Northeast Italy Research Articles

Effects of COVID-19 pandemic on psychiatric and psychological consultation-liaison contacts in a general hospital in North-East of Italy: a retrospective study

BackgroundThe COVID-19 pandemic has prompted significant changes in healthcare, particularly affecting psychiatric and psychological Consultation-Liaison (CL) services in general hospital settings.AimTo assess the effects of COVID-19-related restrictions on utilization of psychiatric and psychological CL services in Northeast Italy during 2020, and to compare it to the use of services in the previous year (2019).MethodsThe study collected data on psychiatric and psychological consultations in 2019 and 2020 from a hospital database. It categorizes consultations by type of patient (inpatient or outpatient) and referral source (hospital wards, general practitioners, other specialists). Pandemic-related restrictions were classified as “lockdown,” “intermediate restrictions,” and “no or reduced restrictions” based on the Covid Stringency Index (CSI). Poisson regression models were employed to analyze the data.ResultsThe findings reveal a significant 28% increase in the number of psychiatric and psychological consultations in 2020. Consultations for outpatients increased by 51%, while those for inpatients decreased by 11%. However, the lockdown and intermediate restriction phases were deemed responsible of a decrease of 42.9% and 19.5% in consultations respectively.DiscussionThis study highlights the persistent psychological burden during the COVID-19 pandemic, alongside reduced CL services due to lockdown measures. Integrating telemedicine into these types of services becomes imperative for meeting patient needs during restrictions. These findings can inform policies and practices to improve effective mental health care delivery during and beyond pandemics. Future research should explore the impact of pandemic-related restrictions on mental healthcare across settings and clinical factors affecting service accessibility.

Preparedness and Public Health: an Italian Local Health Authority plan for a mass gathering in 2023

Abstract Issue Mass gatherings represent an important Public Health challenge. The increased number of people present in a specific area puts local health systems under stress (i.e.workload of emergency services, environmental health and food safety) and at the same time it rises the risks of a potential mass casualty incident. Effective planning and disaster preparedness have to be achieved through collaboration among local health authorities(LHA) and other stakeholders (event planners, law enforcement, local transportation services). Problem Every year, for 3 days, the Italian Alpine troops gather in a different city to remember First World War fallen. During those days, the city centre transit is not allowed to car (in specific areas even to emergency vehicles).In May 2023 this event occurred in Udine, a city in the North East of Italy with almost 100.000 inhabitants. For that year at least 300.000 participants were expected. LHA had to reorganize preparing itself to manage a temporary quadrupled catchment area. Results In the previous months, local authorities met local health representatives and other stakeholders in order to define a single emergency response plan. For healthcare services it was decided to: institute first aid points within the city; reorganise patients’ emergency transport system; increase hospitals’ treatment capacity (beds, life support equipment); increase healthcare professional availability; empower drugstores (opening times, drugs procurement); strengthen human and animal health surveillances;activate alternative communication systems. During the event, LHA updated other authorities involved three times a day about hospital and emergency system situation. At the end of the event,a multiprofessional debriefing meeting was held and no critical situations were reported. Lessons Preparedness requires a great commitment in terms of resources and time, but it is confirmed to be essential to guarantee adequate assistance even in extraordinary conditions. Key messages • Mass gathering s events put under stress all the main areas of public health system. • Public health preparedness cannot be effective without a strong involvement of other public and private stakeholders.

Community case study for surveillance and early case-detection of SARS-CoV-2 infections across high-risk key populations: the Sentinella programme.

