Tuscany Region Of Italy Research Articles

Media and Natural Disasters: Organising Storytelling in the Age of Climate Change

Starting on 2 November 2023, some territories in the Region of Tuscany in Italy were hit by exceptionally intense meteorological and calamitous events. The Region of Tuscany’s government was immediately at the forefront of relief, assisting the population, and aiding restoration. On 3 November, a national state of emergency was declared due to flooding. Journalistic communication is an essential aspect of disaster mitigation, preparedness, response and recovery. In terms of protecting people and reducing damage, journalists and the media have an important role to play. This article reports an Italian case study analysing the behaviour of local media in cases of natural disaster. Nine focus groups were conducted with local journalists covering the flood emergency. The results highlight the role of social and institutional mediation, rather than mere dissemination, played by the local press in emergency situations, a central element in the construction of a community bond, precisely in moments of insecurity and disorientation. The narration of a disaster from the inside seems to have allowed the emergence and representation of hitherto unknown social realities in Tuscany. The goal of the news coverage was widened, making it possible to respond better to the diverse interests of the reading public and to satisfy in a short time and exhaustively the information needs of individual communities in difficulty.

Procurement of devices for pulsed-field ablation of paroxysmal atrial fibrillation: the experience of the Tuscany region in Italy

In this Health Policy article, we describe the experience conducted in Italy in the Tuscany region to implement an appropriate management of the devices available for pulsed-field ablation of paroxysmal atrial fibrillation. For patients who do not respond to pharmacological treatment, ablation techniques have long been a recognized therapeutic standard. Radiofrequency ablation and cryoballoon ablation (both referred to as thermal ablation options) were the first two techniques made available for this therapeutic indication. More recently, pulsed-field ablation has been developed as a means of achieving the same clinical result without any thermal intervention; iIn fact, thermal techniques are more often involved in determining local tissue damages. In 2024, there are already three different devices available to perform pulsed/field ablation, thus minimizing the risk of thermal damage to local tissues. These three devices include Farawave (from Boston), PulseSelect (from Medtronic), and Varipulse (from Johnson & Johnson). Our paper reports on the technical characteristics of these three devices and the available clinical evidence on their effectiveness. The clinical studies for Farawave (the first device developed in 2021) are more numerous than those for PulseSelect and Varipulse, whose development is much more recent. Epidemiological data from the entire region were analysed to determine the total number of the three devices needed by our hospitals on an annual basis. These regional data were interpreted in comparison with the national consumption of these devices. In conclusion, the main strength of the experience described here is that the principles of HTA have been successfully applied in daily practice. For more than 5 years, this policy has been applied in our Centro Operativo in the management of about 80 devices classified as class IIb, III or active implantable.

Patient-reported measures for integrated care assessment: interprofessional collaboration, self-care and outcomes.

Chronicity is spreading and rapidly becoming a urgent issue also for the complexity of care. 32.2 million of NCD deaths (80%) are due to chronic diseases (1). Every country has been developing strategies to guarantee assistance to chronic patients while ensuring the sustainability of the system. Interprofessional collaboration is among the features to improve the assistance for chronic patients and to reach coordination, appropriateness, and continuity along the care pathways (2,3). Data collection on this topic is still scarce, especially from the point of view of patients themselves. Patient Reported Outcome and Experience Measures (PROMs and PREMs) collected in an integrated way can help in understanding the relationship of experience and outcome along the patient care pathway, thus providing a complete vision of the quality and integration of care from the patient perspective (4).
 This work aims at reporting some preliminary results about the impact of interprofessional collaboration on the health outcomes and self-care capacity of chronic heart failure (CHF) patients. 
 Data from the Observatory on PROMs and PREMs of the Tuscany Region in Italy will be used to explore the hypothesis that interprofessional collaboration can lead to better self-care and outcome scores as reported by patients. The selected sample replied to four questionnaires: one at discharge by the hospital, a first follow-up after 30 days; a second follow-up after 7 months; a final follow-up after 12 months (5). Average scores and deltas for the KCCQ-12 and the SCHFI scales will be used to detect potential differences between patients’ self-care, health status and quality of care according to the reported level of integration between the general practitioner and the specialist.
 132 responses were valid to be analysed. At baseline, 23% of patients declared that their GP and their specialist were in contact to take care of the care pathway, 15% declared they did not know. Differences between scores are not significant for the KCCQ-12 on health status and quality of life. A weak difference emerged for the Self-care Maintenance about daily lifestyle adherence. 
 Further research should be conducted on this topic to understand if these results are linked to a scarce knowledge of patients with respect to the joint work of GPs and specialists or if the interprofessional collaboration is not sufficient to guarantee an improvement of outcomes, at least for CHF patients. Indeed, the same analyses could be repeated on other two chronic populations (e.g. diabetic and IBD patients) which are providing their data that will be available next year.
 
