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Purpose: A routine preoperative assessment is considered both ineffective and inefficient. Despite the widespread application of lean thinking in healthcare, there is little evidence of successful experiences in preoperative admissions in order to reduce "No value added" activities. A conceptual framework reporting the drivers (clinic, tools, innovation, organization, and governance) and impacts (patient, efficiency, sustainability, time, learning and growth) was developed. Methodology: Drawing on the experience of an Italian high complexity hospital, this paper analyzes the case study by reporting evidence on how to implement lean in preoperative assessment and how to evaluate the positive results obtained. Results: Applying lean principles, the identification of value improved the appropriateness of care by creating 40 personalized pathways; the value stream resulted in a reduction of "No Value Added Time" from 37% to 28%, chest X-rays from 41% to 14% and cardiac visits from 49% to 37%; the pursuit of continuous flow through innovation contributed to increase the use of digitalization; the new pull organization helped to reduce the average time spent per year by 1.5 h; the continuous improvement was ensured through the governance of results. Conclusion: The proposed framework should be used to improve the quality of care in preoperative admissions by adopting the lean drivers for successful implementation and reporting the impacts. [ABSTRACT FROM AUTHOR]

The positive phototaxis showed by adults of some pestiferous chironomid species, annoying to waterfront residents and businesses, was investigated at Lake Trasimeno (Italy) to develop a strategy against their massive swarms. Two experimental devices (ChiroTraps), located at Passignano sul Trasimeno (PA) and at Sant'Arcangelo (SA), were employed in 2019 and 2020. The total biomass attracted by the traps amounted to 6498.78 g at PA and to 8597.05 g at SA. Chironomids biomass constituted 99.66% and 96.59% of the biomass in these sites, respectively. Only a few specimens of other fauna except chironomids were found at PA. In contrast, the values at SA were considerable, being 91- and 35-fold (number of taxa and weight, respectively) higher than in PA. These results demonstrated that exploiting the light attraction behaviour of adult chironomids is an efficient method for managing their pestiferous populations, thereby reducing the necessity of using insecticides. By comparing the biodiversity in the two sites, it was evident that the differences were linked primarily to the environmental conditions. Finally, it is suggested that light trapping systems should be located in urban centres or floated on the lake surface to maximise the efficiency of trapping chironomids and minimising the impact on biodiversity. [ABSTRACT FROM AUTHOR]

Insect pollinators provide an important ecosystem service that supports global biodiversity and environmental health. The study investigates the effects of the environmental matrix on six oxidative stress biomarkers in the honey bee Apis mellifera. Thirty-five apiaries located in urban, forested, and agricultural areas in Central Italy were sampled during the summer season. Enzyme activities in forager bees were analyzed using an artificial neural network, allowing the identification and representation of the apiary patterns in a Self-Organizing Map. The SOM nodes were correlated with the environmental parameters and tissue levels of eight heavy metals. The results indicated that the apiaries were not clustered according to their spatial distribution. Superoxide dismutase expressed a positive correlation with Cr and Mn concentrations; catalase with Zn, Mn, Fe, and daily maximum air temperature; glutathione S-transferase with Cr, Fe, and daily maximal air temperature; and glutathione reductase showed a negative correlation to Ni and Fe exposure. This study highlights the importance of exploring how environmental stressors affect these insects and the role of oxidative stress biomarkers. Artificial neural networks proved to be a powerful approach to untangle the complex relationships between the environment and oxidative stress biomarkers in honey bees. The application of SOM modeling offers a valuable means of assessing the potential effects of environmental pressures on honey bee populations. [ABSTRACT FROM AUTHOR]

Non-indigenous freshwater bivalves negatively affect invaded ecosystems through different mechanisms, including inter-specific competition for trophic resources. Here, we investigated in Lake Trasimeno (Central Italy) the diet of the invasive Dreissena polymorpha and the native Anodonta anatina. δ15N and δ13C stable isotopes were measured in winter and summer in bivalves, phytoplankton, and sedimentary organic matter (SOM); the relative dietary contributions of the two resources were determined using Bayesian mixing models. To elucidate the different carbon and nitrogen pools characterizing the study site, isotopic analyses were extended to zooplankton and to representatives of the benthic flora and macroinvertebrate fauna. Independently from the season, the two bivalves showed a limited trophic overlap, as mixing models indicated for D. polymorpha a diet based primarily on phytoplankton, while A. anatina relied mainly on SOM. Dietary differences were less marked in summer, when comparable isotopic values characterized phytoplankton and SOM. In winter, conversely, the trophic differentiation between the two species was more evident, and corresponded with a significant enrichment in SOM δ13C values, likely due to a substantial contribution of carbon deriving from decaying macrophytes. Whether differences in ecological and behavioral traits alone can explain the observed trophic segregation between the two species, or if they have actively shifted their diet to reduce competition for food is discussed. We conclude emphasizing the need of an advanced resolution of the influence of non-indigenous species on the flux of energy and matter in invaded lentic systems, including Lake Trasimeno. [ABSTRACT FROM AUTHOR]

