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Children are defined as hypertensive when their blood pressure values equal or exceed the 95th percentile of the blood pressure value distribution in a pediatric population, according to gender, age and height. The population on which reference tables are based is of fundamental importance to establish the threshold values for the diagnosis of hypertension in pediatric age. Before 2017, both American and European guidelines used nomograms created in the same reference population which included children of all weight classes. Given the close and well-known association between hypertension and excess weight in childhood, the 2017 American guidelines proposed new reference nomograms excluding subjects with overweight and obesity from the "historical" reference population. Furthermore, the new American guidelines suggested a fixed cut-off of 130/80 mmHg, starting from 13 years and regardless of gender and height, to make the diagnosis of hypertension. In this document, the Italian Hypertension Society (SIIA) and the Italian Pediatric Society (SIP) jointly discuss a number of issues raised by the new American guidelines that involve the entire medical community, and also address the definition of arterial hypertension in the transition phase between childhood and adulthood. [ABSTRACT FROM AUTHOR]

Aims This article explores the care British nurses provided to victims of typhus during the Second World War. Background Typhus is associated with poverty and overcrowding. During wars in the pre-antibiotic era, civilians were particularly susceptible to epidemics, which military governments feared would spread to their troops. Design This discussion paper draws on archival data from three typhus epidemics in the Second World War to examine the expert work of British nurses in caring for victims during these potential public health disasters. Data Sources The published sources for the paper include material from nursing and medical journals published between 1940-1947. Archival sources come from the National Archives in Kew, the Wellcome Library and the Army Medical Services Museum, between 1943-1945. Of particular interest is the correspondence with Dame Katharine Jones from nurses on active service overseas. Implications for Nursing Whilst epidemics of typhus are now rare, nurses in the present day may be required to care for the public in environments of extreme poverty and overcrowding, where life-threatening infectious diseases are prevalent. This article has demonstrated that it is possible for expert and compassionate nursing to alleviate suffering and prevent death, even when medical technologies are unavailable. Conclusion Expert and compassionate care, adequate nutrition and hydration and attention to hygiene needs are crucial when there are limited pharmacological treatments and medical technologies available to treat infectious diseases. The appreciation of this could have implications for nurses working in current global conflicts. [ABSTRACT FROM AUTHOR]

Traumatic wounds are one of the most common problems leading people to the Emergency Department (ED), accounting for approximately 5,4 % of all the visits, and up to 24 % of all the medical lawsuits. In order to provide a standardized method for wound management in the ED, we have organized a workshop, involving several Italian and European experts. Later, all the discussed statements have been submitted for external validation to a multidisciplinary expert team, based on the so called Delphi method. Eight main statements have been established, each of them comprising different issues, covering the fields of wound classification, infectious risk stratification, tetanus and rabies prophylaxis, wound cleansing, pain management, and suture. Here we present the results of this work, shared by the Academy of Emergency Medicine and Care (AcEMC), and the World Society of Emergency Surgery (WSES). [ABSTRACT FROM AUTHOR]

The importance of non-structural elements on the seismic performance of buildings is now widely recognized. A building cannot achieve a life-safety or continuous functionality performance after an earthquake if all its non-structural elements are damaged and/or out of function. Suspended non-structural elements, such as piping and mechanical services, play a crucial role in maintaining life-safety and functionality of a building after an earthquake. The importance of non-structural elements for the seismic performance of buildings have prompted the development of both force-based and displacement-based seismic design methodologies that can be applied to suspended non-structural elements. This paper focuses on appraising force-based and displacement-based seismic design methodologies available in Europe for suspended non-structural elements by comparing fragility functions for a case-study suspended piping trapeze restraint installation layout located in a mid-to-high seismic zone in Italy. The aim of this study is to determine if the seismic design methodologies available for suspended non-structural elements are capable of producing archetypes that achieve a life-safety performance objective for a design level earthquake (return period of 475 years) and maintain a reasonable performance, in terms of life-safety, for other earthquake intensity levels. Advantages and disadvantages of these methodologies are also highlighted. [ABSTRACT FROM AUTHOR]

This paper investigates different uses of the Journal Impact Factor (JIF) in national journal rankings and discusses the merits of supplementing metrics with expert assessment. Our focus is national journal rankings used as evidence to support decisions about the distribution of institutional funding or career advancement. The seven countries under comparison are China, Denmark, Finland, Italy, Norway, Poland, and Turkey—and the region of Flanders in Belgium. With the exception of Italy, top‐tier journals used in national rankings include those classified at the highest level, or according to tier, or points implemented. A total of 3,565 (75.8%) out of 4,701 unique top‐tier journals were identified as having a JIF, with 55.7% belonging to the first Journal Impact Factor quartile. Journal rankings in China, Flanders, Poland, and Turkey classify journals with a JIF as being top‐tier, but only when they are in the first quartile of the Average Journal Impact Factor Percentile. Journal rankings that result from expert assessment in Denmark, Finland, and Norway regularly classify journals as top‐tier outside the first quartile, particularly in the social sciences and humanities. We conclude that experts, when tasked with metric‐informed journal rankings, take into account quality dimensions that are not covered by JIFs. [ABSTRACT FROM AUTHOR]

Whilst the link between young people's well‐being and the creative arts is strengthening, there is a lack of research which focuses on the roles that artists play to help teachers and parents engage young people in the creative arts. This paper explores the benefits of and barriers to artists working in education in six European countries (England, Iceland, Germany, Greece, Italy and Austria). Using the '5A's model of creativity' and a view of professional development taking place within 'landscapes of practice', the data were analysed in order to explain how creativity is operationalised in the different contexts. Our study highlights the need for policy at a national and transnational level to value the creative arts in order to help teachers cross boundaries and utilise the full potential of the creative arts in schools. Our study also highlights that further research is needed into how artists shape teaching and curriculum and how schools engage parents in the creative arts in order to build an evidence‐base relating to young people's positive mental health that can affect policy at these levels. [ABSTRACT FROM AUTHOR]