 1.2018. “NCD Countdown 2030: Worldwide Trends in NCD Mortality and Progress towards Sustainable Development Goal Target 3.4.” Lancet 
 2.Pascucci2021. “Impact of Interprofessional Collaboration on Chronic Disease Management.” Health Policy 
 3.Davidson2022. “What Do Patients Experience? Interprofessional Collaborative Practice for Chronic Conditions in Primary Care” BMC Primary Care
 4.Pennucci“Can the Jointly Collection of PROMs and PREMs Improve Integrated Care?” IJIC
 5.Pennucci“Piloting a Web-Based Systematic Collection and Reporting of PROMs/PREMs in Chronic Heart Failure.” BMJ Open

Estimating the global production and consumption-based water footprint of a regional economy

The current scenario of increasing use and pollution of water resources and the effects of climate change on natural supply coexist with a high trade interconnection, where impacts are transmitted from local to global scales. Identifying and quantifying these impacts is essential to focus and coordinate policies for sustainability. In this context, this study develops a methodology to estimate the pressures of a regional economy on global water resources. Unlike previous studies, which have focused mainly on the regional and national blue water footprint (WF) of consumption, the proposed framework integrates in an innovative way: i) an estimation of the global green, blue and grey WF, ii) a comparison between production and consumption-based approaches, iii) a spatial disaggregation, and iv) a scarcity-based assessment. Specifically, a regional input-output (IO) model and a global multiregional IO model are used, which allows identifying the origin and quantifying the water incorporated in imports. The Tuscany region in Italy is considered as a case study, where the domestic WF has been studied, but global impacts on water resources are unknown. The results show that, although 42.7 % of Tuscany's imports come from outside Italy, the pressures on water resources exerted abroad represent 81.2 % (production) and 73.4 % (consumption) of total. This result is amplified when only water incorporated under scarcity conditions is considered, reaching 96.3 % (production) and 94.6 % (consumption). The proposed approach allows characterizing the most significant impacts, which could guide policies to promote the consumption and import of products with low water incorporated under stress conditions.

Visceral larva Migrans in a Young Italian Patient: A Diagnostic Dilemma

BackgroundThe association of fever, focal hepatic lesions and peripheral hyper-eosinophilia (FHLH) can be observed in both infectious and non-infectious conditions. Fascioliasis, capillariasis, toxocariasis, all causes of visceral larva migrans (VLM), represent most of the former, whilst lymphomas, eosinophilic leukemias and mastocytosis belong in the non-infectious conditions.MethodsWe prospectively followed a young patient presenting with FHLH in the Tuscany region of Italy.ResultsThe patient was subject to serological and parasitological examination in an attempt to clarify the origin of the lesions. Serologies for both Fasciola hepatica and Toxocara spp. were positive, with the latter presenting a higher index. We opted for treatment with a prolonged course of albendazole due to the serological results and being toxocariasis more frequent in our setting. The patient was then subject to radiological follow-up. The patient responded to treatment with albendazole as shown by a decrease in eosinophils, seronegativization for Toxocara spp., clinical and radiological improvement. Toxocariasis was hence considered the most likely diagnosis.ConclusionsParasitic infections cannot be disregarded in the presence of FHLH. Differential diagnosis between these parasitic infections can be challenging due to the presence of similar clinical presentations and serological cross-reactions, and follow-up of the patient is needed to ensure optimal treatment outcomes.

