.

Telemedicine for Outpatients: A Case Study of the First Experience with Diabetic Patients in the Local Health Authority of Modena.

During the COVID-19 pandemic, telemedicine had the opportunity to demonstrate its potential. In Italy, after an initial period of mistrust, it became clear that remote medicine can provide significant benefits for both healthcare professionals and patients. In the Local Health Unit of Modena (Emilia Romagna region, Northern Italy), great importance was placed on developing, promoting, and managing all telemedicine activities. In particular, it was decided to prioritize the activation of tele-visit services in accordance with the guidelines of the Emilia-Romagna region. This case study aims to illustrate the activities planned and developed at the Local Health Authority of Modena for the implementation of the first service of this kind, the tele-visit service for outpatients suffering from type 1 diabetes mellitus, and to analyze data from the first 12 months of activity (from May 2023 to April 2024) to share reflections on the strengths and critical points encountered. For the activation of tele-visits at the Local Health Authority of Modena, a dedicated working group was established with the mandate to manage all clinical, organizational, and IT aspects. Before starting the service, various preliminary activities were carried out, including selecting the clinical specialty to be activated, defining patient inclusion criteria, implementing IT systems, assessing clinical risks, preparing and distributing information materials, training healthcare personnel, and planning outpatient activities. During the first year of experimental activation of the service (May 2023-April 2024), a total of 72 patients were enrolled in the project, with 103 tele-visits provided. The patients were predominantly women (67%), and the most represented age groups were 30-39 (26%) and 40-49 (21%). Half of the specialists in the Diabetology Service (9/19) participated in the initiative by providing tele-visits, most of whom were young and all of whom were women. The main issues identified through regularly scheduled meetings with professionals, to which the working group is seeking the most appropriate solutions, include poor adherence by many patients who still have doubts about this modality, the habit of many patients rescheduling appointments multiple times, a habit not diminished by this visit method, the non-uniform adherence of professionals, and uneven territorial diffusion of the service. Lastly, professionals reported various IT difficulties. Although the number of tele-visits was not high, the initiative has sparked the interest of several specialists, some of whom have already proposed activating other telemedicine services, with some even suggesting innovative new projects. The next steps will involve extending diabetes monitoring to pregnant women with gestational diabetes and developing tele-visit services for endocrinology, neurology, hematology, and gastroenterology. Implementing a tele-visit service in a Local Health Unit is a complex process. A thorough evaluation of the issues that emerged during the development phases and the initial delivery period can help us to act proactively to prevent the failure of future projects. Our evaluations suggest a need to act on two fronts: on one hand, we must organize further activities to promote telemedicine to both patients and healthcare providers, while on the other hand, we must work to resolve IT issues.

Mortality Risk for Individuals With Cocaine Use Disorders: Clients and Non-Clients of Public Treatment Centres for Drug Addiction

BACKGROUND: This study targeted individuals who turned for the first time to health services following problems caused by cocaine use (CUD). Our aim was to estimate mortality risk for individuals who were clients of PATS (public addiction treatment services) and never-PATS (those who were not). METHOD: Follow-up study. People resident in Emilia Romagna Region (Northern Italy), aged 18 years and older who for the first time turned to a HOS (hospital ward), an ED (emergency department), a MHS (community mental health centre) or to a PATS for cocaine use disorder were selected. The reference period was between 01/01/2009 and 31/12/2019 and the territory was the metropolitan area of Bologna. CMR (Crude mortality rates) per 1000 PY (Person Years) and SMRs (standardized mortality ratios) were calculated. RESULTS: The cohort was made up of 3,196 subjects. CMR was 4.5 (95% CI 3.6-6.6) per thousand patient/years, SMRs were 4.3 (95% CI 3.5-5.4). The results highlight high CMRs (5.5, 95% CI 3.8-8.1) and SMRs (4.7, 95% CI 3.2-6.9) for individuals who never accessed PATS. Higher and statistically significant incidence rate ratios were found from the multivariate analysis among females and natives, in patients never accessed to PATS, aged more than 35 years and reporting using alcohol or opioids at first admission. CONCLUSIONS: Innovative strategies to facilitate the reduction of barriers to access and to facilitate taking charge in PATS for people with cocaine use disorders must be identified.