The aim of this paper is to describe the essential points of Italian and European legislation governing the use of animals in biomedical experimentation. A close look will be taken at the principles of the 3Rs, which represent the mainstay of the legal architecture based on which a correct interpretation may be drawn of the legislative documents on animal experimentation. Furthermore, this paper will address the ways in which Directive 2010/63/EU is implemented in Italian legislation on the welfare of laboratory animals. In addition to an assessment of legal issues (such as the scope of jurisdiction of supervisory authorities tasked with issuing authorizations), it will include a discussion of cases of inadequate and insufficient implementation of the requirements laid down by Directive 2010/63/EU. Both the consistency of the interpretation of national legislation with the Directive and the direct effectiveness of the Directive in national law, in which animal testing has been and still is the subject of heated debate between supporters and opponents, will be examined. [ABSTRACT FROM AUTHOR]

This article examines young people's experiences of open access youth work in settings in the UK, Finland, Estonia, Italy and France. It analyses 844 individual narratives from young people, which communicate the impact of youthwork on their lives. These accounts are then analysed in the light of the European youth work policy goals. It concludes that it is encouraging that what young people identify as the positive impact of youth work are broadly consistent with many of these goals. There are however some disparities which require attention. These include the importance young people place on the social context of youth work, such as friendship, which is largely absent in EU youth work policy; as well as the importance placed on experiential learning. The paper also highlights a tension between 'top down' policy formulation and the 'youth centric' practices of youth work. It concludes with a reminder to policy makers that for youth work to remain successful the spaces and places for young people must remain meaningful to them 'on their terms'. [ABSTRACT FROM AUTHOR]

BACKGROUND: The COVID-19 pandemic has increased the interest in the right to health, which represents a relatively new concept brought about by progress in medical science and the evolution of societies. The Italian Constitution, in article 32, states the right to health without specifications about the parameter of sex, assuming that this fundamental right is property of women and men indiscriminately. OBJECTIVE: To assess whether the right to health has actually been achieved in an equal way from the standpoint of sex, and whether a hypothetically "neutral" approach is actually convincing and profitable in this context. METHODS: This paper analyzes the topic of gender medicine from a scientific and legal perspective, based on current medical literature and its implementation in the Italian and European legal systems. RESULTS: Gender medicine is the only credible response to sex- and gender-based inequalities affecting the right to health, as it provides tools to address persisting inequalities in prevention and treatment, thus pursuing health for all: women and men. CONCLUSIONS: The importance of this path was underlined also by the Summit and the Rome Declaration of 21 May 2021, acknowledging that the topic of sex and gender can no longer be overlooked in focusing a correct and equal healthcare approach. [ABSTRACT FROM AUTHOR]

Teeth fusion is a developmental anomaly characterized by the union of two and, more rarely, three adjacent teeth. The fusion is caused by the physical pressure between two adjacent teeth during their development due to congenital, inherited, acquired or idiopathic factors. Nowadays, fused teeth occur with a frequency ratio between 0.1% and 1% in permanent dentition and 0.5% and 2.5% in primary dentition, and with an equal distribution between males and females. Fused teeth are a rare clinical finding, so there are not standardized clinical protocols and each case should be treated independently. This condition is rare in archaeological populations, likely due to taphonomic processes that cause the lack of information, as well as for the general low occurrence of the defect itself. In the European archaeological literature, there are no reports of two permanent fused teeth so far. Therefore, the present paper represents the first case study of two fused permanent incisors in the past Europe populations as this anomaly has been recognized in an adult man buried in the Longobard cemetery of Guidizzolo (VI–VII century A.D., northern Italy). [ABSTRACT FROM AUTHOR]

To date photovoltaic energy systems have been widely installed on homes in Europe and all over the world. In Europe and in Italy investments in domestic photovoltaic power plants (PV) were boosted by generous feed-in tariffs that made these investments extremely attractive for small private investors, such as homeowners. It is commonly agreed that the greater the building energy efficiency, the greater the property market value. It is of paramount importance to determine the value that PV systems may add to home sale transactions. The aim of the paper is to investigate whether Smart Grids (SGs) innovation can increase market values due to higher production and consumption flexibility. SGs give de facto producers and consumers, the opportunity to be active in the energy market and strategically decide their optimal production/consumption pattern. In this paper, we provide a model based on the real option theory to determine the value of this flexibility and the related market value increase. We model the homeowner decision to invest in a solar home with a PV plant and connect to an SG by comparison to the decision to invest in a solar home not connected to an SG. We determine the property potential market value increase due to the opportunity to perform active energy management given by smart grids and we compare this value increase to the PV plant value per se. To capture the value of managerial flexibility we implement a real option approach. Results of simulations, performed according to zonal prices' trend and volatility in the North and South of Italy, show that in the North and in the South, being connected to an SG increases by about 5-10% the PV investment's value and this quota increases as energy savings and flexibility increase. The greater the flexibility, the greater the property market value. [ABSTRACT FROM AUTHOR]

The Eco-Management and Audit Scheme (EMAS) is a voluntary Regulation that defines the European Environmental Management System (EMS). Today the EMAS is undergoing a revision process, in order to fit the scheme to organizations and stakeholders’ requirements and increase its diffusion. Italy accounts for roughly 1,000 of the 4,000 certified European organizations and, especially during the last five years, a growing number of organizations have not renewed the certification. Thus, the aim of the survey is to investigate why many Italian organizations have dropped out of EMAS, and to identify which enabling measures would be more effective in order to encourage organizations to move back to the certification. The target of the questionnaire were the 339 Italian organizations that did not renew their EMAS registration between 2010 and 2015, and respondents were 99. In the first part of the paper, we present the general findings, while in the second one, certified Public Administrations and private-owned organizations are compared in order to delineate significant differences between the two groups. Concerning motivations for not renewing EMAS, implementation costs were the key reasons for both groups. Conversely, considering the possible enabling measures, while private-owned organizations demand long term tax benefits, Public Administrations prefer a greater consideration of EMAS in public funding. This paper systematically addresses this phenomenon through a survey, contributing to reduce the existing gap in literature and providing a useful input to decision-makers who are overseeing the EMAS revision process. [ABSTRACT FROM AUTHOR]