Development of a waste tires-based integrated energy system for multiple useful outputs in sustainable communities

In this study, a geothermal energy-supported integrated gasification system fed with waste tires for multigenerational purposes is developed to generate multiple useful commodities, including ethanol, sulfuric acid, hydrogen, electricity, cooling, and heat to achieve cleaner applications and meet the essential needs of the community in a sustainable manner. A potential application of this conceptually designed system is for a community identified in the Tuscany region of Italy's Larderello field. The proposed system is then analyzed and assessed by utilizing sensitive the thermodynamic simulations and software. The effects of operational and state-related parameters, such as steam, oxygen, waste tire input rate, reference temperature, and gasifier temperature are examined to analyse and evaluate the integrated waste tire gasification system's performance. The present study further aims to determine the effects of varying system parameters and operating circumstances on the ethanol and hydrogen production rates, with the goal of increasing energy and exergy efficiencies while minimizing hazardous wastes and gas emissions. Furthermore, numerous parametric studies on the waste tire-powered multigeneration system are undertaken accordingly. Both Engineering Equation Solver (EES) and Aspen Plus software packages are utilized as potential tools to perform analysis andsimulation studiesfor this system. The proposed system is fed with 10 kg/s of waste tires, and the energy production is supported by using 14.7 kg/s of geothermal spring water. While the net electricity generation, cooling and heating capacities of this system are obtained to be 18752 kW, 49236 kW and 5363 kW, respectively, while the total hydrogen and ethanol production rates within the integrated system are found to be 3.02 kg/s and 0.13 kg/s. The results also show that the waste tire-based integrated gasification system's overall energetic and exergetic efficiencies become 71.45 % and 69.87 %, respectively.

Changes in Acute Myocardial Infarction, Stroke, and Heart Failure Hospitalizations During COVID-19 Pandemic in Tuscany-An Interrupted Time Series Study.

Objectives: We evaluate the impact of the COVID-19 pandemic on unplanned hospitalization rates for patients without COVID-19, including their length of stay, and in-hospital mortality, overall, and for acute myocardial infarction (AMI), stroke, and heart failure in the Tuscany region of Italy. Methods: We carried out a population-based controlled interrupted time series study using segmented linear regression with an autoregressive error term based on admissions data from all public hospitals in Tuscany. The primary outcome measure was weekly hospitalization rates; secondary outcomes included length of stay, and in-hospital mortality. Results: The implementation of the pandemic-related mitigation measures and fear of infection was associated with large decreases in inpatient hospitalization rates overall (−182 [−234, −130]), unplanned hospitalization (−39 [−51, −26]), and for AMI (−1.32 [−1.98, −0.66]), stroke (−1.51 [−2.56, −0.44]), and heart failure (−8.7 [−11.1, −6.3]). Average length of stay and percent in-hospital mortality for select acute medical conditions did not change significantly. Conclusion: In Tuscany, Italy, the COVID-19 pandemic was associated with large reductions in hospitalization rates overall, as well as for heart failure, and the time sensitive conditions of AMI and stroke during the months January to July 2020.