At the beginning of the COVID-19 pandemic, an ad hoc organisational framework was established between academic, local government and community partners to implement the "Sentinella - Identify, Trace and Prevent" screening programme in Verona, north-east Italy. Between September 2020 and May 2021, key populations not covered by any screening policies at the local and national level were screened for SARS-CoV-2. Target populations were: older adult residents (males >65 years and females >75 years), bus and taxi drivers, social workers, supermarket employees, hospital cleaning and catering staff, researchers working in the local hospitals, students, and people experiencing homelessness (PEH). Five dedicated swab clinics, home testing facilities, and one mobile clinic were activated to collect nasopharyngeal swabs. Molecular analysis was performed for all the subjects; an antigen-rapid diagnostic test (Ag-RDT) was also implemented as a point-of-care test for PEH. Medical follow-up, psychological support, and quarantine facilities were organised for subjects who tested positive for SARS-CoV-2. Overall, 2075 subjects participated in the surveillance programme. Amongst these, 1,572 were residents/workers, whilst 503 were PEH. A total of 127 (6.2%) participants tested positive for SARS-CoV-2. Sixty-nine were residents, 58 PEH. The incidence rate was 4 per 10.000 person/day (95% CI 3.1-5.0). The highest prevalence and incidence rates were found amongst supermarket employees (9.7% and 8.5 per 10.000 person/day, 95% CI 3.81-18.86, respectively), followed by hospital cleaning staff (8.1%, 7.6 per 10.000 person/day, CI 95% 4.9-11.7). Regarding PEH, the prevalence of SARS-CoV-2 was 11.5%. All PEH identified as positive were isolated in dedicated shelter facilities. Amongst the 69 residents/workers who were quarantined, 53 were reached for initial psychological support for assessing the presence of any psychological distress or psychiatric pathology. Amongst the subjects evaluated, 10 (18.9%) presented clinically significant psychological discomfort and accessed the stepped-care psychological intervention. The community partnerships played a pivotal role in optimising early case detection. Promotion of testing helped to prevent and contain more efficiently potential clusters through strategic planning, especially for PEH. Insights from the study highlight the importance of community partnerships in public health emergencies, particularly in the context of highly transmissible diseases pathways.

Human Papillomaviruses 16 and 18 E6 Oncoprotein Detection Test in Primary Oropharyngeal Carcinomas and Metastatic Lymph Nodes: A Cross-Sectional Study.

Accuracy in the diagnosis of HPV-associated oropharyngeal carcinoma (OPSCC) of a rapid, low-cost lateral flow immunochromatographic assay for detecting E6 oncoprotein of HPV-16 and HPV-18 was previously evaluated in a small pilot study. This cross-sectional study aimed to assess on a large case series the sensitivity and specificity of E6 oncoprotein as a diagnostic marker for HPV-associated carcinogenesis in OPSCC. 137 consecutive patients with histologically confirmed OPSCC were enrolled in two hospitals in Northeast Italy. HPV status was determined by PCR for HPV DNA and p16INK4a immunohistochemistry on primary tumor biopsies. An OPSCC was defined as HPV-associated when double positive for high-risk HPV-DNA and p16INK4a overexpression in primary lesion. Cytological samples from primary tumors and metastatic lymph nodes were obtained and tested for HPV16/18 E6 oncoproteins using the lateral flow immunochromatographic assay, which requires between 90 and 120 min to provide a result. Diagnostic performances were calculated as percentage with confidence intervals (CI). Of the 137 OPSCC cases, 68 (49.6%) were HPV-associated, testing positive for both high-risk HPV-DNA and p16INK4a, with HPV16 predominating (82.4%). An average waiting time of 22 days was observed to obtain the results of p16INK4a and HPV-DNA after primary lesions biopsy. In patients with HPV16/18-associated OPSCC, the HPV16/18 E6 oncoprotein was detected in 59 out of 60 cytological samples from the primary lesion (sensitivity: 98.3%; 95% CI: 91.1-100%) and in 45 out of 51 cytological samples from lymph node metastases (sensitivity: 88.2%; 95% CI: 76.1-95.6%). The E6 oncoprotein assay showed a specificity of 100% in both primary tumors and lymph node metastases. The low-cost lateral flow immunochromatographic assay for detecting HPV16/18 E6 oncoproteins confirmed high accuracy for identifying HPV-associated OPSCC, particularly in primary tumors, suggesting its potential as a valuable diagnostic tool in clinical practice. Its rapid diagnostic capability could significantly accelerate the process of treatment decision-making, enhancing the timely management of patients.

Pneumonia-Related Hospitalizations among the Elderly: A Retrospective Study in Northeast Italy.