Integration of seasonal frequency domain electromagnetic surveys and geological data for assessing the integrity of earthen levee systems. The case study of the Panaro River (Northern Italy)

Floods rank among the most widespread and destructive natural hazards worldwide. The progressive degradation, impairment, and breach of earthen riverine levees can occur in both natural and anthropogenic environments, stemming from various scenarios or sequences of events. These may include hydraulic failure due to overtopping because of inadequate height, and structural failure occurring even prior to overtopping, due to insufficient geotechnical and hydraulic characteristics combined with external and internal erosion.Following the catastrophic flood of December 2020, caused by the collapse of a section of the levee system of the Panaro River (a tributary of the Po River, Northern Italy), local Authorities initiated a comprehensive investigation into the causes of the breach. Numerous factors, including geological, geomorphological, and ecological features, were found to have contributed to the progressive decrease of the levee integrity prior to and during the flood. This prompted a broader multidisciplinary study of the Panaro River levee system.The study expanded its focus to include the collapsed section (rebuilt in 2020), as well as an additional 30 km stretch of both the right and left levees north of Modena, totaling 60 km. Detailed geological and geophysical data were integrated into the analysis, with particular emphasis on evaluating the characteristics and integrity features of the levee system.This analysis was carried out using Frequency Domain Electromagnetic Methods (FDEM) on the top of the levees, previously calibrated using Electrical Resistivity Tomography (ERT), geological mapping, core logs, and Cone Penetration Tests (CPTs). The FDEM surveys were repeated in different environmental conditions, specifically in the dry 2021 summer season and in the wet 2023 spring season, during heavy rainfalls that caused disastrous floods in several areas of the Emilia-Romagna Region. Out of the 60 km surveyed in the study area, the comparison of the two datasets highlights an interval of about 4 km where the internal portion of the levees is characterized by relatively coarse-grained materials and higher permeability making it more prone to internal erosion phenomena. This paper describes and integrates the results of these investigations, drawing attention to the strengths and limitations of the FDEM method when applied to extensive surveys on earthen riverine levee systems. The proposed methodology contributes as well to maintenance and retrofitting efforts to reduce flood risk in the context of the present climate change scenarios.

Wild birds as potential bioindicators of environmental antimicrobial resistance: A preliminary investigation

Antimicrobial resistance (AMR) is an issue of global concern that includes human, animal, and environmental health. To tackle this phenomenon, a One Health approach is required through the involvement of all these interconnected elements. The environment poses challenges for investigation, but wildlife animals, not directly exposed to antibiotic treatments and interacting with their habitats, can serve as indicators of AMR contamination. Specifically, wild birds could play a significant role in dissemination of AMR, as they can acquire AMR bacteria from wildlife reservoirs and disperse them through environments. This study aims to assess the prevalence of AMR in commensal bacteria isolated from wild birds and their role as bioindicators of environmental AMR. A total of 73 birds belonging to various species were sampled in the Emilia-Romagna region with buccal, cloacal and feather samplings. The samples were cultured on selective media, colonies were identified using MALDI-TOF technology and antimicrobial susceptibility to different drugs was assessed using the Kirby-Bauer method. The birds' data were statistically evaluated in relation to AMR percentages. In total, 117 bacterial strains were isolated, belonging to 23 genera and 46 different bacterial species. The highest non-susceptibility percentages were observed for tetracycline (12.2 %) and enrofloxacin (8.6 %) considering all bacterial isolates, as well as for oxacillin (46.8 %), clindamycin (29.3 %) and rifampicin (20.8 %), among Gram-positive isolates. In the statistical analysis, a higher AMR percentage was correlated with Gram-positive isolates from birds belonging to rural/urban habitat (p = 0.01). Among Gram-positives, a higher oxacillin non-susceptibility percentage was found to be associated with isolates from birds sampled in province of Bologna (p = 0.007), a higher enrofloxacin non-susceptibility percentage revealed an association with rural/urban habitat (p = 0.02), while a higher non-susceptibility percentage towards rifampicin resulted associated with isolates from migratory birds (p = 0.031). In conclusion, this preliminary study suggests a potential role of wild birds as bioindicators for monitoring AMR contamination in the environment.