Relationship Between Price and Diagnosis-Related Group Tariff for Medical Devices Assessed by a Regional Health Technology Assessment Committee

IntroductionMedical devices (MDs) make up an important share of total in-hospital expenditure. At the level of individual patients, this share is represented by the ratio of the cost of MD incurred by the patient vs. the total cost of in-hospital care for the same patient. If tariffs rather than costs are considered, the denominator of this ratio is given by the diagnosis-related group (DRG) and the ratio is the cost of MD over DRG tariff. The objective of this paper is to present a retrospective analysis comparing the ratio of price vs. DRG tariff for a group of devices belonging to risk class III or active implantable. These devices are those assessed in the years 2020 and 2021 by two committees of the Tuscany region in Italy.Materials and methodsThe information on price and DRG was taken from the health technology assessment (HTA) reports concerning MDs evaluated by the two above-mentioned regional committees in the years 2020 and 2021. In these reports, the information on the cost-effectiveness ratio was reported for a subset of MDs. In all cases, a preliminary qualitative assessment was carried out to determine the presence or absence of a healthcare impact in the post-discharge phase. In these preliminary analyses, the perspective of NHS was adopted.ResultsOur analysis was focused on 24 devices of either class III or active implantable. According to our results, a wide variability was found in the ratios between device price and DRG associated with its use. This ratio ranged from a minimum of about 3% in the case of the Hyalobarrier gel (Nordic Pharma GmbH, Zürich, Switzerland) for post-surgical adhesion to a maximum of 132% in the case of the Neovasc Reducer (EPS Vascular AB, Viken, Sweden), a device indicated in the narrowed coronary sinus. Three devices, i.e., PuraStat (3-D Matrix, Ltd., Tokyo, Japan), Ascyrus Medical Dissection Stent (AMDS, CryoLife, Inc., Kennesaw, GA), and Tendyne (Abbott Cardiovascular, Plymouth, MN), were found to be priced more than the reimbursement tariff (i.e., ratio > 100%). Ratios between 50% and 100% were found in about half of the devices. From our preliminary assessment on the presence of a post-discharge impact, 15 devices out of 24 (62%) were found to determine a substantial impact, while the remaining nine (38%) did not. In general, when costs and benefits of a device do not extend beyond the patients’ discharge, the presence of a ratio > 100% reliably suggests the conclusion that the device price needs to be reduced and/or the tariff needs to be increased. On the other hand, in cases where the device extends its impact beyond the patient’s hospital stay, the decision of reducing price or increasing tariff becomes more complex, and so these adjustments cannot be determined unless more information on some critical aspects is made available.ConclusionsUntil the above-mentioned improvements do not take place, rational interventions on DRG are virtually unfeasible owing to this lack of critical information. On the other hand, it is also difficult to intervene on device prices, again owing to the lack of critical information.

Implementation of a centralized HPV-based cervical cancer screening programme in Tuscany: First round results and comparison with the foregoing Pap-based screening programme.

To evaluate performance of the first round of HPV-based screening in Tuscany region and compare it with the prior round of Pap-based screening. Tuscany region of Italy, where HPV-based cervical cancer screening started in 2013, with a strong level of centralization screening tests at the Regional Laboratory for Cancer Prevention (ISPRO). The transition from Pap- to HPV-based screening was initiated for older women and at 3 out of 12 Tuscany Local Health Units (LHUs). Data from the Florence and Grosseto LHUs (about 300,000 women) were analysed and performance screening indicators estimated. HPV-based indicators recorded good performance, with increased compliance vs. the Pap-based programme. We registered a substantial decrease in waiting times from sampling to test reporting, probably related to the centralization strategy. Since the screening protocol was the same and conducted at a single laboratory, we could hypothesize that the difference in HPV positivity (6.8% in Florence vs. 8.4% in Grosseto) was due to a real difference in HPV prevalence among women of the two LHUs. The transition to HPV-based screening led to a significant increase both in colposcopy referral rate (4.3% vs. 1.2%) and CIN2+ detection rate (8.3‰ vs. 3.4‰). HPV-based is more effective in detecting high-grade precancerous and cancerous lesions than Pap-based screening and is characterized by an "anticipatory effect" in the detection of CIN2+ lesions. The transition from Pap-based to HPV-based screening programme should include increased resources dedicated to colposcopy services. Centralization in a laboratory with long experience in this field promotes efficiency of the screening process.

