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Purpose: Garlic consumption has been inversely associated to intestinal adenoma (IA) and colorectal cancer (CRC) risk, although evidence is not consistent. Gut microbiota has been implied in CRC pathogenesis and is also influenced by garlic consumption. We analyzed whether dietary garlic influence CRC risk and bacterial DNA in blood. Methods: We conducted a case–control study in Italy involving 100 incident CRC cases, 100 IA and 100 healthy controls matched by center, sex and age. We used a validated food frequency questionnaire to assess dietary habits and garlic consumption. Blood bacterial DNA profile was estimated using qPCR and16S rRNA gene profiling. We derived odds ratios (ORs) and the corresponding 95% confidence intervals (CIs) of IA and CRC according to garlic consumption from multiple conditional logistic regression. We used Mann–Whitney and chi-square tests to evaluate taxa differences in abundance and prevalence. Results: The OR of CRC for medium/high versus low/null garlic consumption was 0.27 (95% CI = 0.11–0.66). Differences in garlic consumption were found for selected blood bacterial taxa. Medium/high garlic consumption was associated to an increase of Corynebacteriales order, Nocardiaceae family and Rhodococcus genus, and to a decrease of Family XI and Finegoldia genus. Conclusions: The study adds data on the protective effect of dietary garlic on CRC risk. Moreover, it supports evidence of a translocation of bacterial material to bloodstream and corroborates the hypothesis of a diet-microbiota axis as a mechanism behind the role of garlic in CRC prevention. [ABSTRACT FROM AUTHOR]

Many surveys show that the non-traditional students present a higher risk of dropping out (National Audit Office, 2007; Provasnik & Planty, 2008). Nevertheless, empirical research that tries to understand this phenomenon, also in light of different institutional contexts (e.g. four years or two years, residential or non-residential) and of the composition of the sub-groups included in the label "non-traditional" (adults, workers, part-time students), is still insufficient (Yorke & Longden, 2004). It is interesting, therefore, to thoroughly analyze this type of student, upon whom the present university policies could have a paradoxical effect: on the one hand, they encourage their enrollment in the university system, partly because of the emphasis on lifelong learning, but on the other hand they do not seem to be concerned about understanding their needs and circumstances, thereby maintaining an institutional system designed for a very different type of student. In the light of the literature on student engagement, social integration, and adult learning, this empirical study (n = 228 students) explored the relationship between first-year academic experience and non-traditional students' retention. Results show that engagement, social integration, and meaningfulness of learning experience have different effects on non-traditional and traditional students' retention. (Contains 3 tables.)

Purpose: Bike sharing (BS) is a phenomenon of growing interest in the sustainable mobility field. In recent years, many governments have implemented concrete actions to diffuse the services in cities, trying to encourage citizens' sustainable behavior. Several mobile applications (apps) related to the mobility sector have embedded gamification mechanics applied in non-gaming contexts, able to create and increase user engagement and to manage users' behavior (Deterding et al., 2011). The main purpose of this study is to understand whether app perception influences gamification, and how gamification improves service quality and user loyalty in BS systems. Design/methodology/approach: To examine the impact of gamification on service quality and loyalty, the study performed secondary data collection and qualitative analysis with in-depth interviews. Thereafter, a quantitative analysis was conducted, and the theoretical model was analyzed through structural equation modeling (SEM). Findings: findings showed that the use of gamification mechanics in BS services improves users' loyalty and directly influences service quality. The gamification tool improves users' engagement, transferring rules, facilitating the achievement of goals and quality standards and enhancing the BS usage. Originality/value: This study uniquely contributes an understanding of the effect of gamification on service quality and loyalty in BS usage. It also provides some insight for companies and policymakers into implementing gamification mechanics in order to address new challenges for quality management. [ABSTRACT FROM AUTHOR]