The engagement of young people has been a neglected area in youth justice and drug policy and practice. This paper explores the concept of 'engagement' in relation to drug interventions in custodial and community settings in different European countries. Interviews were undertaken with young people (aged 14–25 years) in contact with the criminal justice system who use illegal drugs and with practitioners involved in the delivery of interventions for our target group in Denmark, Italy, Poland, and the UK. The key techniques to engage young people were described in similar terms across the countries. These included forming relationships based on trust, honesty, and empathy, setting goals collaboratively, and employing practitioners with lived experience and understanding. The objectives and activities on offer are often constrained by criminal justice contexts. Despite the differences between the countries in terms of criminal justice systems and the structure of drug interventions, there were remarkable similarities in the ways young people and practitioners described effective engagement. Strong emphasis on operational engagement to ensure positive relationships between young people and practitioners was important in the design and delivery of interventions. Practitioners working in criminal justice contexts need to have flexibility and autonomy to work creatively to find ways to engage, connect, and inspire young people. [ABSTRACT FROM AUTHOR]

Based on research undertaken as part of the EU funded EPPIC project, this paper aims to update and elaborate on the relationship between drug use and offending behaviours by exploring variations within a cross-national sample of drug-experienced young people in touch with criminal justice systems. Adopting a trajectory-based approach, interviews were undertaken with 198 young people aged 15–25 in six European countries (Austria, Denmark, Germany, Italy, Poland, and UK). Data were analysed by applying the Bennett and Holloway categorization of the drugs-crime link, with a focus on the concept of social exclusion as developed by Seddon. Three main types of mechanisms (economic, pharmaceutical, and lifestyles) are used to interpret the data, showing how the relationship between drugs and offending can vary according to type of substances and over time. Furthermore, it can be associated with very different degrees of social exclusion and needs. The results suggest that while economic inequalities still play key roles in explaining drug use and offending, both behaviours can originate from a state of relative deprivation, resulting from the contradictions inherent in 'bulimic societies' that raise aspirations and desires while providing young people scarce opportunities for self-realisation and social recognition. [ABSTRACT FROM AUTHOR]

The paper addresses the issues of admissibility of human embryo research and the legal protection to be recognized, in light of the growing importance that scientific research has been gaining in the clinical and biomedical fields of embryonic stem cells for therapeutic purposes. As for human embryo experimentation, particularly on cryopreserved supernumerary embryos, European legislation varies, since the European Court has granted member States a wide margin of appreciation. Some countries, including Italy, have strict legislation protecting embryos from the fertilisation stage, whereas others have taken permissive approaches, allowing experimentation until 14 days after fertilisation. Science, however, has shown that the 14-day limit can be moved. The author finds it necessary to achieve broad international consensus and shared regulations. Lawmakers, however, need to balance respect for the principle of life, represented by the embryo, against scientific needs, in order to devise sound regulations safeguarding both apparently conflicting fundamental values. [ABSTRACT FROM AUTHOR]

Psychosocial hazards have the potential to cause harm to employee health and negatively affect organisational outcomes. Work-related stress is an outcome of exposure to psychosocial risks that has received broad attention at research and policy level in the last decades. Great awareness raising efforts have been made in the European Union, including at the macro policy level, with several differences and approaches across countries. However, evaluation of policy-level interventions to address psychosocial risks is still scarce. This paper focuses on Italy as one of the cases where the policy context on psychosocial risks recently changed with the introduction of the Legislative Decree 81/2008. Using data collected through the European Survey of Enterprises of New and Emerging Risks (ESENER) immediately after (2009) and six years after (2014) the implementation of this new legislation, this paper aims to evaluate the impact of its introduction by exploring differences in the reported level of organisational action as concerns psychosocial risk management. The sample was composed of 2984 respondents corresponding to 1501 highest-ranking managers responsible for health and safety at work in 2009 and 1483 persons who know best about the way safety and health risks are managed at their workplace in 2014. Findings highlighted a decreasing reported concern from the respondents about psychosocial risks over time and an improvement in the management of work-related stress. The paper also highlights the use of large-scale surveys such as ESENER as an important tool in evaluating health and safety management trends over time in European enterprises. [ABSTRACT FROM AUTHOR]

This paper explores the changing role of Islam in Europe, via the case of Italy. The focus is on the contemporary geographies of the changing identities and relationships in the Euro-Mediterranean region. The article intends to challenge the continuous representation of Islam in Europe between homogeneity and otherness. Indeed, the approach considers that relationships which shape places (and are shaped by places) do not stem only from media narratives, from powers and ideologies in general, but also from people's everyday inter-ethnic, inter-cultural, and emotional interactions. The latter do not occur in a vacuum, but rather in places and digital communication channels under grids of power. They are sometimes characterized by behaviours of self-caging and last but not least they always develop in light of geographical transformative power of encounters as 'situated' dynamics of people. Encounters are further shaped and have transformative potential within realms of 'moral geographies' of people and society's values and beliefs while dealing with 'difference'. The paper is based on a series of fieldwork carried out by the author over the years including expert interviews (interreligious dialogue associations, religious leaders, and researchers) and surveys/interviews with immigrants from across the Mediterranean, and on available data and literature for Italy. Main findings for policy-making can be summarized as follows: Europe is a periphery for Umma, not a central place, but in contrast to some origin countries, Islam versions as Islam as predominant not a minority religion. Conversely, the European tradition of human rights, universalism, and democracy should be re-examined and practiced not only in the abstract but in the concrete form of engaged human relations with 'empathy', while laissez faire multiculturalism, aggressive assimilation or 'culturalism' exceptions should be avoided. [ABSTRACT FROM AUTHOR]