A Deep Learning Approach for Change Points Detection in InSAR Time Series

Interferometric SAR (InSAR) algorithms exploit synthetic aperture radar (SAR) images to estimate ground displacements, which are updated at each new satellite acquisition, over wide areas. The analysis of the resulting time series finds its application, among others, in monitoring tasks regarding seismic faults, subsidence, landslides, and urban structures, for which an accurate and timely response is required. Typical analyses consist of identifying among the numerous time series the ones that exhibit an anomalous displacement, thus deserving to be further investigated. In practice, this is realized by selecting the time series that is characterized by trend changes w.r.t. the historical behavior. In this work, we propose a deep learning approach for change point detection in the InSAR time series. The designed architecture combines long short-term memory (LSTM) cells, to model the temporal correlation among samples in the input time series, and time-gated LSTM (TGLSTM) cells, to consider the sampling rate as additional information during learning. We further propose a solution to the lack of ground truth by developing a suitable pipeline for realistic data simulation. The method has been developed and validated through a large suite of experiments. Both quantitative and qualitative analyses have been conducted to demonstrate the detection capabilities of the learned model and how it is a valid alternative to the statistical reference algorithm. We further applied the developed method in a real continuous monitoring project to analyze the InSAR time series over the Tuscany region in Italy, proving its effectiveness in the real domain.

From European forestry strategies to implementing local policies: a study on public forest workers in the Tuscany region of Italy

Even though forests represent almost half of the EU territory, the implementation of forestry strategies is delegated to local government institutions. This study proposes an overview of the main European forestry strategies, national (Italian) guidelines and local implementation instruments (in Tuscany). This approach made it possible to identify the actual executors of forestry policies, i.e., the public forest workers. The paper provides a framework of the recent dynamics of regional forestry instruments, their effects on available financial resources and their technicaloperational consequences. Furthermore, Tuscan public forest worker profiles were defined through an online questionnaire. The results show that it is essential to activate constant monitoring of local actions in order to verify the effectiveness of superordinate forestry policies.

A Data-driven approach to renewable energy source planning at regional level

ABSTRACT A correlation analysis based on Markowitz Portfolio Theory and data from meteorological station are used to develop a decision-making tool for the optimal spatial installation of renewable energy sources from Wind turbines and PV panels. A case study involving power generation plants and weather stations in the region of Tuscany in Italy is developed. The results show that temporal correlations of solar and wind generation profiles are characterized by correlation and anticorrelation. This feature is used for supporting decision-making on investments in renewable energy at the territorial level.

P651 Diagnostic delay, effectiveness and safety outcomes in a real-world cohort of patients with Crohn’s disease: data from administrative databases in Tuscany, Italy