Background: The paper aims to understand the main antecedents related to the blood donation propensity related to both donors and non-donors. With our research, we will analyse the two perspectives to identify similarities and differences concentrating on the Italian context. Blood is a vital resource that strongly affects every national healthcare system's efficacy and sustainability and the system's ability to achieve the goal of universal coverage.Methods: The purpose of this paper is to understand the main antecedents of citizens' blood donation intention and the propensity to encourage communication about blood donation among both donors and non-donors. The Theory of Planned Behaviour is adopted as a theoretical lens. An empirical investigation was performed in Italy, adopting a mixed methods research design. First, a qualitative analysis was carried out through 30 in-depth interviews. Then, a survey was used to quantitatively investigate the intention to donate among both donors (N = 173) and non-donors (N = 87). A conceptual model was developed and tested through Structural Equation Modelling, developing a multi-group approach.Results: The present study confirms the relations proposed by the Theory of Planned Behaviour, even though some differences between the two groups are shown. The construct Information and Communication is crucial for donors, non-donors, whereas for non-donor inhibitors is vital. Service quality has an impact on the propensity to recommend and communicate the value of blood donation.Conclusion: This paper reveals the main differences between donor and non-donor perspectives. Fruitful insights for enhancing blood donation awareness are provided. [ABSTRACT FROM AUTHOR]

Client aggression is increasingly a stressor in the workplace. This study aims to analyze how and why these experiences may trigger burnout. Focusing on health care workers, we tested a moderated mediation model of the relationship between exposure to third-party (patients and/or relatives) verbal aggression and burnout with the goal of assessing the mediation effects of emotion work and the moderating effects of personal resources (i.e., perceived self-efficacy in communication with patients) and job resources (job control, role clarity, social support by colleagues and by supervisors) on this relationship. A purposive sample of 356 nurses was recruited from four hospitals in northern Italy. A structured, self-report questionnaire was used to collect data. Mediated and moderated mediation regression models with PROCESS were used to test the hypotheses. As postulated, emotion work mediated the relationship between patient third-party aggression and nurses' burnout. Role clarity and supervisors' support were found to reduce the harmful effects of emotion work triggered by third-party aggression. Unexpectedly, perceived self-efficacy in communication did not have a buffering effect in the tested model. These results offer a novel approach to designing preventive actions aimed at cultivating resources to counter the impact of perceived exposure to client aggression on well-being. [ABSTRACT FROM AUTHOR]

Background: Migraine is one of the most common neurological diseases and an estimated 1.04 billion people worldwide have been diagnosed with migraine. Available data suggest that migraine is world widely associated with a high economic burden, but there is great variability in estimated costs that depends on the geographical, methodological and temporal differences between the studies. The purpose of this study was to quantify the annual direct cost of episodic migraine (EM) and chronic migraine (CM), both for the patient and for the National Health System (NHS), using data from subjects who attended an Italian tertiary headache centre. Furthermore, we evaluated comparatively the impact of gender and age on the economic burden of migraine. Methods: We conducted a retrospective and non-interventional observational analysis of the electronic medical records of subjects with EM and CM who consecutively attended the Regional Referral Headache Centre of Rome and undergoing continuous treatment in the 2 years prior to 31 January 2019. This approach was intended to prevent distorsions due to natural fluctuations in migraine status over time. The collected data included demographic characteristics, number of specialist visits, consumption of medications, diagnostic tests, accesses in the emergency department (ED) and days of hospitalization due to the pathology. Results: Our sample consisted of 548 patients (85.4% women and 14.6% men): 65.5% had CM and 34.5% had EM. The average annual expenditure per patient was €1482. 82.8% of the total cost (€1227) was covered by the NHS. The main item of expenditure were medications that represented 86.8% (€1286), followed by specialist visits (10.2%), hospitalizations for (1.9%), diagnostic tests for (1%) and ED visits for (0.1%). Costs were significantly higher for women than men (€1517 vs. €1274, p = 0.013) and increased with age (p = 0.002). The annual direct cost of CM was 4.8-fold higher than that of EM (€2037 vs. €427, p = 0.001). Conclusion: Our results provide a valuable estimate of the annual direct cost of CM and EM patients in the specific setting of a tertiary headache centre and confirm the high economic impact of migraine on both the NHS and patients. [ABSTRACT FROM AUTHOR]