Chikungunya virus (CHIKV) is a mosquito-borne infection that is emerging in temperate areas of Europe, following the expansion of one of its vector species, Aedes albopictus. Although CHIKV fever is a self-limiting disease, with a clinical syndrome often resolving within few days, it can also cause severe sequelae, including chronic polyarthralgia lasting up to 5 years. Additionally, CHIKV outbreaks may limit blood bank donations, adding economic burden on the health system. Public health authorities in Europe need to increase their preparedness against this emerging threat. Two large CHIKV outbreaks occurred in Italy in 2007 and 2017, with hundreds of cases and significant geographical spread. The aim of this paper is to review and compare the 2 Italian outbreaks in terms of available estimates of key epidemiological features, patient clinical presentation, virus and immunological characteristics, and public health response. Recommendations for public health and future directions for research are also discussed and highlighted. Key results: Both outbreaks started in small towns, but cases were also detected in nearby larger cities where transmission was limited to small clusters. The time spans between the first and the last symptom onsets were similar between the 2 outbreaks, and the delay from the symptom onset of the index case and the first case notified was considerable. Comparable infection and transmission rates were observed in laboratory. The basic reproductive number (R0) was estimated in the range of 1.8–6 (2007) and 1.5–2.6 (2017). Clinical characteristics were similar between outbreaks, and no acute complications were reported, though a higher frequency of ocular symptoms, myalgia, and rash was observed in 2017. Very little is known about the immune mediator profile of CHIKV-infected patients during the 2 outbreaks. Regarding public health responses, after the 2007 outbreak, the Italian Ministry of Health developed national guidelines to implement surveillance and good practices to prevent and control autochthonous transmission. However, only a few regional authorities implemented it, and the perception of outbreak risk and knowledge of clinical symptoms and transmission dynamics by general practitioners remained low. Major conclusions: Efforts should be devoted to developing suitable procedures for early detection of virus circulation in the population, possibly through the analysis of medical records in near real time. Increasing the awareness of CHIKV of general practitioners and public health officials through tailored education may be effective, especially in small coastal towns where the outbreak risk may be higher. A key element is also the shift of citizen awareness from considering Aedes mosquitoes not only as a nuisance problem but also as a public health one. We advocate the need of strengthening the surveillance and of promoting the active participation of the communities to prevent and contain future outbreaks. Author summary: In Europe, vector-borne diseases have been increasing during the last decades. CHIKV is an example of a neglected emerging disease transmitted by the alien mosquitoes Ae. albopictus that caused 2 large outbreaks in Italy in 2007 and 2017. It is important to compare the main epidemiological, clinical, virological, and immunological features, as well as the public health responses, to increase preparedness to face future outbreaks. [ABSTRACT FROM AUTHOR]

Population aging is exacerbating the loss of competences in the workforce and simultaneously young people neither in employment nor in education and training (NEETs) are struggling to be reengaged in employment. These issues, which are deemed priorities for the European policy agenda, could be addressed by triggering active aging dimensions, valuing and exploiting older adult entrepreneurs' knowledge for enhancing youngsters' entrepreneurial attitudes, through mentoring. This paper reports the results of a study based on an intergenerational learning program, carried out in 2018 in Germany, Italy and Slovenia. The study was aimed at developing and testing one training on mentoring addressing 41 older adult entrepreneurs (55 and over), and two intergenerational learning trainings aiming at boosting entrepreneurial competences of 33 NEETs (aged 18–29). The impact of the program on older adult entrepreneurs and NEETs was assessed through a pre and post-evaluation using qualitative and quantitative tools. Findings at country level were treated as national case-studies and then the latter were compared by considering them as a multiple embedded case-study. Results indicated that, to different extent in the study countries, mentors learned and enhanced mentoring competences, e.g. active listening and the capability of orienting, improved well-being and self-esteem, social inclusion and active aging attitude. Moreover, NEETs acquired entrepreneurial and socio-relational competences by benefiting from the full exploitation of mentors' know-how and the trust relationship with them. Companies, trade unions, educational and voluntary organizations should cooperate to adopt intergenerational learning programs as good practices for older adults and NEETs' lifelong learning promotion. [ABSTRACT FROM AUTHOR]

Ecoregionalization is the process by which a territory is classified in similar areas according to specific environmental and climatic factors. The climate and the environment strongly influence the presence and distribution of vectors responsible for significant human and animal diseases worldwide. In this paper, we developed a map of the eco-climatic regions of Italy adopting a data-driven spatial clustering approach using recent and detailed spatial data on climatic and environmental factors. We selected seven variables, relevant for a broad set of human and animal vector-borne diseases (VBDs): standard deviation of altitude, mean daytime land surface temperature, mean amplitude and peak timing of the annual cycle of land surface temperature, mean and amplitude of the annual cycle of greenness value, and daily mean amount of rainfall. Principal Component Analysis followed by multivariate geographic clustering using the k-medoids technique were used to group the pixels with similar characteristics into different ecoregions, and at different spatial resolutions (250 m, 1 km and 2 km). We showed that the spatial structure of ecoregions is generally maintained at different spatial resolutions and we compared the resulting ecoregion maps with two datasets related to Bluetongue vectors and West Nile Disease (WND) outbreaks in Italy. The known characteristics of Culicoides imicola habitat were well captured by 2/22 specific ecoregions (at 250 m resolution). Culicoides obsoletus/scoticus occupy all sampled ecoregions, according to its known widespread distribution across the peninsula. WND outbreak locations strongly cluster in 4/22 ecoregions, dominated by human influenced landscape, with intense cultivations and complex irrigation network. This approach could be a supportive tool in case of VBDs, defining pixel-based areas that are conducive environment for VBD spread, indicating where surveillance and prevention measures could be prioritized in Italy. Also, ecoregions suitable to specific VBDs vectors could inform entomological surveillance strategies. [ABSTRACT FROM AUTHOR]

Agriculture, one of the main economic pillars in Europe, plays a growing important role towards the environmental sustainability of the extra-urban land, in which the agricultural activities may proactively contribute to control and regulate the whole ecological conditions. Modern agriculture currently needs big quantities of agrochemicals, which are necessary for the growth and protection of crops and animals. These agrochemicals are commercially distributed to consumers in many types of containers. The most widely used packaging solutions usually employ plastic materials (e.g., containers for liquid pesticide; sacks for granular fertiliser; etc.). These materials, after the use of the agrochemical, need to be decontaminated, before being entrained in a recycling process, in the framework of a circular economy. In the present paper the main results coming from a EU-funded international project are reported, with specific reference to a pilot station that was realised in Italy with the aim to implement and test a codified system for the decontamination of these plastic containers for agrochemicals. The experimental tests were supported by relevant laboratory analysis, which have confirmed that the triple-rinsing decontamination procedure - traditionally employed by farmers for washing and decontaminating these containers - may be effective only under some well-defined conditions. Triple rinsing by farmers has indeed led to an only partial decontamination of the plastic containers, if farmers did not follow an appropriate triple-rinsing protocol, or did not triple-rinse the containers immediately after their emptying. [ABSTRACT FROM AUTHOR]