Abstract Background Diagnostic delay (DD) of Crohn’s disease (CD) is poorly investigated in the real-world setting, and could affect significantly the outcome of CD. The aim of the present study was to quantify the possible DD of CD in CD patients in Tuscany region of Italy, evaluating effectiveness and safety outcomes in CD patients with DD. Methods We conducted a retrospective cohort study on data extracted from administrative databases of Tuscany. We included patients >18 years old (yo) with a record of ICD-9 diagnosis for CD or disease exemption or a dispensation of oral budesonide from 6/1/2011 to 6/30/2016 (index date, ID) whichever came first. Patients with a look-back period (time before ID) < 5 y and follow-up (FUP) < 3 y were excluded. Patients with at least one Emergency Department (ED) access or hospitalisation for gastrointestinal causes in the lookback period (excluding 6 months before ID) could have a possible DD. DD was classified in short (up to 18 months) and long (up to 60 months). We performed survival analyses (Kaplan-Meier curves) for effectiveness (time free from the first: dispensation of azathioprine, biologic drug and ileocecal resection surgery) and safety outcomes (time free from first: ED access and/or hospitalization for any cause). Hazard ratio (HR) was calculated by using Cox models adjusted for age, gender and number of concomitant drugs in the month before ID. Both outcomes were evaluated for dichotomous (No DD and DD) and categorical variables of DD (No DD, short DD and long DD). Results Among 3342 CD patients, 584 (17,5%) had a suspected DD: 212 and 372 patients had short and long DD, respectively, p<0.001. The effectiveness analysis revealed that about the 20% of patients with long DD were treated with a biologic within 3 years, as compared with those with short DD or no DD (10%), p=0.0007. The adjusted (a)HR for biologic drug was 1.30 (Confidence Interval, CI 95%: 1.12–1.56) for patients with long DD and 1.02 (CI 95%:0.82–1.30) for those with short DD. No significant aHRs were found for the other effectiveness outcomes. The safety analysis showed that 75% of patients with DD had first ED access or hospitalization for any causes with the FUP, as compared with those without (about 60%), p<0.001. The aHR showed an increased risk for safety outcomes in patients with DD: 1.71 (CI 95%:1.61–1.91) for the ED accesses, 1.31 (CI 95%:1.19–1.49) for hospitalization, and 1.54 (CI 95%:1.41–1.71) for the composite outcome. Conclusion More than 17% of patients had a putative DD (mostly long DD). A risk of treatment with biologic drug, ED accesses and hospitalizations for any cause was found for patients with DD compared with those timely diagnosed.

Prolonged care delivery time and reduced rate of electrophysiological procedures during the lockdown period due to Covid-19 outbreak

ABSTRACT Objectives The aim of this study is to demonstrate how Electrophysiology activity has been impacted by the pandemic Coronavirus disease 2019 (COVID-19). Methods In this multicenter retrospective study, we analyze all consecutive patients admitted for electrophysiological procedures during the COVID-19 lockdown in the Tuscany region of Italy, comparing them to patients hospitalized in the corresponding period of the previous year. Results The impact of COVID-19 on cardiac arrhythmia management was impressive, with a reduction of more than 50% in all kinds of procedures. A gender gap was observed, with a more relevant reduction for female patients. Arrhythmic urgencies requiring a device implant showed a reduced time from symptoms to first medical contact but the time from first medical contact to procedure was significantly prolonged. Conclusion Hospitals need to consider how outbreaks may affect health systems beyond the immediate infection. Routine activity should be based on a risk assessment between the prompt performance of procedure and its postponement. Retrospective observational analysis such as this study could be decisive in evidence-based medicine of any future pathogen outbreak. Nonstandard Abbreviations and Acronyms PM= pacemakerICD= implantable cardioverter defibrillatorECV= electrical cardioversionEPS= electrophysiological studyAP= ablations proceduresCIED= cardiac implantable electronic devicesWCD= wearable cardioverter defibrillatorEP Lab= Electrophysiology LaboratoriesAVNRT =atrioventricular nodal reentry tachycardiaAVRT= atrioventricular reentry tachycardiaAFL= atrial flutterAF= atrial fibrillationVT= ventricular tachycardiaAT= atrial tachycardia

The first wave of the SARS-CoV-2 epidemic in Tuscany (Italy): A SI2R2D compartmental model with uncertainty evaluation.

With the aim of studying the spread of the SARS-CoV-2 infection in the Tuscany region of Italy during the first epidemic wave (February-June 2020), we define a compartmental model that accounts for both detected and undetected infections and assumes that only notified cases can die. We estimate the infection fatality rate, the case fatality rate, and the basic reproduction number, modeled as a time-varying function, by calibrating on the cumulative daily number of observed deaths and notified infected, after fixing to plausible values the other model parameters to assure identifiability. The confidence intervals are estimated by a parametric bootstrap procedure and a Global Sensitivity Analysis is performed to assess the sensitivity of the estimates to changes in the values of the fixed parameters. According to our results, the basic reproduction number drops from an initial value of 6.055 to 0 at the end of the national lockdown, then it grows again, but remaining under 1. At the beginning of the epidemic, the case and the infection fatality rates are estimated to be 13.1% and 2.3%, respectively. Among the parameters considered as fixed, the average time from infection to recovery for the not notified infected appears to be the most impacting one on the model estimates. The probability for an infected to be notified has a relevant impact on the infection fatality rate and on the shape of the epidemic curve. This stresses the need of collecting information on these parameters to better understand the phenomenon and get reliable predictions.