Background: In both the elderly and children, pneumonia remains one of the leading causes of hospitalization. This study aimed to assess the impact of pneumonia-related hospitalizations in the population over 65 years of age in the Veneto Region. Methods: This retrospective study analyzed hospital discharge records for patients aged 65 and older who resided in the Veneto Region and had a diagnosis of pneumonia from 2007 to 2023. The hospitalizations were identified using specific ICD-9-CM codes for pneumonia as a discharge diagnosis. Hospitalization rates, mortality rates, the prevalence of complications and comorbidities, the length of stay, and associated costs were calculated by age and year. Results: From 2007 to 2023, there were 139,201 hospitalizations for pneumonia. Emergency admissions accounted for 92.1% of these cases, and only 2.0% had a specific diagnosis of pneumococcal pneumonia. The median length of stay was 10 days, and the median diagnosis-related group (DRG) tariff per hospitalization was EUR 3307. Excluding the pandemic years, the hospitalization rates remained stable at approximately 850 cases per 100,000 inhabitants before 2019. After 2022, the rates started to increase again. Overall, in the investigated period, the results showed a negative trend (average Annual Percentage Change (AAPC) of -1.931, p < 0.0001). However, when only considering the pre-pandemic years, the trend was stable, while a decline was observed starting in 2020 (AAPC of -19.697, p = 0.001). The overall discharge mortality rates ranged from 13% to 19.3% but were significantly higher in those over 85 years of age (20.6% compared with 6.5% and 12.0% in the 65-74 and 75-84 age groups, respectively). Conclusions: This study highlights the substantial burden of pneumonia in individuals over 65 years of age, showing the impacts on public health.

Media Usage and Adherence to the Mediterranean Diet in Children

Background: Increased screen time in children is significantly associated with lower adherence to the Mediterranean diet (MD). The purpose of this study was to explore the association between different types of media use and the adherence to the MD in children. Methods: The study sample included 332 children aged 10–11 years attending the fifth year of primary school in Veneto, north-east Italy. The children’s mothers were surveyed on their children’s adherence to the MD, using the KidMed questionnaire, and on the time of media use, using the Media Activity Form-Parent (MAF-P). A multivariable backward stepwise linear regression was applied, adjusting the association for other potential confounding factors. Results: Children’s primary digital activities were watching TV or streaming platforms (5.0 h/week) and video content (2.5 h/week), followed by digital games (2.3 h/week). Lower adherence to the Mediterranean diet was associated with digital games (regression coefficient −0.65, SE 0.29, p = 0.026) and time spent watching TV or streaming platforms (regression coefficient −0.60, SE 0.29, p = 0.04). Conclusion: Interventions to promote healthier diets justify an approach that includes media education. Providing parents with recommendations on children’s use of digital media devices can empower them to improve their children’s well-being.

Prevalence, Species Distribution and Resistance of Candidemia in Pediatric and Adult Patients in a Northeast Italy University Hospital.

Candidemia and invasive candidiasis (IC) are causes of morbidity and mortality in healthcare settings, with notable differences between children and adults. Understanding the species distribution and antimicrobial susceptibility profiles of clinical isolates can guide empiric therapy in patients at risk of IC. This study investigated the incidence and antifungal susceptibility patterns of yeasts involved in IC in pediatric and adult patients from 2019 to 2023. The average incidence of IC was 0.715 per 1000 patients, increasing over the study period; infants had the highest incidence rates. Over half of the IC episodes occurred in intensive care units (ICUs). Non-albicans Candida (NAC) species represented the most frequently isolated species in adults and children (55.96% and 50.0%, respectively), with the prevalence of C. parapsilosis (26.45% and 14.7%, respectively), N. glabratus (14.97% and 8.82%, respectively) and C. tropicalis (4.36% and 2.94%, respectively). C. lusitaniae was identified in 14.7% of pediatric IC cases. In NAC species, antifungal resistance has also increased over the five years of the study: 69.12% were resistant to azoles and 7.35% were resistant to micafungin. Resistance was higher in pediatric patients. Our study highlights differences in IC characteristics between pediatric and adult populations and emphasizes the importance of targeted antifungal stewardship in ICU patients with NAC invasive infections.