Aim: This paper introduces the study on the European Union Project on complementary therapies and discusses project outputs and results. The goal of the European Union Project was to improve the professional knowledge and skills of women's health and oncology nurses regarding CT. Background: The increasing and widespread use of complementary therapies in the women's health and oncology population requires nurses to be educated about their suitable and safe use. Many nurses do not have proper training in complementary therapies and therefore should not inform their patients about them. Methods: The 'Improving the Nursing Care with Best Complementary Therapy Strategies Based on European Union Standards' (BestCARE) project was a strategic partnership within Erasmus plus for vocational education and training. The BestCARE project was coordinated by the Akdeniz University Nursing Faculty and was carried out with six partners from Turkey and Europe. Results: Fifteen nurses from Turkey and Italy were trained in complementary therapies in England. In addition, training courses and seminars were held in Turkey and Italy for women's health and oncology nurses. The BestCARE programme consisted of 14 work packages. The BestCARE programme was implemented via websites, an e‐learning training programme, training videos, reference and handbook, a curriculum proposal on complementary therapies and a simulation laboratory. Conclusion and implications for nursing and/or health policy: The BestCARE project allowed nurses to gain knowledge, experience and skills about complementary therapies and created a cultural awareness and sensitivity towards patients, caregivers and health professionals. [ABSTRACT FROM AUTHOR]

Over the past decades, the number of effective and safe child vaccines available has increased. Yet, more and more parents have become concerned about vaccine safety. The authors address the following question: are vaccinations, especially in children, to be considered as mandatory treatment or should parents be entitled to choose whether to have their children vaccinated or not? In Europe, eleven countries have instituted mandates, whereas others have opted for mere recommendations and rely on information campaigns. Italy is one of those which have recently enacted legislation designed to broaden the scope of mandatory vaccinations. The paper's authors argue that it is certainly hard to draw the line between individual and collective rights, yet it is incumbent upon state authorities to foster the common interest and the public good, which gives governments a right and an obligation to promote immunisation, at least until the safety threshold is reached. [ABSTRACT FROM AUTHOR]

Abstract: Inks and paper are the main materials and components of library and archive collections. Since the beginning of paper and ink production empirical recipes have been followed, but in the 19th century with the transformation of Europe during the Industrial Revolution, the continent became the main leader for the discovery of new products and new industrial production processes. The aim of this study is to shed light on paper and ink production processes during this key historical period. In this study we have chosen some documents preserved in the archive of the Soprintendenza dei Beni Architettonici e Paesaggistici (B.A.P.) di Venezia e Laguna, held in the Palazzo Ducale (Ducal Palace) of Venice. Attenuated total reflection Fourier transform infrared spectroscopy (ATR-FT-IR), and inductively coupled plasma-mass spectrometry (ICP-MS) allowed us to obtain a qualitative and quantitative characterization of the organic and inorganic components in both paper and inks. Cluster analysis and principal component analysis (PCA) were employed for statistical analysis of the results. [Copyright &y& Elsevier]

Background: The Sarcoma Policy Checklist was created by a multidisciplinary expert group to provide policymakers with priority areas to improve care for sarcoma patients.Main Body: This paper draws on this research, by looking more closely at how France, Germany, Italy, Spain, Sweden and the United Kingdom are addressing each of these priority areas. It aims to highlight key gaps in research, policy and practice, as well as ongoing initiatives that may impact the future care of sarcoma patients in different European countries. A pragmatic review of the published and web-based literature was undertaken. Telephone interviews were conducted in each country with clinical and patient experts to substantiate findings. Research findings were discussed within the expert group and developed into five core policy recommendations. The five identified priority areas were: the development of designated and accredited centres of reference; more professional training; multidisciplinary care; greater incentives for research and innovation; and more rapid access to effective treatments. Most of the countries studied have ongoing initiatives addressing many of these priorities; however, many are in early stages of development, or require additional funding and resources.Conclusion: Gaps in access to quality care are particularly concerning in many of Europe's lower-resourced countries. Equitable access to information, clinical trials, innovative treatments and quality specialist care should be available to all sarcoma patients. Achieving this across Europe will require close collaboration between all stakeholders at both the national and European level. [ABSTRACT FROM AUTHOR]

During the second half of the 20th century farming systems in hilly and mountainous areas of Mediterranean Europe were progressively abandoned and the forest cover subsequently re-expanded. This paper investigates the environmental impacts of land-use/land-cover (LULC) changes on hydrological ecosystem functions (HEFs) in the Upper Alento River Catchment (UARC) in southern Italy. We document the human-driven post-war landscape in 1955 with its maximum expansion of pasture and crops. By 1998 forest cover had doubled and cropland had roughly halved due to decades of land abandonment and reduction in human pressure. In 2015 secondary forests occupied about 70% of the catchment and orchards about 20%. The 1998 land-use scenario was implemented within the Automated Geospatial Watershed Assessment (AGWA) model which was calibrated and validated by direct water yield measurements recorded in the period 1995–2004 in the water reservoir delimited by an earth-dam located at the UARC outlet. Numerical simulations, assumed under “steady” climate conditions, offer “pseudo-realistic” scenarios that help interpret differences in water budget and sediment transport when the 1998 land-use scenario is compared to those of 1955 and 2015. With reference to funding opportunities offered by the European Union in the recent decades, this study provides some practical guidance on the impact of cropland reconversion on HEFs and on measures to mitigate soil erosion in this Mediterranean area. Viewed from the demand-side perspective, natural re-expansion of forest and afforestation reduce water yield and increase actual evapotranspiration. However, our modeling results are framed also within a supply - side approach examining the sensitivity of water yield to precipitation characteristics. [ABSTRACT FROM AUTHOR]