The region of Lombardy was the epicenter of the COVID-19 outbreak in Italy. Emergency Hospital 19 (EH19) was built in the Milan metropolitan area during the pandemic's second wave as a facility of Humanitas Clinical and Research Center (HCRC). The present study aimed to assess whether the implementation of EH19 was effective in improving the quality of care of COVID-19 patients during the second wave compared with the first one. The demographics, mortality rate, and in-hospital length of stay (LOS) of two groups of patients were compared: the study group involved patients admitted at HCRC and managed in EH19 during the second pandemic wave, while the control group included patients managed exclusively at HCRC throughout the first wave. The study and control group included 903 (56.7%) and 690 (43.3%) patients, respectively. The study group was six years older on average and had more pre-existing comorbidities. EH19 was associated with a decrease in the intensive care unit admission rate (16.9% vs. 8.75%, p < 0.001), and an equal decrease in invasive oxygen therapy (3.8% vs. 0.23%, p < 0.001). Crude mortality was similar but overlap propensity score weighting revealed a trend toward a potential small decrease. The adjusted difference in LOS was not significant. The implementation of an additional COVID-19 hospital facility was effective in improving the overall quality of care of COVID-19 patients during the first wave of the pandemic when compared with the second. Further studies are necessary to validate the suggested approach. [ABSTRACT FROM AUTHOR]

Background: Bariatric surgery is the most effective treatment for patients affected by morbid obesity. The Enhanced Recovery After Surgery (ERAS) protocol increases clinical outcomes, but the most recent literature shows incomplete patients' adherence. This study aims to demonstrate the feasibility of applying a Value-Based Healthcare (VBHC) strategy associated with ERAS to increase patients' engagement and outcomes. Method: A multiprofessional team redesigned the process considering ERAS recommendations and patients' feedbacks. Outcomes that matter to patients were defined with structured patients' interviews and collected in the electronic clinical record. Adherence to the pathway and the cost of the cycle of care were measured to demonstrate sustainability. A model was developed to grant its replicability. Results: A total of 2.122 patients were included. The lowest adherence to the protocol for a single item was 82%. 74% of excess weight loss; 90% better comorbidities control; 77.5% had no pain after surgery; 61% no postoperative nausea and vomiting. Zero mortality; 1.8% overall morbidity; 0.4% readmission and reoperation rate within 30 days. The average length of stay is 2.1 days. Patient-Reported Outcome Measures (PROMs) documented increased productivity and quality of life. Conclusion: Building a caring relationship by a multidisciplinary team, adding patient wellness in a VBHC framework on top of ERAS as a patient-centered approach, increases patients' engagement and adherence to the pathway of care, resulting in better health outcomes (clinical and PROMs). The Value-Based Model is sustainable and replicable; it represents the prototype for redesigning other pathways and may become a model for other organizations. [ABSTRACT FROM AUTHOR]

This pilot study examined the effect of recombinant type I human collagen on post- surgical diabetic foot lesion healing by secondary intention. Twenty-four patients (17 male, 7 female; mean age 66.2±2.4 years; duration of diabetes 9.7±4.2 years, HbA1c 7.3±1.5%) were randomised to receive type 1 recombinant human collagen plus standard treatment (n=12) or standard treatment (n=12). They were evaluated weekly for 6 months or until complete healing had occurred. Rate and time of healing, recurrence and adverse reactions/hypersensitivity to treatment were recorded. The group that received type 1 recombinant human collagen had a significantly higher healing rate (83.3% versus 58.3%, P<0.01) and shorter healing time (64±4 days versus 90±11 days, P<0.02) than the group receiving standard treatment. There were no between-group differences in adverse events, recurrence or re-interventions during follow-up. The addition of type I recombinant human collagen to standard treatment increased healing rate and shortened healing time in patients with post-surgical diabetic foot wounds. [ABSTRACT FROM AUTHOR]

The use antimicrobials for therapeutic and metaphylactic purpose in humans and agriculture exerts selective pressure on animal and environmental microbiota resulting in the survival and spread of antimicrobial resistance genes among bacteria and subsequent development of resistance in bacteria. Previous studies have shown that honey bees' microbiota (Apis mellifera) can accumulate antimicrobial resistance genes in their microbiome and act as collectors and disseminators of resistance genes. The aim of this study was to investigate to what extent honey bees act as reservoir of select antimicrobial resistance genes. This study was conducted on 35 groups of bees. Bees were collected from 35 sites in Umbria, Italy. PCR was used to screen pooled ground bees' specimens for genes that code for resistance against antimicrobials that are commonly used in humans and in veterinary medicine including aminoglycosides (aph), beta-lactams (blaZ), tetracycline (tetM) and sulphonamides (sul1 and sul2). Twenty-four samples out of 35 (68.57%) were positive for at least one antimicrobial resistance gene. Two samples were positive for the aph, 5.71%; eight for blaZ, 22.86%; three for tetM, 8.57%; ten for sul1, 28.57% and eighteen for sul2, 51.43%. Positivity to more than one antimicrobial resistance gene was observed in nine samples, 25.71%. The multivariate analysis identified "presence of farms nearby" as the factor most closely related to PCR positivity. Honey bees (Apis mellifera) from Umbria, Italy, carry antimicrobial resistance genes and can be used as indicators of the presence of resistance genes in the environment. [ABSTRACT FROM AUTHOR]