Interpreting the shifts in forest structure, plant community composition, diversity, and functional identity by using remote sensing-derived wildfire severity

BackgroundWildfires are increasingly impacting ecosystems worldwide especially in temperate dry habitats, often interplaying with other global changes (e.g., alien plant invasions). Understanding the ecological consequences of wildfires is crucial for effective conservation and management strategies. The aim of this study was to investigate the impacts of wildfire severity on plant community (both the canopy trees and herbaceous layer) and alien plant invasion, combining field observations and remotely sensed data.We conducted an observational study in the Karst forests (North-East Italy) 1 year after the large wildfire which affected the area in 2022. We assessed the impact through 35 field plots (200 m2 each) distributed among different fire severity (i.e., the loss of organic matter) classes assessed using the differenced normalized burn ratio (dNBR) calculated from satellite images. In each plot, tree species, diameter, vitality, resprouting capacity, and seedling density were measured. In addition, herb species richness (taxonomical diversity) was quantified, and plant cover was visually estimated. Functional diversity was also assessed considering six functional traits retrieved from databases.ResultsSome woody species (e.g., Quercus pubescens) showed a higher resistance to the fire (i.e., lower mortality rate), while others showed a higher resilience (i.e., recovery after fire through resprouting or seedlings, e.g., Cotinus coggygria). The transition to a shrub-dominated community (i.e., Cotinus coggygria) where fire severity was the highest underlines the dynamic nature of the post-fire succession. We detected a significant variation in the herbaceous plant community composition, diversity, and functional identity (i.e., community-weighted mean of trait) along the fire severity gradient. In particular, high-fire severity areas exhibited higher species richness compared to low-severity or unburned areas. Total alien plant cover increased with fire severity, while native cover remained constant. We also found shifts in species that enhance traits related to germination potential and growth strategy.ConclusionsOur results highlight the vulnerability of the forest stands to an increase in wildfire severity, resulting in significant mortality and changes in tree community structure. This study contributes to the understanding of ecological processes after wildfires using a novel remote sensing approach in a temperate forest, emphasizing the need for conservation strategies aimed at mitigating high severity wildfires.

Transformative Institutions and Capabilities to Aspire in the Context of Radical Uncertainty: Lessons from the Covid-19 Pandemic

ABSTRACT The article addresses the issue of transformative institutions and capabilities to aspire by framing it in the context of the radical uncertainty arising from today's structural crises, which strongly challenge the very ways and possibility of prefiguring a desirable future. Following the reflections of Amartya Sen and Arjun Appadurai, capabilities to aspire are not just an individual matter, as the conditions that enable their development are deeply embedded in social and institutional contexts. The article explains why and in what sense current contexts of uncertainty require transformative institutional dynamics that strengthen the ways in which alternative futures can be imagined and pursued, and what this implies with respect to capabilities to aspire. The analysis refers to the empirical field of the Covid-19 pandemic and in particular to a research study on the community health programme called “Micro-areas” implemented in the north-east of Italy. The case is a paradigmatic example of the relationship between transformative institutional dynamics and capabilities to aspire in contexts of crisis. In the conclusions, the article highlights some institutional factors that emerge as important with respect to the development of capabilities to aspire.

Teledialysis: The First Northeast Italy Experience of Telehealth in Peritoneal Dialysis

Teledialysis: The First Northeast Italy Experience of Telehealth in Peritoneal Dialysis

Habitat Suitability of Ixodes ricinus Ticks Carrying Pathogens in North-East Italy.

Ixodes ricinus ticks are ubiquitous in Europe, including in North-East Italy. These ticks are important vectors of several zoonotic pathogens of public health relevance. In this study, the habitat suitability range of I. ricinus ticks infected with zoonotic pathogens was predicted in North-East Italy, and relevant spatial predictors were identified. In 2015-2021, ticks were collected at 26 sampling sites in the study area. The collected ticks were screened for the presence of pathogens using PCR assays. For Borrelia, Rickettsia and Anaplasma/Ehrlichia species, data allowed for ecological niche modelling using Maxent. Environmental determinants potentially related to tick habitat suitability were used as model inputs. Predicted suitable habitat distributions revealed hotspots of the probability of pathogen presence in I. ricinus ticks mainly in the central and upper parts of the study area. Key environmental predictors were temperature, rainfall and altitude, and vegetation index for specific pathogens (Rickettsia and Anaplasma/Ehrlichia species). Increased risk of exposure to tick-borne pathogens upon tick bites in the predicted hotspot areas can, therefore, be expected. This provides useful information for public health risk managers in this and other similar regions.

Serological Evidence and Self-reported Outcomes in Patients with Adrenal Insufficiency during the First Waves of COVID-19 in North-East Italy.