Background: The European Disability Strategy (2010-2020) seeks to significantly raise the proportion of people with disabilities working in the open labour market. The ERGO WORK project is a collaboration of academic and industrial partners in six European countries, focused on understanding and tackling barriers to workplace inclusion for workers with disabilities. Methods: This study sought to explore the perceptions and needs of stakeholders in terms of workplace adaptation to the needs of employees with disabilities. An exploratory online survey was completed by 480 participants across six countries. Results: The analysis suggests that workplaces could be further improved to meet the needs of employees with considerable scope for training within companies to raise awareness about employees' needs, employers' obligations and workplace adaptation. Conclusions: This snapshot suggests there is still a gap between intent and reality in workplace inclusion and further strategies are needed to improve the opportunities for employees with disabilities. The paper argues that ergonomics may have a key role to play in tackling these challenges and adapting the workplace environment and job design to suit the needs of individual employees. [ABSTRACT FROM AUTHOR]

Objectives: There is a growing consensus worldwide that palliative care needs to be both more inclusive of conditions other than cancer and to improve. This paper explores some common challenges currently faced by professionals providing palliative care for patients with either cancer or dementia across five countries. Method: One focus group (n = 7) and 67 interviews were conducted in 2012 across five countries: England, Germany, Italy, the Netherlands and Norway, with professionals from dementia, cancer and palliative care settings. Results: The interviews revealed five common challenges faced across the five countries: communication difficulties (between services; and between professionals, and patients and their families); the variable extent of structural/functional integration of services; the difficulties in funding of palliative care services; problematic processes of care (boundaries, definitions, knowledge, skills and inclusiveness) and, finally, time constraints. Conclusion: These are not problems distinct to palliative care, but they may have different origins and explanations compared to other areas of health care. This paper explored deeper themes hidden behind a discourse about barriers and facilitators to improving care. [ABSTRACT FROM AUTHOR]

Sequential cropping in the Biogasdoneright™ (BDR™) system in Italy has recently gained attention to combine food and renewable energy production in a sustainable way, as well as for carbon sequestration. However, little is known on the potential to expand the practice in other regions of Europe. In this paper, sequential crop calendars were developed for different EU climate regions, and the EU biomethane potential of the anaerobic digestion (AD) of sequential crops was estimated for a Conservative_Scenario and a Maximum_Scenario, assuming different percentages of primary crop land dedicated to the practice and biogas yields. A total EU biomethane potential of 46 bcm/yr and 185 bcm/yr was estimated from the AD of sequential crops in the two scenarios, respectively, and the Continental region registered the highest potential compared to the other regions. The additional benefits of the combination of sequential cropping with other agricultural conservation practices and digestate use included in BDR™ systems were also discussed. In conclusion, the paper shows that with appropriate innovations in crop management, sequential cropping could be applied in different agroclimatic regions of Europe, contributing to climate and renewable energy targets. [ABSTRACT FROM AUTHOR]

This paper investigates the multiple dimensions in the identity constructions of the daughters of the Muslim migrations to Italy. It focuses on the transformations in the way girls and young women relate to religion, in the transition from the generation of mothers, who emigrated from countries with a Muslim majority, to the generation of daughters, who grow up in a European context where Islam is a minority religion. It discusses ‘transmissions’, ‘translations’ and ‘betrayals’ in the migration experience, from a standpoint which highlights the specificities of gender and of generation. The article is based on an intersectional analysis of biographical accounts by Muslim girls and young women of Bengali and Moroccan origin who were born and/or grew up in Italy. Intersecting religious identity with other identity lines such as national belonging (to the parents’ country of origin and to the country where they were born or grew up), gender, class, color and age, multiple reactions and positions emerged. In this context, the religious dimension inherited/experienced/reinvented/called into question by the daughters of migrations appeared to be in constant evolution. Indeed, the stories contained herein of young Muslims tell of the emergence of European Islam. [ABSTRACT FROM PUBLISHER]

The number of elderly patients requiring hospitalisation in Europe is rising. With a greater proportion of elderly people in the population comes a greater demand for health services and, in particular, hospital care. Thus, with a growing number of elderly patients requiring hospitalisation competing with non-elderly patients for a fixed (and in some cases, decreasing) number of hospital beds, this results in much longer waiting times for patients, often with a less satisfactory hospital experience. However, if a better understanding of the recurring nature of elderly patient movements between the community and hospital can be developed, then it may be possible for alternative provisions of care in the community to be put in place and thus prevent readmission to hospital. The research in this paper aims to model the multiple patient transitions between hospital and community by utilising a mixture of conditional Coxian phase-type distributions that incorporates Bayes' theorem. For the purpose of demonstration, the results of a simulation study are presented and the model is applied to hospital readmission data from the Lombardy region of Italy. Copyright © 2016 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background: Accounting for patients' perspective has become increasingly important. Based on the Consumer Quality Index method (founded on Consumer Assessment of Healthcare Providers and Systems) a questionnaire was recently developed for Dutch cancer patients. As a next step, this study aimed to adapt and pilot this questionnaire for international comparison of cancer patients experience and satisfaction with care in six European countries.Method: The Consumer Quality Index was translated into the local language at the participating pilot sites using cross-translation. A minimum of 100 patients per site were surveyed through convenience sampling. Data from seven pilot sites in six countries was collected through an online and paper-based survey. Internal consistency was tested by calculating Cronbach's alpha and validity by means of cognitive interviews. Demographic factors were compared as possible influencing factors.Results: A total of 698 patients from six European countries filled the questionnaire. Cronbach's alpha was good or satisfactory in 8 out of 10 categories. Patient satisfaction significantly differed between the countries. We observed no difference in patient satisfaction for age, gender, education, and tumor type, but satisfaction was significantly higher in patients with a higher level of activation.Conclusion: This European Cancer Consumer Quality Index(ECCQI) showed promising scores on internal consistency (reliability) and a good internal validity. The ECCQI is to our knowledge the first to measure and compare experiences and satisfaction of cancer patients on an international level, it may enable healthcare providers to improve the quality of cancer care. [ABSTRACT FROM AUTHOR]