Home range, routine movement, and dispersal are key factors affecting the population distribution, thus playing a crucial role in spatial dynamics and gene flow. In this regard, detailed investigations on insects require the capture of the specimens and subsequent manipulation. The movement and the abundance of a population of the damselfly Coenagrion mercuriale were monitored using the mark-recapture method at a breeding site located in a Mediterranean watercourse in Central Italy. The study area was a transect of 250 m along a ditch, subdivided into five stretches varying from 40 to 70 m each. A total of 849 adults was captured and 210 specimens of them were recaptured on a 17-day survey (from mid-June to early July 2018), corresponding to an estimation of population size of 5,600 specimens. Recapture and survival probabilities revealed no significant effect ensuing from handling and marking with different colours. Specimens of different stretches showed different sedentary rate. The recaptured individuals had a low vagility, with a high proportion of individuals which are incline to philopatry. [ABSTRACT FROM AUTHOR]

Coenagrion mercuriale (Charpentier, 1840) is a damselfly classified as 'Near Threatened' by the Global IUCN Red List and as 'Endangered' in some parts of its range. The species is characterized by fragmented and declining populations with their core in the western Mediterranean and parts of western Europe. This study reported the first estimates of survival rate and population size for a southern European population of Coenagrion mercuriale living in central Italy. Surveys were carried out in 2017 in the peak of the flight period applying capture–recapture models. More than 1200 specimens were captured on 11 occasions and the sex ratio observed was male-biased (2.8:1). Daily survival probabilities ranged from 0.662 ± 0.059 to 0.868 ± 0.045. Maximum longevity was 14 days for males. The maximum number of estimated individuals on any day was 507.2 ± 49.6 for males, and 219.8 ± 27.7 for females in mid-June. The estimate of the cumulative population size was about 4000 specimens, with a mean density of 1.2 individuals/m2 at the breeding site. Our results pointed out that population ecology of the Southern Damselfly in central Italy is similar to that of the populations living in the northern limit of its range. The present study also indicated that monitoring plans, with seven marking occasions at least, can provide consistent estimations of population size, useful for evaluating the viability of populations and for assessing the species conservation status. [ABSTRACT FROM AUTHOR]

The aim of this consensus paper was to define the state of the art on cognitive assessment of persons with multiple sclerosis (PwMS), with the purpose of providing recommendations for the Italian centers involved in MS management. While there are no formal guidelines published regarding the assessment of cognitive function in MS, on the basis of an expert opinion meeting, held in Milan (Italy) on July 4, 2016, we report the recommendations of a panel of Italian experts including MS neurologists and neuropsychologists for the assessment and follow-up of cognitive function in adult MS subjects. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the impact on outcome (healing, amputation, survival) of chronic ischemic heart disease (CIHD) in a group of DFU patients (DFPs) treated for CLTI. Method: We prospectively studied 50 consecutive DFPs (age 74,30±10,98 yrs, 35M/15F, duration of diabetes (DD) 23,04±12,57 yrs) treated with endovascular revascularization for CLTI in our Department between January and June 2022, and followed up for a mean of 6,4±3,2 months, 8/50(16%) were dialysed; 33/50(66%) had a history of previous limb revascularization. We divided them according to the presence [Group1, 28/50(56%) age 73.2±11.7 yrs, 21M/7F, DD 26.1±12.9 yrs] or absence [Group2, 22/50(44%) age 75.7±10.1 yrs, 14M/8F, DD 19.2±11.2 yrs] of CIHD assessed by means of echocardiography, and compared them for major amputation (MA), survival and healing rates during follow up. Results: All patients were successfully revascularized and dismissed after 6.2±4.1 days; at follow-up 4/50(8%) patients underwent major amputation for progression of disease, 5/50(10%) patients died not healed, 23/50(66%) healed, 16(32%) did not heal and 2/50(4%) patients were lost to follow up. Group 1 showed a significant lower healing rate compared to Group 2 (n=10/25 40% vs n=14/19 74%, p<0,05). No significant differences were observed between the two groups for and survival or MA rates. Conclusion: Our study confirms the high prevalence of CIHD in DFU patients and its negative prognostic role in the healing process, and claims for more attention on this subtle co-morbidity. [ABSTRACT FROM AUTHOR]

Aim: We aimed to evaluate if a proactive multidisciplinary diagnostic program could improve outcomes in the management of multidrug resistant (MDR) diabetic foot (DF) osteomyelitis (OM). Method: We evaluated all the consecutive patients undergoing to minor amputation for OM July-December 2021 in our department (Group A). Intraoperative bone specimens were collected for microbiological and histological analysis on whose results antibacterial therapy was decided. Controls were patients admitted January-June 2021 with same indications (Group B) but with no systematic intraoperative bone sampling. Clinical and demographic characteristics, procedures, healing rate (HR) and healing time (HT), were compared between the groups. Results / Discussion: We derived data from 89 patients: 46 in Group A [51.7%; age 68.8±13.5 yrs; diabetes duration (DD) 19.6±11.6 yrs Hba1c 8.7±4.8%;] and 43 in Group B (48.3%; age 70.4±12.9 yrs; DD 18.8±12.1 yrs; Hba1c 8.4±5.1%). No differences in demographic and clinical features, i.e. renal failure (39.1% vs 37.2%, p=ns), ischemic cardiac disease (41.3% vs 39.5%, p=ns), peripheral arterial disease (65.2% vs 67.4%, p=ns) and peripheral revascularizations (56.5% vs 53.4%, p=ns). Group A had a higher healing rate (80.4% vs 60.4%, p=0.0021) and a shorter healing time (67±41 days vs 134±92 days, p=0.020) compared to Group B. Conclusion: Systematic intraoperative bone sampling for culture and histology, and consequent antibiotic adaptation, increases healing rates and reduces healing times in DF patients submitted to minor amputations for OM. [ABSTRACT FROM AUTHOR]