COVID-19 is a potentially serious new infection first reported in North East Italy in Spring, 2020. Patients with adrenal insufficiency (AI) have a known increased risk of infections that could precipitate to adrenal crisis. Even COVID-19-related psycho-social impact could affect their health, requiring a dynamic adaptation of daily glucocorticoid (GC) therapy. The aim of this study was to evaluate the incidence of COVID-19 infection and self-reported outcomes in AI patients after the first pandemic waves. It was an open-label, cross-sectional monocentric study on 84 (65 primary, 19 secondary) AI patients resident in Veneto and followed-up in our clinical Endocrine Unit. All patients underwent serological investigation of anti-SARS-CoV2 IgG, answered the purpose-built "ADDICOVID" questionnaire in August, 2020, and were re-contacted to reevaluate COVID-19 infection occurrence in March-April, 2021. All patients resulted negative to the serological test for anti-SARS-CoV2 IgG at the end of the first pandemic wave. After the third wave, COVID-19 infection occurred in 8 patients without the need for hospitalization. Half patients felt an increased risk of COVID-19 infection, significantly associated with increased stress and GC stress dose. Only one patient reported stress-correlated adrenal crisis. The majority of AI workers changed working habits, significantly reducing COVID- 19-related stress. AI patients did not show an increased incidence of COVID-19, but the perception of increased COVID-19 infection risk significantly impacted their psychological well-being, working habits, and GC daily doses. Therapeutic patient education is crucial, especially for AI workers, to prevent and treat situations that could lead to an adrenal crisis.

“Every idea made life easier:” A critical discourse analysis of creative employee-driven innovation in the Italian healthcare system

PurposeThe purpose of this study is to scrutinize the connection between creativity and innovation in the context of public healthcare. This is achieved by applying the theoretical concept of employee-driven innovation (EDI) to explore employees’ perceptions of their creative engagement in innovation processes, as well as to capture the managerial implications of setting up such processes in the sector.Design/methodology/approachA critical discourse analysis (CDA) is applied as a methodological lens to capture the interaction between the macro-level production and meso-level distribution of innovation discourse (top-down), and the micro-level perception of, and response to, the same (bottom-up). This study is based on a qualitative approach and is set in the public healthcare system of the Autonomous Province of Trento, Northeast Italy. In total, 26 semi-structured interviews were conducted with 22 healthcare professionals. For triangulation purposes, observation and document analysis were also performed.FindingsThe findings of this study reveal that tensions are present between the macro-level discourses and the meso-level strategies around innovation, and the micro-level perceptions of employees’ creative engagement in innovation processes. Healthcare professionals’ creative efforts are not easily recognized and supported by top management, which in turn does not receive a framework of reference in policies acknowledging the importance of human skills and creativity in innovation processes.Research limitations/implicationsThat this is a single case study implies a limitation on the generalizability of its results, but the results may nevertheless be transferable to similar empirical contexts. Therefore, a multiple case study design would be preferable in future studies in order to study EDI strategies and policies across various types of organizations in the public sector. Moreover, apart from CDA, other theoretical and methodological lenses can be applied to investigate the interaction between top-down organizing and bottom-up responses to innovation.Originality/valueThis study contributes to the EDI literature by providing a more integrative understanding of EDI in the public sector, demonstrating the importance of scrutinizing the interactions between employees and top-level management.

Mapping Forest Growing Stock and Its Current Annual Increment Using Random Forest and Remote Sensing Data in Northeast Italy

The role of forests in providing multiple goods and services has been recognized worldwide. In such a context, reliable spatial predictions of forest attributes such as tree volume and current increment are fundamental for conducting forest monitoring, improving restoration programs, and supporting decision-making processes. This article presents the methodology and the results of the wall-to-wall spatialization of the growing stock volume and the current annual increment measured in 273 plots of data of the Italian National Forest Inventory over an area of more than 3260 km2 in the Friuli Venezia Giulia region (Northeast Italy). To this aim, a random forest model was tested using as predictors 4 spectral indices from Sentinel-2, a high-resolution Canopy Height Model derived from LiDAR, and geo-morphological data. According to the Leave One Out cross-validation procedure, the model for the growing stock shows an R2 and an RMSE% of 0.67 and 41%, respectively. Instead, an R2 of 0.47 and an RMSE% of 57% were obtained for the current annual increment. The validation with an independent dataset further improved the models’ performances, yielding significantly higher R2 values of 0.84 and 0.83 for volume and for increment, respectively. Our results underline a relatively higher importance of LiDAR-derived metrics compared to other covariates in estimating both attributes, as they were even twice as important as vegetation indices for growing stock. Therefore, these metrics are promising for the development of a national LiDAR-based model.