A New Method for Automated Clearcut Disturbance Detection in Mediterranean Coppice Forests Using Landsat Time Series

A Landsat time series has been recognized as a viable source of information for monitoring and assessing forest disturbances and for continuous reporting on forest dynamics. This study focused on developing automated procedures for detecting disturbances in Mediterranean coppice forests which are characterized by rapid regrowth after a cut. Specifically, new methods specific to Mediterranean coppice forests are needed for mapping clearcut disturbances over time and for estimating related indicators in the context of Sustainable Forest Management and Biodiversity International monitoring frameworks. The aim of this work was to develop a new change detection algorithm for mapping clearcut disturbances in Mediterranean coppice forests with Landsat time series (LTS) using a short time window. Accuracy for the new algorithm, characterized as the Two Thresholds Method (TTM), was evaluated using an independent clearcut reference dataset over a temporal period of the 13 years between 2001 and 2013. TTM was also evaluated against two benchmark approaches: (i) LandTrendr, and (ii) the forest loss category of the Global Forest Change Map. Overall Accuracy for LandTrendr and TTM were greater than 0.94. Meanwhile, smaller accuracies were always obtained for the GFC. In particular, Producer’s Accuracy ranged between 0.45 and 0.84 for TTM and between 0.49 and 0.83 for LT, while for the GFC, PA ranged between 0 and 0.38. User’s Accuracy ranged between 0.86 and 0.96 for TTM and between 0.73 and 0.91 for LT, while for the GFC UA ranged between 0.19 and 1.00. Moreover, to illustrate the utility of TTM for mapping clearcut disturbances in Mediterranean coppice forests, we applied TTM to a Landsat scene that covered almost the entirety of the Tuscany region in Italy.

Numerical modelling of land subsidence related to groundwater withdrawal in the Firenze-Prato-Pistoia basin (central Italy)

The Tuscany region of Italy is widely affected by subsidence, landslides and floods, which severely impact buildings and infrastructure. In particular, Firenze-Prato-Pistoia basin has a long experience of ground deformation related to groundwater withdrawal. European remote-sensing satellite (ERS) data collected since 1992 have revealed the presence of several subsiding areas in the basin such as the south-eastern portion of the city of Pistoia. Sentinel-1 persistent scatterer interferometry (PSI) measurements for 2015–2018 confirmed the long-term subsidence of this area, associated with intense horticulture (plant nurseries). At the same time, Sentinel-1 data revealed the unexpected movement of Pistoia historic center, which has always been considered stable in the past. To identify the complex relationship between aquifer conditions and ground displacement, a hydrogeologic model of the Pistoia aquifers was developed, applying an integrated modelling procedure. Hydrodynamic-parameter distributions, calibrated and validated by means of Sentinel-1 PSI measurements, suggest that subsidence in Pistoia area is probably related with the combined impacts of groundwater extraction and highly compressible aquitards. To evaluate the potential evolution of ground displacement, numerical simulations were extended until 2050, using regional and global climate model data, analyzing three different pumping-rate scenarios. This led to the development of several subsidence hazard maps of the city of Pistoia that display the influence of groundwater extraction in controlling land subsidence in the area. This study emphasizes the importance of developing proper groundwater management policies, especially in alluvial aquifers made of fine compressible sediments, in order to sustainably utilize underground freshwater resources and to avoid related side effects.