Aim: Anemia is a marker of severity in patients with diabetes mellitus, associated with higher mortality. Aim of this study was to test its impact on diabetic foot (DF) inpatients. Method: We retrospectively searched patients admitted for DF in our Department between July and December 2021 (Group A) and compared them with patients admitted in the same period in Diabetology Department for diabetes-related diagnosis different from DF (Group B). We compared demographic and clinical characteristics focusing on blood crasis: mean (HB) or maximum (HHB) haemoglobin concentration, mean corpuscular volume (MCV), mean corpuscular hemoglobin content (MCH), mean corpuscular hemoglobin content (MCHC), red blood cell count (RBC) and hematocrit (HCT) were extracted from charts at admission. Length of admission and in-hospital mortality were compared. Results / Discussion: We studied 211 patients: 106 in Group A and 105 in Group B. No differences in age while patients of Group A had a longer disease duration (19.4±11.3 yrs vs 7.96±10.4 yrs, p<0.05). Anemia was more prevalent in Group A (72.6%) than B (52.3%): p<0.01. HB (10.34±2.0 g/dl vs 11.1±2.2 g/dl, p<0.05) was significantly lower in Group A with no difference in HHB, MCV, MCH and MCHC. HCT was significantly lower in Group A (32.3±5.7% vs 36.5±7.3%, p<0.05) as well as RBC (3.7±0.7x106/microl vs 4.2±0.8 106/microl, p<0.05). Group B showed longer duration of admission (13.8±9.6 days vs 7.6±4.9 days, p<0.001) and higher mortality rate during admission (8.58% vs 0.94%, p<0.01). Conclusion: Despite its high prevalence in DF inpatients, anemia is not associated with a worse short-term prognosis. [ABSTRACT FROM AUTHOR]

Aim: Diabetes Mellitus (DM) is associated with an higher incidence of many forms of cancer, while DFS is characterized by high cardiovascular mortality and morbidity, but its propensity to cancer has not be ascertained so far. Our Aim was to measure the prevalence of cancer in DFS and check for possible associations between the two conditions. Method: we retrospectively searched the databases of our Department for all the consecutive patients admitted in the Medical department of our hospital between January of 2019 and December of 2021 with a admission diagnosis of DM with (DFS+) or without (DFS-) DFS. We compared the prevalence of cancer between the groups and we checked for possible correlations between the two conditions not influenced by other known possible predictors (familiariaty, age, sex, smoking, rena insufficiency, anaemia). Results / Discussion: Comprehensively 222 DFS + and 223 DFS - controls were studied. Overall cancer prevalence was 15.3% and in DFS+ was significantly higher than both DM (11.7% p=0.008) and controls (13.3%, p=0.031). Univariate regression showed a significant association between cancer and DF ( p = 0.007), age at admission(p = < 0.001), years of diabetes(p = 0.017) and hemoglobin(p = 0.03). At multivariate regression only DF(p=0.021), and age at admission (p < 0.001) persisted as independent predictors. Conclusion: DFS is characterized by a higher prevalence of cancer compared to both DM patients and non diabetic controls and can be considered as an independent risk factor for neoplasms. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the efficacy of infrared thermal imaging (IRT) in predicting healing of diabetic foot (DF) trans-metatarsal amputation (TMA). Method: we prospectively studied all the consecutive DF patients admitted in our department May-June 2022 who had indication for TMA, didn't have a non-revascularizable critical ischemia and weren't smoker. We evaluated them with IRT (FLIR ET 500 infrared thermal camera) measuring skin temperature (ST) pre-operational (V0), one (V1) and two (V2) days after TMA, and at the desuture (V3) in three points of the plantar flap. Patients were then divided into two group: healed (G1) and not healed (G2) at three weeks. Results / Discussion: we enrolled 10 patients (6G1/4G2), [1/9 DM1/DM2, duration of diabetes 21.3±7.3 yrs, TcPO2 46.8±4.8 mmHg]. At V0 average ST did not differ between the groups (35.45±0.42°C in G1 vs 34.73±0.42°C in G2), at V1 [36.05±0.17°C vs 34.57±0.32°C (p<0.002)] and V2 [36.25±0.17°C vs 34.35±1.46°C (p<0.046)] ST was significantly higher in G1 than in G2, while at V3 no differences were found between the groups [34.65±0.33 in G1 vs 34.12±0.2 in G2 (p=0.095)]. Conclusion: Our preliminary data shows that ST measured with IRT in the days immediately after TMA in DF patients may predict healing of the surgical wound at 3 weeks. [ABSTRACT FROM AUTHOR]