Background and aim: Headache is very often the cause for seeking an emergency department (ED). However, less is known about the different diagnosis of headache disorders in the ED, their management and treatment. The aim of this survey is to analyse the management of headache patients in two different ED in Europe. Methods: This retrospective survey was performed from September 2018 until January 2019. Patients were collected from the San Luca Hospital, Milan, Italy and the Ordensklinikum Barmherzige Schwestern, Linz, Austria. Only patients with a non-traumatic headache, as the primary reason for medical clarification, were included. Patients were analysed for their complexity and range of examination, their diagnoses, acute treatment and overall efficacy rate. Results: The survey consists of 415 patients, with a mean age of 43.32 (SD ±17.72); 65% were female. Technical investigation was performed in 57.8% of patients. For acute treatment non-steroidal-anti-inflammatory drugs (NSAIDs) were the most used, whereas triptans were not given. A primary headache disorder was diagnosed in 45.3% of patients, being migraine the most common, but in 32% of cases the diagnosis was not further specified. Life-threatening secondary headaches accounted for less than 2% of cases. Conclusions: The vast majority of patients attending an ED because of headache are suffering from a primary headache disorder. Life-threatening secondary headaches are rare but seek attention. NSAIDs are by far the most common drugs for treating headaches in the ED, but not triptans. [ABSTRACT FROM AUTHOR]

Purpose: Sustainable mobility and collaborative consumption are debated issues in the literature. In this field, car sharing (CS) represents a growing tendency that attracts interest by academicians for its potential positive impact on sustainability. This study aims to understand the main drivers of CS usage, unveiling the role of service quality and the possible inhibitors. Design/methodology/approach: Based on theoretical assumptions in the literature, the authors developed a theoretical framework that aims at understanding the main antecedents of CS usage. An empirical investigation involving the city of Rome (Italy) was performed. The study presents a qualitative and quantitative survey, while the proposed theoretical model has been tested through structural equation modelling statistical techniques. Findings: The findings show that usefulness positively affects the intention to use CS services. Moreover, the green attitude and expected service quality indirectly influence the intention to use CS services impacting perceived usefulness. The results show that the expected service quality has a strong influence on usefulness, whereas green attitude has a weaker influence on usefulness. The intention to use CS services is directly influenced by the usefulness and inhibitors that affect it negatively. Originality/value: The originality of this paper lies in the fact that this study discloses the main antecedents of the intention to use CS services, emphasizing the role of service quality. This study provides fruitful insights to policy and decision-makers to understand how to improve the CS usage in the urban transport system of the city of Rome. It suggests developing a higher level of service quality in the vehicles, suitable technological applications and effective communication as well as on overcoming its main inhibitors. [ABSTRACT FROM AUTHOR]

The main purpose of this paper is to assess and gain a deeper understanding of the role of service quality in sustainable mobility. Specifically, the study aims to understand user perceptions related to service quality in urban public transport systems and to investigate whether they induce the adoption of adopt more sustainable behaviours for mobility purposes by opting for alternative means of transportation such as car-sharing, bike-sharing, and car-pooling instead of using one's own private car. Indeed, it is becoming vital for cities to investigate the norm of owning a car as a solution and to break this norm to allow citizens to stop using their car as an environmentally friendly solution. On the basis of the above theoretical assumptions, we develop a theoretical framework that aims to fill the literature gaps and is therefore oriented towards understand the linkage among the service quality of the urban public transportation system, service loyalty to urban public transport, the intention to use one's own private car less, and the intention to use sustainable means of transportation, mainly car-sharing. An empirical investigation involving the city of Rome, Italy, is performed. The study proposes a territorial analysis and a qualitative and quantitative survey. The aim of this empirical study is two-fold: i) to learn the state of the art of the urban public transport system of the city under investigation and ii) to explore citizens' perceptions of the service quality of public transport and to understand their intentions to use public transport more, to use their own cars less and to adopt sustainable means of transportation such as car-sharing. PLS-PM statistical tools are used for data analysis. Our findings confirm that service quality has a direct effect on the intention to use public transport more and that this effect affects both the intention to use one's own car less and the intention to use sustainable means of transportation such as car-sharing more. [ABSTRACT FROM AUTHOR]