Waste services' performance assessment: The case of Tuscany, Italy

This paper assesses the performance of waste services in the region of Tuscany in Italy. It adopts non-parametric techniques for this purpose. Furthermore, it investigates the influence of the operational environment on the estimated performance by using the robust order-m technique. Meaningful levels of inefficiency were found in the Italian waste services. A specification of the ownership of the operator entrusted with waste management by municipalities and the formal adoption of the zero-waste strategy are included as environmental variables.The study concludes that the influence of the operational environment is a determinant of performance. The income per capita is negatively associated with efficiency, while population density is positively associated. Furthermore, efficiency levels are lower for municipalities with higher mixed waste per capita produced. Improving good pro-environmental behaviours is likely to improve efficiency and, thus, tariffs. The empirical results support the idea that it is necessary to make relevant organizational decisions that imply higher costs to increase the refuse collection rate. An increase in the separate collection rate beyond 50% is associated with the reduction of the efficiency level reached. Efficiency analysis does not consider the additional costs and the opportunities for municipalities to get revenues by selling them as secondary raw materials. Besides, the adoption of a zero-waste strategy is related to higher efficiency in MSW service provision. Finally, results about the ownership issue support the idea that privatization is not necessarily associated with the performance improvement of the waste services.

Pathotypes and Antimicrobial Susceptibility of Escherichia Coli Isolated from Wild Boar (Sus scrofa) in Tuscany.

Simple SummaryIn recent years, in geographic areas such as Central Italy, the wild boar population has greatly increased. Although wildlife represents a fundamental resource for ecosystems and biodiversity, wild animals could act as reservoirs for different pathogens, representing an issue for human and domestic animal health. This investigation reports the presence and circulation of pathogenic and antimicrobial-resistant Escherichia coli in wild boar hunted in Tuscany (Italy). Different pathotypes, responsible for human and animal diseases, were detected. Furthermore, resistance to commonly used antibiotics was detected in a large percentage of isolates. Considering the possibility of contact between wild boars, domestic animals, and humans, active monitoring of pathogens is essential for epidemiological purposes.Wild boar are among the most widespread wild mammals in Europe. Although this species can act as a reservoir for different pathogens, data about its role as a carrier of pathogenic and antimicrobial-resistant Escherichia coli are still scarce. The aim of this study was to evaluate the occurrence of antimicrobial-resistant and pathogenic Escherichia coli in wild boar in the Tuscany region of Italy. During the hunting season of 2018–2019, E. coli was isolated from 175 of 200 animals and subjected to antimicrobial resistance tests and PCR for detection of resistance and virulence factor genes. The highest resistance rates were against cephalothin (94.3%), amoxicillin–clavulanic acid (87.4%), ampicillin (68.6%), and tetracycline (44.6%). The most detected resistance genes were blaCMY-2 (54.3%), sul1 (38.9%), sul2 (30.9%), and tetG (24.6%). Concerning genes encoding virulence factors, 55 of 175 isolates (31.4%) were negative for all tested genes. The most detected genes were hlyA (47.4%), astA (29.1%), stx2 (24.6%), eaeA (17.1%), and stx1 (11.4%). E. coli was classified as Shiga toxin-producing E. coli (STEC) (21.7%), enterohemorrhagic E. coli (EHEC) (6.3%), enteroaggregative E. coli (EAEC) (5.1%), and atypical enteropathogenic E. coli (aEPEC) (3.4%). Enterotoxigenic E. coli (ETEC), enteroinvasive E. coli (EIEC), and typical enteropathogenic E. coli (tEPEC) were not detected. Our results show that wild boars could carry pathogenic and antimicrobial-resistant E. coli, representing a possible reservoir of domestic animal and human pathogens.

Rapid detection of carbapenem resistant Klebsiella pneumoniae directly from positive blood cultures during an outbreak in the Tuscany region in Italy

Rapid detection of carbapenem resistant Klebsiella pneumoniae directly from positive blood cultures during an outbreak in the Tuscany region in Italy