Aim: Diabetic foot (DF) is a marker of cardiovascular pathology, often underestimated and undetected because of lack of symptoms in the presence of neuropathy; we aimed to evaluate the efficacy of a proactive cardiological screening in a high-risk cohort of DF patients affected by CLTI in identifying undetected cardiac pathologies in need of specialistic care. Method: Fifty consecutive patients (age 74,3±10,98 yrs, 35M/15F, 3 T1DM and 47 T2DM) underwent a pro-active cardiologic evaluation including electrocardiogram and echography of the heart [all performed by the same cardiologist (LC)] before the endovascular revascularization for CLTI in our DF Section between January and June 2022, as part of the multidisciplinary management program. Results / Discussion: Twenty-eight out of 50(56%) patients had a history of chronic ischemic heart disease, 5/50(10%) chronic heart failure and 8/50(16%) a moderate-severe valvulopathy. The proactive screening identified 5/50(10%) cases that needed specific cardiac treatment before the endovascular revascularization of the limb. In detail, we identified 3 patients with acute heart failure, 1 with a silent ischemic coronary disease and 1 with a severe valvulopathy. Conclusion: The proactive cardiological screening revealed not previously recognized heart disease in up to 10% of CLTI patients. These data highlight the importance of screening high-risk DF patients before revascularization. [ABSTRACT FROM AUTHOR]

Aim: Diabetic Foot Syndrome (DFS) is associated with a high risk of cardiovascular morbidity and major amputation (MA). Likewise, cancer is a well-established risk for cardiovascular disease. Our aim was to assess if DFS patients with cancer have a worse cardiovascular profile and surgical outcomes compared to DFS patients without cancer. Method: We retrospectively analyzed the charts data of 223 consecutive DFS patients [M:166/F:57, age: 69.6±10.4,T2DM 94.66%/T1DM 5.4%] admitted between January 2019 and December 2021 in our Department for interventional procedures (Revascularization and/or foot surgery). Prevalence of cancer, cardiovascular pathologies, MA and re-intervention were derivated. Results / Discussion: Cancer was observed in 47 (21.1%) DFS patients. Patients with cancer were older (71.5 vs 68 yrs, p<0.01) and with a longer history of diabetes (24.5 vs 19 yrs,p<0.05). Major cardiovascular events, atrial fibrillation and renal failure prevalence didn't differ between patients with and without cancer. After a median time of 5 months, reoperation was performed in 35.4% of patients, without any difference between cancer+ and cancer- DFS. Globally, MA prevalence was 9.6%. Although, MA prevalence did not differ between patients with and without cancer, patients with blood cancer (n=9) showed a higher prevalence of MA than those with solid tumors (33.3% vs 5.1%, p<0.05) and those without cancer (9.7%, p<0.05). Conclusion: Cardiovascular profile, surgical outcome and reoperation rate didn't differ between DFS patients with and without cancer. More studies are needed to confirm that DFS patients with blood tumors could present higher risk of MA. [ABSTRACT FROM AUTHOR]

In this paper we explored the heavy metal bioaccumulation (Cd, Cu, Pb and Zn) in Procambarus clarkii , a crayfish recently suggested as a potential bioindicator for metals pollution in freshwater systems. The present study is focused on crayfishes populations caught in a heavily polluted industrial and in a reference sites (Central Italy), though the results are generalized with a thorough analysis of literature metadata. In agreement with the literature, the hepatopancreas (Hep, detoxification tissues) of the red swamp crayfish showed a higher concentration of heavy metals in comparison to the abdominal muscle (AbM, not detoxification tissues) in the sites under scrutiny. Hep/AbM concentration ratio was dependent on the specific metal investigated and on its sediment contamination level. Specifically we found that Hep/AbM ratio decreases as follows: Cd (11.7) > Cu (5.5) > Pb (3.6) > Zn (1.0) and Pb (4.34) > Cd (3.66) > Zn (1.69) > Cu (0.87) for the industrial and reference sites, respectively. The analysis of our bioaccumulation data as well as of literature metadata allowed to elaborate a specific contamination index (Toxic Contamination Index, TCI), dependent only on the bioaccumulation data of hepatopancreas and abdominal muscle. In the industrial site, TCI expressed values much higher than the unit for Cd and Cu, confirming that these metals were the main contaminants; in contrast for lower levels of heavy metals, as those observed in the reference site for Cu, Zn and Pb, the index provided values below unit. TCI is proposed as a useful and easy tool to assess the toxicity level of contaminated sites by heavy metals in the environmental management. [ABSTRACT FROM AUTHOR]

Soon after the earthquake that damaged L'Aquila municipality and its Province in the Abruzzi Region, Italy, on the 6th of April 2009, a widespread damage and usability assessment of buildings was launched. In 3 months, about 70,000 buildings were inspected, with the AeDES form, by public servants and professionals coordinated by the Italian Civil Protection Department. The paper, after describing the procedures and the form that were used for the assessment, discusses the time evolution of the inspections and analyses the data on building type and seismic damage. The empirical damage distribution conditional upon seismic intensity and building type is provided and the role of several vulnerability factors, such as the quality of masonry, the construction year, the number of stories, and the pre-existing damage, is highlighted. Lastly the damage consequences, such as the immediate occupancy conditional upon building damage and building type, are reported. [ABSTRACT FROM AUTHOR]