Background. The Brief Balance Evaluation Systems Test (Brief-BESTest) was recently proposed as a clinical tool for quickly measuring balance disorders, but its measurement properties warrant investigation. Objective. The study objective was to perform a detailed analysis of the psychometric properties of the Brief-BESTest by means of Classical Test Theory and Rasch analysis. Design. This was an observational measurement study. Methods. Brief-BESTest data were collected from a sample of 244 participants. Internal consistency was analyzed with the Cronbach a and item-to-total correlations. Test-retest reliability and interrater reliability were investigated in a subgroup of 21 participants. The minimum detectable change at the 95% confidence level was calculated. Scale dimensionality was examined through Horn parallel analysis; this step was followed by exploratory factor analysis for ordinal data. Finally, data were examined using Rasch analysis (rating scale model). Results. The Cronbach a was .89, and all item-to-total correlations were greater than .40. Test-retest reliability had an intraclass correlation coefficient (ICC) (2,1) of .94, and interrater reliability had an ICC (2,1) of .90. The minimum detectable change at the 95% confidence level was 4.30 points. The unidimensionality of the test was confirmed, but 1 item showed low communality. Rasch analysis revealed the inadequacy of response categories, 5 misfitting items, minor mistargeting, moderate person reliability (.80), and 2 pairs of locally dependent items. Limitations. The sample was a cross-section of people who had balance disorders from different neurological etiologies and were recruited consecutively at a single rehabilitation facility. Conclusions. The Brief-BESTest was confirmed to have some acceptable-to-good reliability indexes when calculated according to Classical Test Theory, but the scale showed fairly limited sensitivity to change. Rasch analysis indicated that item selection should be improved from a psychometric point of view. Item redundancy needs to be reduced, and the metric coverage of the measured construct needs to be improved with new items. [ABSTRACT FROM AUTHOR]

This study aimed to understand the relationship between care provider (employee) satisfaction and patient satisfaction and to identify key drivers of their satisfaction. The European Foundation for Quality Management-based 4P model and Picker’s Patient Experience quality dimension were used as the theoretical basis for understanding the satisfaction relationship along with the key drivers. A cross-sectional survey was conducted in two wards (maternity and cardiology) from June to August 2014. The partial least squares structural equation modelling method was used to analyse the data. For the 4P model, we found strong evidence for the influence of enablers on the results and eventually on employee satisfaction. Likewise, we found strong evidence for the effect of patients’ experience on their overall satisfaction and eventually on their loyalty. Concerning the relationship between employee and patient satisfaction, we found that a higher patient satisfaction level in one ward was associated with higher employee satisfaction in the same ward. Other findings include the identification of key drivers of patient and employee satisfaction along with improvement priorities for each ward. This study provides insights that can be useful for healthcare managers and policy-makers responsible for developing and planning strategies for more sustainable healthcare organisations. [ABSTRACT FROM PUBLISHER]

Purpose - The purpose of this study is to identify possible correlations between the stated "enablers" and "results" in excellence models, and to explain how different variables contribute to the "enablers" and "results". A cross-case study of two different excellence models, the Common Assessment Framework (CAF) in Italy and the Swedish Institute for Quality (SIQ) model for performance excellence, is proposed. Design/methodology/approach - The study is based on the evaluation of assessment reports of public organizations across two countries, Italy and Sweden. Canonical correlation was used for data analysis. Two hypotheses were formulated: There is a correlation between "enablers" and "results" in the CAF model, and there is a correlation between "enablers" and "results" in the SIQ model. Findings - The results show that the hypotheses are supported. It turned out that the correlation is higher for the SIQ model than for the CAF model. For the CAF model, "strategy and planning" is the main contributor to the "enablers", and for the SIQ model, "human resource development" is the main contributor. For the "results" set, similar criteria provide the strongest contributor for both models; these are "customer/citizen-oriented results" for the CAF and "customer satisfaction" for the SIQ. Originality/value - The paper contributes to the knowledge gained from a cross-case analysis of two different excellence models applied in public sector organizations, the CAF in Italy and the SIQ model for performance excellence in Sweden. The paper also contributes to an ongoing discussion of a need of excellence models being adapted specifically for the public sector; from this study, no support for such a sector-specific model is shown. [ABSTRACT FROM AUTHOR]