Navigating Improper Care Settings: Nurses' Experiences Assisting Oncological Patients at the End of Life in Surgical Departments.

Despite the growing preference for end-of-life care at home, numerous oncological patients continue to spend their final moments in surgical wards. This incongruity in settings may contribute to "dysthanasia," unnecessarily prolonging futile treatments and resulting in undue suffering. As frontline caregivers, nurses frequently bear the brunt of these challenging situations for patients and their families. To investigate the experiences of nurses providing care to terminally ill oncological patients inappropriately admitted to surgical departments. We adopted a phenomenological descriptive study. Nurses purposefully selected from 7 distinct surgical units at a University Hospital in Northeast Italy were recruited. Data collection took place through open-ended semistructured interviews. The interview content was analyzed using Colaizzi's framework. The study with 26 participants revealed emotional challenges, especially for less-experienced nurses. Diverse perspectives among nurses emphasized the need for better palliative care knowledge. Despite the commitment to quality care, collaboration challenges and discordant goals with physicians impacted comprehensive care delivery. Dysthanasia relates to participants' challenges in caring for oncological patients in inappropriate settings, hindering transparent communication and exacerbating discordance with doctors. Communication and collaboration among healthcare professionals, particularly nurses, and surgeons are crucial. Ongoing education in end-of-life care, coupled with advance care planning, empowers patients, aligns treatment choices, and prevents dysthanasia across diverse healthcare settings.

Investigating the Hepatitis E Virus (HEV) Diversity in Rat Reservoirs from Northern Italy.

Hepatitis E virus belonging to the Rocahepevirus ratti species, genotype HEV-C1, has been extensively reported in rats in Europe, Asia and North America. Recently, human cases of hepatitis associated with HEV-C1 infection have been reported, but the zoonotic nature of rat-HEV remains controversial. The transmission route of rat-HEV is unidentified and requires further investigation. The HEV strains of the Paslahepevirus balayani species, belonging to the same Hepeviridae family, and including the zoonotic genotype HEV-3 usually found in pigs, have also sporadically been identified in rats. We sampled 115 rats (liver, lung, feces) between 2020 and 2023 in Northeast Italy and the HEV detection was carried out by using Reverse Transcription PCR. HEV RNA was detected in 3/115 (2.6%) rats who tested positive for HEV-C1 strains in paired lung, intestinal contents and liver samples. Overall, none tested positive for the Paslahepevirus balayani strains. In conclusion, our results confirm the presence of HEV-rat in Italy with a prevalence similar to previous studies but show that there is a wide heterogeneity of strains in circulation. The detection of HEV-C1 genotype of Rocahepevirus ratti species in some human cases of acute hepatitis suggests that HEV-C1 may be an underestimated source of human infections. This finding, with the geographically widespread detection of HEV-C1 in rats, raises questions about the role of rats as hosts for both HEV-C1 and HEV-3 and the possibility of zoonotic transmission.

An alternative approach for the sediment control of in-channel stony debris flows with an application to the case study of Ru Secco Creek (Venetian Dolomites, Northeast Italy)

Controlling sediment to reduce debris-flow hazard is generally approached using retention basins that can be closed or have an outlet structure, generally an open check dam. They are usually placed in mild slope zones that allow minimal works for the excavation and the foundation of the outlet structure if present. Recently, it has been shown that the detention of sediments can also be achieved in the high-sloping reaches of debris-flow channels using deposition areas, basins that are open on the downstream side. In this work, we propose an approach for controlling the sediment volume transported by debris flows consisting of a cascade of deposition areas and retention basins. We also include a framework for planning, sizing, and checking the works. Two scenarios are considered, corresponding to the maximum values of the debris-flow peak discharge and volume, respectively. Moreover, the presence or absence of boulders is also considered. For this purpose, a method that evaluates the clogging of a single open check dam as a function of the coarse fraction of the sediment volume is simply extended to the case of multiple dams and implemented in a routing model. The proposed approach is applied along Ru Secco Creek in northeast Italy to defend a resort area and a village hit by a high-magnitude debris flow in 2015. After a careful survey and study, a solution with a combination of deposition areas and retention basins is planned and sized. The validity and performance of the proposed solution are analyzed using debris-flow modeling for two scenarios, considering both the absence and presence of boulders. Most of the sediment volume transported by debris flows is trapped, and a small solid discharge flows downstream of the works.