We used self-organizing maps (SOM, neural network) to bring out patterns of benthic macroinvertebrate diversity in relation to river pollution. Fourteen stations were sampled over various seasons in the Nestore drainage basin (Central Italy) and characterized for macroinvertebrate communities, nutrient and heavy metal concentrations. Physicochemical variables were introduced into a SOM previously trained with macroinvertebrate data. Patterns of communities matched spatial and seasonal changes in environmental conditions, including water chemistry related to economic activities in the catchment. Although our analyses did not allow us to establish the specific effect of any given environmental parameter upon macroinvertebrate community composition based on the field study, they enabled us to map the ecological health of river ecosystems in a readily interpretable manner. [ABSTRACT FROM AUTHOR]

1. Introduction of alien species is one of the major threats to aquatic biota and knowledge of the major correlates of their occurrence is pivotal in planning reliable conservation strategies. 2. To understand whether specific freshwater habitats are more likely to be invaded than others, a dataset on the occurrence of 1604 species in 54 taxonomic groups from 181 sites across the Italian peninsula was gathered. 3. The EUNIS habitat classificationwas used, selecting for the study's seven habitat types at the secondEUNIS level, including lentic (EUNIS C1; 64 sites), lotic (EUNIS C2; 99 sites) and highly artificial (EUNIS J5; 18 sites) habitats. 4. The aim of the study was to test whether the overall number of alien species and the proportion of alien species for each taxonomic group differed between habitat types and could be explained by environmental, human-mediated, or climatic factors. 5. Using generalized linear mixed effect models to account for potential confounding factors, only average air temperature of the site was a significant positive predictor of the occurrence of alien species, regardless of habitat type, species richness, and other climatic variables. 6. A direct effect of temperature could be excluded given the origin of alien species, mostly from colder areas than Italy. Thus, an indirect effect could be hypothesized at the Italian latitudes, with warmer areas potentially more likely to be visited by tourists than colder areas. If this hypothesis is confirmed, the results of the analyses call for a compromise between the maintenance of recreational activities in the wild and the preservation of a natural environment to prevent the arrival and spread of alien species. On the other hand, no further recommendations can be implemented regarding habitat susceptibility to alien species. [ABSTRACT FROM AUTHOR]

Background BICAMS (Brief International Cognitive Assessment for Multiple Sclerosis) has been recently developed as brief, practical and universal assessment tool for cognitive impairment in MS subjects. It includes the Symbol Digit Modalities Test (SDMT), the California Verbal Learning Test-2 (CVLT2) and the Brief Visuospatial Memory Test-Revised (BVMT-R). In this study we aimed at gathering regression based normative data for the BICAMS battery in the Italian population. Methods healthy subjects were consecutively recruited among patient friends and relatives. Corrections for demographics were calculated using multivariable linear regression models. Test-retest reliability was assessed using the Pearson correlation coefficient. Results The BICAMS battery was administered to 273 healthy subjects (180 women, mean age 38.9 ± 13.0 years, mean education 14.9 ± 3.0 years). Test-retest reliability was good for all the tests. Conclusions The study provided normative data of the BICAMS for the Italian population confirming good test-retest reliability which can facilitate the use of the battery in clinical practice, also for longitudinal patient assessments. [ABSTRACT FROM AUTHOR]

The evaluation of the overall performance of a green building is complex, since many construction, energy and environmental aspects have to be considered. The Umbria Region in Italy, through various public tenders, recently funded several residential buildings, innovative in terms of construction quality, green technologies and sustainable solutions, such as natural building materials, integrated sunspaces, PV (photovoltaic) modules and solar collectors, geothermal heat pumps, that had to be adopted to obtain the public contribution. The University of Perugia carried out an extended monitoring of these buildings, in order to verify the actual achievement of design objectives, to certify the real savings in terms of energy and environmental loads and to assess the indoor comfort conditions for occupants. In situ thermal, acoustical and lighting measurements were carried out for more than one year. Energy simulations were performed by means of codes which implement the algorithms required by the Italian Law. Moreover, a comparison between real consumptions and simulated energy requirements was carried out. Finally, the buildings were characterized from the environmental sustainability point of view, using the method adopted by the Umbria Region. This assessment was borrowed from ITACA (Institute for Innovation and Transparency in Government Procurement and Environmental Compatibility) procedure [an Italian procedure similar to Leadership in Energy and Environmental Design (LEED)] and consists of 20 worksheets, one for each different performance indicator, at the aim of carefully describing the environmental quality of the building. [ABSTRACT FROM AUTHOR]

The article discusses the results of the study on potamon fluviatile's morphometric homogeneity and allometric growth in Italy. It details how the study was conducted which involved 942 crabs obtained from nine sites in the central and southern parts of the country that were sexed and classified. The study reportedly revealed the absence of morphometric markers that discriminates among populations.