The urgency to cope with the international economic crisis has led to efforts to identify innovative tools and frameworks that are capable of regenerating local and national economic development. The enhancement of the cultural heritage sector can be a strategic factor in improving the competitiveness of country systems. In Italy, the nation's rich cultural heritage is not managed in an efficient and effective manner, even though it embodies a tremendous opportunity to enhance local economic growth, especially in light of the role of new cultural technology districts (CTDs). This article intends to present the CTD business model aimed to promote local and regional development in Italy, to attract domestic and international tourist flows and spread them out more evenly across all regional territories and to verify the CTD's opportunity through the Lazio Region experience. [ABSTRACT FROM AUTHOR]

Aim In Emergency Departments, fragmentation and breakdown in information exchange can be important factors leading to adverse events. This article aims to consider the critical aspects of collaborative teamwork in Emergency Departments that may have an impact on the information flow. Background On the basis of Distributed Cognition Theory, we have assumed that cognitive outcomes in critical-care settings are not confined to the thoughts of isolated individuals; rather, they are better understood as properties of a distributed cognitive system across the minds of the clinical team members and across the technological artefacts. Design We report on an exploratory ethnographic study of two Emergency Departments. Methods Data were collected over a period of four months in 2008 via observation and interviews. Results The results highlight a specific distribution of cognitive work between physicians and nurses. The nurse's roles as information highlighter, memory keeper and process organizer helped to ensure the information flow and to overcome some of the problems identified with the computer-assisted communication process. Such distribution of cognitive work improved care quality, but it crossed established professional boundaries. Conclusion As cross-boundary distribution of cognitive work in Emergency Departments can be perceived as role substitution, building an interprofessional working system is needed to avoid information breakdown in fast-moving contexts. To realize an interprofessional working system, practice-based training is required, aimed at developing a deep understanding of team cognition. [ABSTRACT FROM AUTHOR]

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Abstract: In the present work we report on a new measurement of resonance strengths ωγ in the reaction 25Mg(p, γ)26Al at and 189 keV. This study was performed at the LUNA facility in the Gran Sasso underground laboratory using a 4π BGO summing crystal. For the first time the 92 keV resonance was directly observed and a resonance strength was determined. Additionally, the γ-ray branchings and strength of the 189 keV resonance were studied with a high resolution HPGe detector yielding an ωγ value in agreement with the BGO measurement, but 20% larger compared to previous works. [Copyright &y& Elsevier]

Abstract: The process is a key reaction in both Big-Bang nucleosynthesis and p–p chain of Hydrogen Burning in Stars. A new measurement of the cross section has been performed at the INFN Gran Sasso underground laboratory by both the activation and the prompt γ detection methods. The present work reports full details of the prompt γ detection experiment, focusing on the determination of the systematic uncertainty. The final data, including activation measurements at LUNA, are compared with the results of the last generation experiments and two different theoretical models are used to obtain the S-factor at solar energies. [Copyright &y& Elsevier]

Abstract: In stars with temperatures above , hydrogen burning is dominated by the CNO cycle. Its rate is determined by the slowest process, the 14N(p, γ)15O reaction. Deep underground in Italy''s Gran Sasso laboratory, at the LUNA 400 kV accelerator, the cross section of this reaction has been measured at energies much lower than ever achieved before. Using a windowless gas target and a 4π BGO summing detector, direct cross section data has been obtained down to 70 keV, reaching a value of 0.24 picobarn. The Gamow peak has been covered by experimental data for several scenarios of stable and explosive hydrogen burning. In addition, the strength of the 259 keV resonance has been remeasured. The thermonuclear reaction rate has been calculated for temperatures , for the first time with negligible impact from extrapolations. [Copyright &y& Elsevier]