Digitisation as a tool to enhance learning processes and organisational knowledge in Social Services. First results from a qualitative study conducted in the North East of Italy

Digitisation as a tool to enhance learning processes and organisational knowledge in Social Services. First results from a qualitative study conducted in the North East of Italy

Incidence, healthcare resource utilization and costs of hospitalized patients with tick-borne encephalitis (TBE) in Italy

ObjectiveOur study's objective was to assess the incidence trends and healthcare resource utilization of hospitalizations for Tick-Borne Encephalitis (TBE) and associated costs in Italy in order to improve public awareness and preventive measures. MethodsThis retrospective observational study was based on the Italian Ministry of Health's Hospital Discharge Record (HDR) database. Data were gathered across Italy from 2015 to 2019, selecting hospitalizations with ICD-9 code 063 related to TBE, both in primary and secondary diagnoses. For each year, we collected the following variables: number of hospitalizations, hospitalization rate, mortality rate, mean length of hospital stay, hospital ward, and cost of hospitalization. ResultsThere were a total of 237 hospitalizations from 2015 to 2019; 62 % of those were male. The lowest number of TBE hospitalizations was in 2015 (21 cases, corresponding to 0.35 per million inhabitants), the highest in 2019 (64 cases, 1.04 per million inhabitants). The summer months saw a greater than average number of hospitalizations. For the years analyzed, the cumulative number of cases peaked in June (54 cases), July (46 cases), and August (35 cases). There were only two deaths registered in our study sample. TBE cases were mostly localized in the North-Eastern regions of Italy. TBE incidence during the study period in the most affected areas were: Autonomous Province of Trento, ranging from 11.2 to 42.3 per million inhabitants, Autonomous Province of South Tyrol, from 0 to 21.1 per million inhabitants, and Veneto Region, from 2.6 to 4.5 per million inhabitants. In the study period, the average length of hospital stay was largely stable ranging from 10.6 days to 12.8 days, with related costs ranging from 5,813.7 € to 7,352.5 €. ConclusionsAccording to our data, the majority of TBE hospitalizations occur in North-East Italy with an increasing trend over the analyzed period. Even though Italy has fewer TBE cases than other neighboring European countries, the health and economic impact can be high in the affected areas.

Multi-Objective Optimization of an Energy Community Powered by a Distributed Polygeneration System

This paper presents a multi-objective optimization model for the integration of polygeneration systems into energy communities (ECs), by analyzing a case study. The concept of ECs is increasingly seen as beneficial for reducing global energy consumption and greenhouse gas emissions. Polygeneration systems have the potential to play a crucial role in this context, since they are known for producing multiple energy services from a single energy resource, besides the possibility of being fed also by renewable energy sources. However, optimizing the configuration and operation of these systems within ECs presents complex challenges due to the variety of technologies involved, their interactions, and the dynamic behavior of buildings. Therefore, the aim of this work is developing a mathematical model using a mixed integer linear programming (MILP) algorithm to optimally design and operate polygeneration systems integrated into ECs. The model is applied to a case study of an EC comprising nine buildings in a small city in the northeast of Italy. The work rests on the single- and multi-objective optimization of the polygeneration systems taking into account the sharing of electricity among the buildings (both self-produced and/or the purchased from the grid), as well as the sharing of heating and cooling between the buildings through a district heating and cooling network (DHCN). The main results from the EC case study show the possibility of reducing the total annual CO2 emissions by around 24.3% (about 1.72 kt CO2/year) while increasing the total annual costs by 1.9% (about 0.09 M€/year) or reducing the total annual costs by 31.9% (about 1.47 M€/year) while increasing the total annual CO2 emissions by 2.2% (about 0.16 kt CO2/year). The work developed within this research can be adapted to different case studies, such as in the residential–commercial buildings and industrial sectors. Therefore, the model resulting from this work constitutes an effective tool to optimally design and operate polygeneration systems integrated into ECs.