Abstract: Buildings’ thermal-energetic assessment and the relative proposal of new technical solutions applied to both summer and winter analyses has a strategic role in increasing the year-round performance of buildings. Buildings’ dynamic analysis is by now a well-established procedure to study effective building energy performance given real climate considerations. Then in this work, a concise and effective methodology for analyzing buildings’ thermal performance in a dynamic environment is proposed and applied to different case studies, consisting of single-family residential buildings’ prototypes. This procedure is aimed to define different performance levels by proper non-dimensional indexes named thermal deviation indexes (TDI). These indexes values could express in a concise way buildings’ thermal behavior, different optimization strategies impact, sensitivity analysis results. Buildings’ prototypes representing the case studies are three free-floating houses where the architectural shape role and the sensitivity of different envelope features are analyzed, also supported by experimental results regarding envelope properties measured on existing residential buildings in Italy. The three prototypes are respectively designed to optimize summer or winter energy performance or to represent the typical Italian house before and after energy efficiency regulation is implemented. To better define the important envelope parameters necessary to calibrate the numerical models, experimental activities are conducted. In particular, thermal insulation level and roof reflectance, characterized by means of spectrophotometrical measurements, are measured both in the case of an old traditional Italian building and in the case of a modern building. The results of the dynamic analysis are expressed in terms of TDI values, to define buildings’ thermal performance with respect to the variation of all the considered architectural and envelope’s properties (i.e. architectural layout, mass and insulation, roof reflectance, Solar Heat Gain Coefficients of windows’ glasses, weather data) within a specific climatic context. For validating the proposed method, the obtained TDI results are compared with those obtained from existing procedures. In particular, the TDI values are correlated to an adaptive comfort indicator, for verifying how much the TDI could be effective for evaluating free-running buildings thermal performance during both summer and winter. [Copyright &y& Elsevier]

The article focuses on interpreting the policies and practices of girls in the Italian Communist Party (PCI) from a gender studies perspective. The author discusses Enrico Berlinguer, leader of Italy's young communists, and his choice of moral role models for communist girls, Italian partisan hero Irma Bandiera and catholic saint Maria Goretti. He analyzes the competition between the communist and catholic youth networks, the political implications of these movements, and the activities organised for female members of the Italian Young Communist League.

In recent years, Lake Trasimeno (Central Italy) has been affected by massive chironomid swarms that have been a serious nuisance to inhabitants and tourists. The introduction of 'tofo lamps', to divert chironomid midges from inhabited areas, has exploited the natural attraction that these insects have for artificial light. These tofo lamps had a high white light intensity (450 W) and were equipped with an external net that imitates the fish net, called 'tofo'. The attractive efficiency of such lamps was tested in the summers of 2007, 2008 and 2009 by monitoring these devices in areas on eastern (S. Feliciano) and western (Castiglione del Lago) sides of Lake Trasimeno. The most attracted taxa included the species causing a serious nuisance, i.e. the large-sized Chironomus plumosus, and the small-sized Tanypus punctipennis and Procladius sp. In summer, massive swarms of the last two taxa preceded those of C. plumosus. Female chironomids were much more attracted than were males by the artificial white light, with a sex ratio much lower than 1. In addition, the percentage of gravid females of C. plumosus was higher than that of females not carrying eggs. Artificial lights were confirmed as effective in diverting the pestiferous chironomids, a feature that should be carefully considered in order to limit the nuisance from these insects and to avoid spreading insecticides in natural environments. [ABSTRACT FROM AUTHOR]

With the elections of 18 April 1948, for Italian Communists the prospect of coming to power in the short term vanished. In the aftermath of the elections, the sustained confrontation of the Cold War at the international level and the unfavourable political context in Italy deeply shaped the tone and content of the Communist press, including the educational magazines for young militants. This article deals with the representations of the political enemies in the press for young Communists between 18 April 1948 and the electoral campaign against the legge truffa in 1953. Attention is paid to how the Communist press portrayed, in particular by visual means, the different subjects that made up the ruling anti-Communist bloc: the US government; Christian Democrats; the Catholic Church; and, finally, the Italian business world. In particular, the analysis underlines the relevance that a 'nation-' and 'gender-' related discourse had in the construction of political enemies. [ABSTRACT FROM AUTHOR]

In applied river ecology it is implicitly assumed that community structure is a surrogate for functional properties. To test this hypothesis, 26 sites were sampled for macroinvertebrates in a Central Italian stream system impacted by 13 trout farms (1 upstream and 1 downstream site per facility). We used a fuzzy-coding approach of biological traits combined with species distribution analysis. Trout farm locally impacted the structure of macroinvertebrate communities, but serial disturbances at the stream system scale did not affect the overall regional diversity pattern. Impacted sites had species with large body size, which fed upon microorganisms and fine detritus, and which showed asexual reproduction. Least impact sites hosted small-sized invertebrates showing sexual reproduction, and feeding upon plant material and/or algae. (© 2010 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim) [ABSTRACT FROM AUTHOR]