Autologous Cryopreserved Adipose Tissue Using an Innovative Technique: An In Vitro Biological Characterization

Abstract Background Utilization of autologous adipose tissue transplantation in plastic and orthopedic surgery such as breast reconstruction and intra-articular injection has become an attractive surgical treatment with satisfactory clinical outcomes. Nevertheless, repeated liposuctions necessary to harvest fatty tissue, normally performed with sedation or general anesthesia, may represent a noteworthy concern. Objectives The aim of this study was to demonstrate through an in vitro characterization the validity of the surgical option of cryopreserved autologous adipose tissue harvested in a single shot for repeated graft transfer in breast reconstruction without impairment of cell viability and sterility. Methods Adipose tissue was collected by standard liposuction from patients who needed numerous fat grafting procedures for breast reconstruction. According to an innovative and patented cryopreservation method, autologous adipose tissue was subsequently fractioned in a sterile bag system and frozen at the RER Tissue Bank of the Emilia Romagna Region. Each graft was evaluated for sterility and cell viability immediately after harvesting, and 1, 3, 6, 12, and preliminarily 18 months after cryopreservation and thawing. Results In vitro results showed that after processing, middle-term and long-term cryopreservation, and subsequent thawing, autologous cryopreserved adipose tissue retained absence of bacterial contamination, high cellular viability, and unmodified histomorphological properties, thereby ensuring maintenance of the stromal vascular niche and the filling properties in different multistep surgical procedures. Conclusions In vitro study and sterility assessment showed that autologous cryopreserved adipose tissue grafting is a safe procedure, making it possible to avoid multiple liposuction surgery. No impairment of sterility, cell viability, or morphology was observed over time.

Comparison between Liquid and Tablet Formulations in the Treatment of Congenital Hypothyroidism up to 3 Years of Age: The First Italian Study.

Background/Objectives: Levothyroxine (L-T4) is available for use in congenital hypothyroidism (CH) in three formulations: tablets, drops, and oral solution. This study aims to compare the efficacy and safety of all three L-T4 formulations. Methods: We enrolled 63 children born between January 2019 and April 2023 in the Emilia-Romagna Region (Italy) and diagnosed with CH by newborn screening. They were divided according to the L-T4 formulation used: drops (Group D), oral solution (Group S), and tablets (Group T). Clinical and laboratory data were collected up to 3 years after the start of replacement therapy. Results: Serum-free thyroxine (sFT4) and thyroid stimulating hormone (sTSH) normalization occurred within the first month of treatment in most patients of all groups. No negative effects on growth and cognitive development were observed. At 7-15 days we found higher median sTSH levels (p = 0.031) and a greater percentage of patients with sTSH > 5 µU/mL (p = 0.011) in Group S than in Group T, but comparable sFT4 levels. At 12 months, a greater percentage of patients of Group D showed sFT4 values below the normal range than Group S (p = 0.011) and Group T (p = 0.038); Conclusions: Overall, our study reported an equal efficacy of the L-T4 oral solution compared to drops and tablets in CH treatment. A larger series of patients and a long-term follow-up are needed.

Tax incentives and environmental performance: The pay-as-you-throw policy in Emilia-Romagna, Italy

This study investigates the impact of implementing the pay-as-you-throw policy as a fiscal incentive mechanism for municipal waste management across municipalities in the Emilia-Romagna region, Italy. Utilizing panel data from 2010 to 2022 and employing a synthetic control with staggered treatment adoption, we evaluate the policy's effects on environmental and local public finance performances. Our findings reveal that treated municipalities witness an average 10% increase in separate waste collection alongside a parallel reduction in municipal waste production since the policy outset, equating to approximately 60 kg per capita annually. Furthermore, our analysis indicates that the policy enables local governments to reduce current energy and environmental expenditures by roughly €130 per capita annually in our optimal model. Notably, results hold robust across three recently developed estimators using difference-in-differences with staggered treatment adoption over time. The policy proves overall effectiveness in promoting circularity within municipal waste management systems, leading to better environmental performances, and decreased environmental management expenses. These implications underscore the potential value for local governments to adopt similar strategies where not yet envisaged.