SUMMARY In this paper, we present a significant update of the Italian present-day stress data compilation not only to improve the knowledge on the tectonic setting of the region or to constrain future geodynamic models, but also to understand the mechanics of processes linked to faulting and earthquakes. In this paper, we have analysed, revised and collected new contemporary stress data from borehole breakouts and we have assembled earthquake and fault data. In total, 206 new quality-ranked entries complete the definition of the horizontal stress orientation and tectonic regime in some areas, and bring new information mainly in Sicily and along the Apenninic belt. Now the global Italian data set consists of 715 data points, including 499 of A-C quality, representing an increase of 37 per cent compared to the previous compilation. The alignment of horizontal stresses measured in some regions, closely matches the ∼N-S first-order stress field orientation of ongoing relative crustal motions between Eurasia and Africa plates. The Apenninic belt shows a diffuse extensional stress regime indicating a ∼NE-SW direction of extension, that we interpret as related to a second-order stress field. The horizontal stress rotations observed in peculiar areas reflect a complex interaction between first-order stress field and local effects revealing the importance of the tectonic structure orientations. In particular, in Sicily the new data delineate a more complete tectonic picture evidencing adjacent areas characterized by distinct stress regime: northern offshore of Sicily and in the Hyblean plateau the alignment of horizontal stresses is consistent with the crustal motions, whereas different directions have been observed along the belt and foredeep. [ABSTRACT FROM AUTHOR]

Due to a long-standing history of human impact, it is rare to find in Europe old-growth stands associated to primary forests; the term “old-growthness” is more appropriate to assess old-growth forests in European countries: i.e. the degree to which forest stands, which may or may not have been impacted by humans, express the structural variability commonly found in old-growth forests. The paper focuses on operational methods to assess and promote old-growthness in countries, like Italy, where old-growthness detection is a difficult task because of the scarcity of “relatively old” forest stands. Lessons learnt from research experiences carried out in Italy are reviewed; research findings mostly come from unmanaged tracts of previously managed forest stands that have reached structural and compositional traits typical of the mature stage of forest dynamics. A commentary discussion is provided on the following topics: (i) how to operationally assess old-growthness of forest stands, by coupling remote sensing based approaches and snapshot inventories of structural features; (ii) what forest structural attributes appear to be more strictly related to old-growthness in Mediterranean forests and (iii) how to promote old-growthness in managed forest stands. The paper concludes pointing out open research questions and pragmatic considerations for managing forests for old-growthness. [ABSTRACT FROM PUBLISHER]

The current paper presents a preliminary algorithm most commonly used for designing the base isolation devices. The algorithm addresses exclusively the base isolation systems which use Laminated Rubber Bearings (LRBs), one of the most used devices in the world. In the first part of the paper the theoretical aspects will be presented by focusing on two different designing approaches (stress approach and strain approach). The seismic conditions will be defined according to three different seismic codes: the European Code (EUROCODE- 1998), the Italian Code and the Romanian Code. In the second part of the paper, several parametrical studies are performed using the designing procedure presented in the first part. The aim of these studies is to obtain a clear understanding of the design procedures and also to determine the influence of seismic characteristics on studied parameters. Finally, the last part of the paper presents a comparison between different solutions obtained for the base isolation system when we consider the same building (Demonstration building on HDNR isolators situated near Java, Indonesia) and different seismic parameters. The chosen seismic conditions correspond to the seismic parameters defined by the above mentioned codes. [ABSTRACT FROM AUTHOR]

Abstract: The paper examines the role and function of public–private interplay in the development of municipal initiatives in the broadband sector. The analysis of initiatives in the Netherlands and Italy shows how the interaction between public and private stakeholders can facilitate local broadband initiatives. This interaction has been vital in aligning the interests of different private and (semi-)public parties, in designing the network and in aggregating sufficient demand for broadband services. The comparative analysis examines the steps involved in these initiatives and the strengths and weaknesses of joint public–private activities. The paper shows that the challenge for cooperating stakeholders has been to foster further investment in the upgrading of the network and in the provision of advanced broadband services. [ABSTRACT FROM AUTHOR]

The paper provides a descriptive account of recent changes in Italian higher education policy, focusing in particular on the impact that recent reforms have had on the internal governance of the nation’s universities. The paper shows how the government’s policy of reform (which is currently moving away from the traditional “command and control” approach to a “steering from a distance” policy) risks being either ineffective or attaining its goals too slowly due to the persistence of deeply rooted, previous institutional governance practices. The greater autonomy currently enjoyed by universities is managed in a corporatistic-oligarchic decision-making style, which leads to sluggish distributive outputs and institutional adaptation to external changes. The paper provides empirical evidence of this institutional inconsistency. In an attempt to deal with this problem, there have been discussions and debate in recent years about re-designing the institutional arrangement of universities, even though it is unlikely that any coherent decisions will be taken on this matter, due to the intractability of the problem resulting from a series of political, cultural and social factors. [ABSTRACT FROM AUTHOR]

This paper highlights the juridical Genetic Modified Organisms statu artis and its legal definition in Italy, Europe and in the rest of the world in order to compare different cultural approaches to needs, interests, fears and precautions against a not scientifically certain innovation. It also stresses the legislative processes towards an extended participation that unifies economic interests, political goals, customer satisfaction, collective safety, and human construction for a sustainable future, a new form of governance. The paper ends with a sociological and comparative analysis of needs, fears, interests and responsibilities related to GMO in Italy and Europe, with the aim of defining some possible evolutions of ruling uncertainty today.

What explains regulators’ preferences concerning the Single Supervisory Mechanism (SSM)? The paper answers this question by providing an alternative account of the creation of the SSM using an institutionalist perspective. It is argued that the creation of the SSM does not simply reflect the material interests of governments and domestic financial firms, but that regulators’ positions were also significantly affected by the institutional environment in which they operated. Two characteristics of domestic supervisory governance are identified: the institutional responsibilities of banking regulators (microprudential and/or macroprudential) and the fragmentation of supervisory and monetary policies. The empirical analysis demonstrates the relevance of these factors for shaping regulators’ preferences both within and across countries. [ABSTRACT FROM PUBLISHER]