The Chiascio River (central Italy) macrobenthic invertebrate community is analysed in relation to the management of a recently constructed reservoir located about halfway along the watercourse. The dam was originally planned for irrigation purposes, but since 2005 has only been used to regulate the minimum flow of the river, with partial filling in spring and total discharge in autumn. Seasonal sampling surveys, conducted from 1996 to 1999 at 13 stations along the river, yielded 45,744 specimens of benthic macroinvertebrates belonging to 109 taxa. The functional feeding analysis revealed a zone of discontinuity downstream of the dam, with high values of shredders and low values of collectors. The discontinuity is probably due to the reintroduction, in autumn, of the stored particulate organic matter. This altered the trophic structure of the benthic community just downstream of the dam, moving it towards a facies of lower stream order. [ABSTRACT FROM AUTHOR]

Simple Summary: The population of Procambarus clarkii was surveyed twenty years after its introduction into Lake Trasimeno (Central Italy), investigating both ecological and genetic aspects. Our results confirmed that P. clarkii is well acclimatized with a stable population structure, mainly characterized by a unique mitochondrial lineage, suggesting that a single introduction event may have occurred in the lake, complemented by secondary events. The deliberate or accidental introduction of invasive alien species (IAS) causes negative ecological and economic impacts altering ecosystem processes, imperiling native species and causing damage to human endeavors. A monthly monitoring program was performed in Lake Trasimeno (Central Italy) from July 2018 to July 2019 in order to provide an upgrade of the population ecology of Procambarus clarkii and to assess the genetic diversity by analyzing the relationships among mitochondrial DNA diversity. Our results confirmed that P. clarkii is well acclimatized in the lake, revealing a stable population structure favored by the resources and conditions typical of this ecosystem, which seem to be optimal for the maintenance of the species. Four distinct mitochondrial haplotypes were detected, but one of them was clearly overrepresented (76%), suggesting that a single predominant introduction event may have occurred in this area, likely followed by secondary events. The identification of the typical genetic variants provides a better understanding of the evolutionary scenarios of P. clarkii in this biotope and it can be helpful in management plans concerning the expanding populations of this invasive alien species. [ABSTRACT FROM AUTHOR]

The mentum deformity incidence in Chironomus plumosus larvae to assess the environmental contamination level in Lake Trasimeno, Central Italy, was investigated. The survey lasted from May 2018 to August 2019. Fifty-one samplings were carried out: 34 in the littoral zone and 17 in the central zone. The deformity assessment was based on 737 and 2767 larval specimens of C.plumosus collected from the littoral and central zones, respectively. Comparison of the larval morphometric variables between normal and deformed specimens highlighted that the deformities did not cause alterations of the larval growth. The deformity incidence amounted to 7.22% in the whole Trasimeno's ecosystem, reaching 8.28% in the littoral zone and 6.94% in the central zone. Among the different seasonal cohorts, the spring cohort had overall the highest deformity value (11.41%). The deformity type assessment protocol highlighted that the most common deformity type was "round/filed teeth" (64%). The results of this 2018–2019 survey revealed a low deformity incidence, within the background range of relatively low-impacted freshwaters. Comparison with previous investigations (2000–2010) of the same habitat showed a clear decrease of the deformity incidence. This study further contributes to the evaluation of the mentum deformity in chironomids that represent an indicator endpoint of the anthropogenic contamination level in freshwaters. [ABSTRACT FROM AUTHOR]

In the original article, Maria Pia Amato's second affiliation was not included. The second affiliation is IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy. The correct affiliation is presented here. [ABSTRACT FROM AUTHOR]

Aim: To evaluate clinical outcomes in patients who underwent diabetic foot surgery (DFS) managed directly by diabetologists in a third-level Centre over 15-year.Methods: We retrospectively evaluated 1.857 patients affected by diabetic foot (Age 67.1 ± 12.3 yrs, diabetes duration 19.2 ± 9.8 yrs, HbA1c 8.1 ± 2.0%) treated in our Department between 2001 and 2015 and divided them into 3 groups: Group 1, treated between 2001 and 2005 (448 pts), group 2, between 2006 and 2010 (540 pts) and Group 3, between 2011 and 2015 (869 pts). Main clinical outcomes [peripheral revascularization rate (PR), healing rate (HR), healing time (HT), recurrences after healing (R), major amputation (MA) and death (D) rates] were compared between groups.Results: The overall outcomes of our cohort were: HR 81.6% (HT 143 ± 54 days), PR 84.8%, MA 4.9% and D 27.9%. There were no differences in clinical characteristics, except for age, higher (p < 0.05) in Group 3 (70.6 ± 14.7 yrs) than in Groups 1 (64.4 ± 11.6 yrs) and 2 (65.1 ± 11.2 yrs). No differences emerged when comparing HR and MA; HT was shorter (p < 0.05) in group 3 (104 ± 44 days) than in Group 2 (169 ± 72 days) and 1 (235 ± 67 days). D was higher (p < 0.05) in Group 3 (43.8%) than in Group 1 (23.1%) and 2 (28.1%). PR was 19.4% in Group 1, 28.1% in Group 2 and 53.8% in Group 3 (p < 0.05).Conclusions: Despite the increasing age and complexity of patients our data show improvement of outcomes throughout 15 years, probably due to better surgical techniques, more aggressive medical therapy and more effective treatment of critical limb ischemia. [ABSTRACT FROM AUTHOR]