Millets and sorghum as promising alternatives to maize for enhancing climate change adaptation strategies in the Mediterranean Basin

ContextClimate change is increasingly requiring the adoption of both climate-resilient alternative crops and sustainable management practices. Millets and sorghum are increasingly recommended as alternatives to maize in addressing these issues, yet there are no studies comparing the environmental impacts of food-crop millets and sorghum with maize, under sustainable management in Mediterranean area. ObjectiveThe present study examined for the first time the environmental and economic impacts, as well as agronomic performances, of rainfed cultivated proso millet, sorghum and maize over a three-year period under challenging climatic conditions in Emilia-Romagna region, Italy. MethodsDifferent kinds of trials were realized during three years of experimentation in one location in Ravenna province. The first trial aimed to compare proso millet, sorghum and maize agronomical performances and water use efficiency in a low-input system. The second trial aimed to compare soil fertility and biodiversity impacts of two different agronomical management systems (low-input and high input) for the summer crops previously described. Soil basic fertility parameters were monitored and ground dwelling arthropods were collected and analyzed using pitfall traps. The last trial of this study intended to evaluate the environmental and economic performances of the previous cereal crops cultivated in the low-input and high-input systems, applying the Life Cycle Assessment (LCA) and the Life Cycle Costing (LCC) methodologies. ResultsBoth organic sorghum and millet showed high potential as viable summer-crop alternatives, not only to organic maize, based on yield, water use efficiency, disease tolerance and weed competition, but also to conventional maize, based on reduced environmental and economic impacts. Positive land impacts including improved beneficial arthropod abundances and preserved soil fertility were evident under organic management. In fact, the comparative LCA and LCC, carried out with primary data from conventionally cultivated maize and sorghum within central-north Italy and the organic experimental field under investigation, showed that the Global Warming and Eutrophication Potential, were comparable between the organically cultivated crops and significantly lower than conventional maize and sorghum. ConclusionsThe results highlighted the potential of sorghum and millet cultivation as rainfed summer-crop alternative to maize in climate-change context, especially in low-input agronomical systems. In particular, under rainfed, organic management over three years, proso millet yielded consistently. ImplicationsUnder the sustainable practices of the present study, proso millet outperformed maize for yield and WUE stability, as well as potential costs saved, related to the production amount per unit area and potential revenue.

Distribution of honey bee mitochondrial DNA haplotypes in an Italian region where a legislative act is protecting the Apis mellifera ligustica subspecies

The conservation of the genetic integrity of Apis mellifera subspecies has emerged as an important objective. In 2019, the Emilia-Romagna region became the first Italian regional authority to issue a law specifically addressing the protection of the native Apis mellifera ligustica subspecies. In this study we analysed a highly informative portion of the mitochondrial DNA (mtDNA), widely used for assessing genetic diversity of honey bee populations. By analysing 1143 honey bees sampled after the introduction of this law, we provided a snapshot of the distribution of mtDNA haplotypes in this region. The two most frequent mtDNA haplotypes were C1 (characteristic of A. m. ligustica) and C2 (characteristic of A. m. carnica), reported in 86.5% and 11.0% of the analysed bees, respectively. About 1.3% and 1.1% of the analysed bees carried mtDNA haplotypes of the A and M lineages (haplotypes A1a, A1e, A4, A26, A65 and two novel ones, A2w and A6a; M3, M3a, M4 and M79). Continued genetic monitoring will be important to assess the impact of this regional law over the coming years. Based on the obtained results, we recommend a more stringent policy to prevent the erosion of the genetic integrity of the native subspecies A. m. ligustica.

Appropriateness of antibiotic prescribing in paediatrics: retrospective controlled study assessing a multifaceted intervention in Northern Italy in a 7-year period

BackgroundAcademic detailing, audit and feedback, and peer comparison have been advocated as effective ways to promote appropriateness of prescribing and antimicrobial stewardship (AMS). This study explored the effectiveness of a...

Description and validation of Vehicular Emissions from Road Traffic (VERT) 1.0, an R-based framework for estimating road transport emissions from traffic flows

Abstract. VERT (Vehicular Emissions from Road Traffic) is an R package developed to estimate traffic emissions of a wide range of pollutants and greenhouse gases based on traffic estimates and vehicle fleet composition data, following the EMEP/EEA methodology. Compared to other tools available in the literature, VERT is characterised by its ease of use and rapid configuration, while it maintains great flexibility in user input. It is capable of estimating exhaust, non-exhaust, resuspension, and evaporative emissions and is designed to accommodate future updates of available emission factors. In this paper, case studies conducted at both urban and regional scales demonstrate VERT's ability to accurately assess transport emissions. In an urban setting, VERT is integrated with the Lagrangian dispersion model GRAMM–GRAL and provides NOx concentrations in line with observed trends at monitoring stations, especially near traffic hotspots. On a regional scale, VERT simulations provide emission estimates that are highly consistent with the reference inventories for the Emilia-Romagna region (Italy). These findings make VERT a valuable tool for air quality management and traffic emission scenario assessment.