Therapeutic use of an unauthorised drug (or of an authorised drug for an unauthorised indication) for patients with a life-threating disease is permitted outside a clinical trial as an Expanded Access Programme (EAP).The regulations regarding EAPs is not the same all over the world. For example, the recommendation of the European Medicines Agency (EMA) in EU countries also includes within EAPs patients who have been treated in a clinical trial and who wish to continue the treatment. Nevertheless, the patients treated in a clinical trial could have the option of continuing treatment for an extended period in an Open-label Extension study, aimed to generate long-term data on efficacy, safety, tolerability and administration.The aims of this paper - based on the difficulties and incoherence encountered by an Italian Ethic Committee (EC) during the authorisation process of EAPs - are: understanding the origin of this misclassification by analysing differences and similarities among USA, European and Italian regulations concerning EAPs; and showing difficulties in classifying international study protocols as a consequence of the lack of harmonisation of definitions.We performed a critical review of the current USA, European and Italian regulations and we analysed some practical cases by retrieving protocols from Clinicaltrials.gov and the Italian Clinical Trials Registry (OsSC) containing in the title the keywords 'Expanded Access Programme', "'Expanded Access', 'Open-label Extension study' or 'Early Access'.We observed that the Food and Drug Administration ( FDA) definition of EAP is very clear while the EMA definition is similar to that of an Open-label Extension study. This lack of a clear definition generates misclassification and it is possible to find an EAP with an efficacy or safety endpoint; or an EAP managed as a clinical trial; or an EAP classified in Clinical Trials Registries as a phase II, III or IV clinical trial.The internationalisation of the studies requires a harmonisation on a global level of legislation and definitions to eliminate misclassification of protocols. For this reason, the authors suggest that: a) the EMA definition should be harmonised with the FDA definition of EAPs, b) European regulation, even if optional, should be adopted in a compulsory way by national regulations. Moreover, separate registries for both EAPs and clinical trials should be organised. [ABSTRACT FROM AUTHOR]

Career decisions are amongst the most important we make. Unsurprisingly, much published research exists on this particular aspect of career behaviour. However, the overwhelming majority of studies have been carried out on young people making initial career decisions. This paper extends our understanding by examining how mid-career adults in three European countries (Denmark, France and Italy) actually make career decisions. Characteristic patterns of behaviour recur when individuals approach points of transition or of crisis; each of these transitioning styles is illustrated by an iconic case. Emergent findings support the growing body of evidence that challenges the dominant policy and practice orthodoxy, which places rationality at the centre of the process, by recognising the importance of emotion and context. [ABSTRACT FROM PUBLISHER]

The growth of a societal base of xenophobia in Europe poses a challenge for the Muslim minorities to alter power relations in the society. In the light of the previous and the current research as well as established theoretical insights, this paper suggests that racial discourse now strategically allows a particular form of pluralism in society, a dominant pluralism, which occludes the possibility for the Muslims to be involved equally in the public and political life. The results of the qualitative analysis, based on interviews conducted with groups holding xenophobic ideas in Austria, Bulgaria and Italy, confirmed earlier observations on contemporary racism, which suggested incommensurability of Muslim minorities with the European culture; their non-assimilative adaptation to society; their expulsion if this adaptation fails and advocating populism. Space is a crucial aspect of exclusion in this discursive frame because minorities are excluded from public and communicative spaces. The discourse is supported by the conceptual sources of a dominant form of pluralism that are found in Michel Foucault and master–slave relationship in philosophy. [ABSTRACT FROM PUBLISHER]

Since the late 1990s, the main Italian ‘welfare cultures’ and the resulting innovation strategies of the welfare system refer to the question of ‘pluralization’. The current crisis is causing the expansion of the public functions carried out by different private actors. As a consequence, discussions of welfare cultures are increasingly making reference to the notion of horizontal subsidiarity that requires new forms of governance. Three subsidiarity approaches emerge: the liberal subsidiarity approach which is related to the ‘free choice’ welfare model; the incomplete subsidiarity approach related to the ‘second welfare’ strategy; and the radical subsidiarity approach related to the ‘radical plural welfare society’ perspective. The paper develops a theoretical discussion of these different welfare cultures—these latter seen through the point of view of subsidiarity—arguing that the problems arising from an economic understanding of welfare pluralization could be addressed by a cultural change which sees in the definition of a new plural welfare system and role for the public sphere the opportunity for aggregating social demand, reinforcing social ties, creating shared value and re-socializing social risks. The hypothesis is that the ‘radical subsidiarity’ approach could better capture these chances for social innovation that this phase of crisis can unlock. [ABSTRACT FROM PUBLISHER]

Gaps in regulations pertaining to the collection and storage of biological materials in a biobank, at least in the European context, have made the writing of local guidelines essential from an ethical point of view. Nevertheless, until recently, the elaboration of local guidelines for the collection, use and storage of biological materials in a biobank has been the exception in Italy and all European countries. In this context, it is of value to know the policies, even if they are unwritten, of local ethics committees (ECs) engaged in the evaluation of research protocols involving biobanks and biological materials. This paper presents the results of a survey carried out among local Italian ECs (229) to document their attitudes and policies regarding the management of the ethical issues related to biobanks and the use of biological materials. A questionnaire was developed to investigate the areas regarded as critical from an ethical-legal point of view: informed consent and information to the subjects; protection of confidentiality; communication of research results; access/transfer of biological materials and related data; ownership of samples and data and intellectual property rights; and subjects' remuneration and benefit sharing. Twenty-six ECs from the Italian Institutes for Research and Care (62%) and 26 other ECs (14%) participated in the survey. [ABSTRACT FROM AUTHOR]

The introduction of Levallois technology in Europe marked the transition from the Lower to the early Middle Paleolithic. This new method of flake production was accompanied by significant behavioral changes in hominin populations. The emergence of this technological advance is considered homogeneous in the European archaeological record at the Marine isotopic stage (MIS) 9/MIS 8 boundary. In this paper we report a series of combined electron spin resonance/U-series dates on mammal bones and teeth recovered from the lower units of San Bernardino Cave (Italy) and the technological analyses of the lithic assemblages. The San Bernardino Cave has yielded the earliest evidence of Levallois production on the Italian Peninsula recovered to date. In addition to our results and the review of the archaeological record, we describe the chronological and geographical differences between European territories and diversities in terms of technological developments. The belated emergence of Levallois technology in Italy compared to western Europe corresponds to the late Italian Neanderthal speciation event. The new radiometric dates and the technological analyses of San Bernardino Cave raise the issue of the different roles of glacial refugia in the peopling and the spread of innovative flaking strategies in Europe during the late Middle Pleistocene. [ABSTRACT FROM AUTHOR]