Comparative analysis of conventional and machine learning techniques for rainfall threshold evaluation under complex geological conditions

This research focuses on the essential task of defining rainfall thresholds in regions with complex geological features, specifically at a regional scale. It examines a variety of methodologies, from traditional empirical-statistical methods to cutting-edge machine learning (ML) techniques, for establishing these thresholds. The Emilia-Romagna region in Italy, known for its intricate geological structure and prevalence of weak rocks that often lead to large and deep-seated landslides, serves as the study area. The region’s complex interplay between rainfall and landslide incidences poses a significant challenge in accurately determining rainfall thresholds. The effectiveness of ML methods is compared against conventional empirical-statistical approaches, evaluating factors such as prediction accuracy, model complexity, and the interpretability of results for use by regional landslide warning system operators. The findings indicate that machine learning techniques have an edge over traditional methods, yielding higher performance scores and fewer false positives. Nevertheless, these advancements are modest when considering the increased complexity of ML methods and the incorporation of additional rainfall parameters. This underlines the continued need for improvements in data quality and volume. The study stresses the importance of enhancing data collection and analysis techniques, especially in an era where advanced AI tools are increasingly available, to improve the accuracy of predicting rainfall thresholds for effective landslide warning systems.

Effect of early administration of tetracosactide on mortality and host response in critically ill patients requiring rescue surgery: a sensitivity analysis of the STOPSHOCK phase 3 randomized controlled trial

BackgroundUndifferentiated shock is recognized as a criticality state that is transitional in immune-mediated topology for casual risk of lethal microcirculatory dysfunction. This was a sensitivity analysis of a drug (tetracosactide; TCS10) targeting melanocortin receptors (MCRs) in a phase 3 randomized controlled trial to improve cardiovascular surgical rescue outcome by reversing mortality and hemostatic disorders.MethodsSensitivity analysis was based on a randomized, two-arm, multicenter, double-blind, controlled trial. The Naïve Bayes classifier was performed by density-based sensitivity index for principal strata as proportional hazard model of 30-day surgical risk mortality according to European System for Cardiac Operative Risk Evaluation inputs-outputs in 100 consecutive cases (from August to September 2013 from Emilia Romagna region, Italy). Patients included an agent-based TCS10 group (10 mg, single intravenous bolus before surgery; n = 56) and control group (n = 44) and the association with cytokines, lactate, and bleeding-blood transfusion episodes with the prior-risk log-odds for mortality rate in time-to-event was analyzed.ResultsThirty-day mortality was significantly improved in the TCS10 group vs. control group (0 vs. 8 deaths, P < 0.0001). Baseline levels of interleukin (IL)-6, IL-10, and lactate were associated with bleeding episodes, independent of TCS10 treatment [odds ratio (OR) = 1.90, 95% confidence interval (CI) 1.39–2.79; OR = 1.53, 95%CI 1.17–2.12; and OR = 2.92, 95%CI 1.40–6.66, respectively], while baseline level of Fms-like tyrosine kinase 3 ligand (Flt3L) was associated with lower bleeding rates in TCS10-treated patients (OR = 0.31, 95%CI 0.11–0.90, P = 0.03). For every 8 TCS10-treated patients, 1 bleeding case was avoided. Blood transfusion episodes were significantly reduced in the TCS10 group compared to the control group (OR = 0.32, 95%CI 0.14–0.73, P = 0.01). For every 4 TCS10-treated patients, 1 transfusion case was avoided.ConclusionsSensitivity index underlines the quality target product profile of TCS10 in the runway of emergency casualty care. To introduce the technology readiness level in real-life critically ill patients, further large-scale studies are required.Trial registrationEuropean Union Drug Regulating Authorities Clinical Trials Database (EudraCT Number: 2007-006445-41).