Search Results (79)

The socio-economic geography of the Italian territory is framed by strong imbalances in the settlement development, with consequent inequalities in terms of accessibility to essential services. These challenges are most critical in the ‘inner areas’, which are remote from metropolitan and urban centers and affected by chronic demographic decline and depopulation. Both European and national policies have relied primarily on financial interventions, often implemented with limited integration into comprehensive urban and territorial planning frameworks. Using a case study methodology, this research examines the area-based strategies of the 72 pilot areas designated under the 2014–2020 program-ming cycle of the National Strategy for Inner Areas (SNAI). The main research question guiding this study is as follows: how does economic planning intersect with territorial governance in Italy’s inner areas, and what is the specific role of local autonomies and the management of core functions, particularly in relation to urban and regional planning? Through this lens, this study proposes a conceptual reframing of the inter-municipal ad-ministrative scale as a strategic framework for promoting more effective territorial policies. Full article

Background: Artificial intelligence (AI) is being increasingly promoted as a means to enhance diagnostic accuracy, to streamline workflows, and to improve overall care quality in primary care. However, empirical evidence on how primary care physicians (PCPs) perceive, engage with, and emotionally respond to AI technologies in everyday clinical settings remains limited. Concerns persist regarding AI’s usability, transparency, and potential impact on professional identity, workload, and the physician–patient relationship. Methods: This qualitative study investigated the lived experiences and perceptions of 28 PCPs practicing in diverse outpatient settings across Germany. Participants were purposively sampled to ensure variation in age, practice characteristics, and digital proficiency. Data were collected through in-depth, semi-structured interviews, which were audio-recorded, transcribed verbatim, and subjected to rigorous thematic analysis employing Mayring’s qualitative content analysis framework. Results: Participants demonstrated a fundamentally ambivalent stance toward AI integration in primary care. Perceived advantages included enhanced diagnostic support, relief from administrative burdens, and facilitation of preventive care. Conversely, physicians reported concerns about workflow disruption due to excessive system prompts, lack of algorithmic transparency, increased cognitive and emotional strain, and perceived threats to clinical autonomy and accountability. The implications for the physician–patient relationship were seen as double-edged: while some believed AI could foster trust through transparent use, others feared depersonalization of care. Crucial prerequisites for successful implementation included transparent and explainable systems, structured training opportunities, clinician involvement in design processes, and seamless integration into clinical routines. Conclusions: Primary care physicians’ engagement with AI is marked by cautious optimism, shaped by both perceived utility and significant concerns. Effective and ethically sound implementation requires co-design approaches that embed clinical expertise, ensure algorithmic transparency, and align AI applications with the realities of primary care workflows. Moreover, foundational AI literacy should be incorporated into undergraduate health professional curricula to equip future clinicians with the competencies necessary for responsible and confident use. These strategies are essential to safeguard professional integrity, support clinician well-being, and maintain the humanistic core of primary care. Full article

In the context of Industry 4.0 (I4.0), the Asset Administration Shell (AAS) has been gaining significant attention in recent years. The AAS serves as a standardized digital representation of an asset, encapsulating all relevant information about the asset throughout its lifecycle. Since its introduction in 2015, the past decade has seen considerable progress in developing traditional AAS solutions, namely AAS Type 1 and Type 2. As this initial phase reaches maturity, it becomes essential to shift focus toward AAS Type 3 (proactive), a specific category that extends traditional AAS functionalities by incorporating higher levels of autonomy, intelligence, and collaborative capabilities. However, AAS Type 3 is still in its early stages, lacking formal specifications and comprehensive implementation guidelines. In this context, Multi-Agent Systems (MAS) have been investigated as a means to enhance traditional AAS solutions toward the realization of AAS Type 3, particularly by embedding autonomous, intelligent, and collaborative behaviors. Building on this perspective, this paper explores the role of MAS in realizing AAS Type 3 through a comprehensive analysis of existing agent-based AAS approaches in the literature. Furthermore, this paper proposes a reference model based on common patterns found in the literature to support the development of AAS Type 3 solutions, contributing to the discussion on the formalization of specifications and providing greater clarity on this emerging topic. Finally, to better demonstrate key aspects of the model, some illustrative examples are presented to guide its application and facilitate understanding. Full article

Background and Objectives: AI is transforming healthcare, with family doctors at the forefront. As primary care providers, they play a key role in integrating AI into patient care. Despite AI’s potential, concerns about trust, data privacy, and physician autonomy persist. Little research exists on family doctors’ perspectives. This study investigates the views of Lithuanian family physicians on AI’s ethical challenges and benefits, aiming to support responsible implementation. Materials and Methods: A review of the literature was conducted (2015–2025) using Google Scholar, PubMed, and Scopus. This qualitative study explored family physicians’ perceptions of AI in Lithuania, focusing on ethics, AI’s role, experience, training, and concerns about replacement. Informed consent and ethical guidelines were followed. Results: AI has strong potential in family medicine, automating administrative tasks, improving diagnostic accuracy, and supporting patient autonomy. AI tools, like clinical documentation systems and smart devices save time, allowing physicians to focus on patient care. They also improve diagnostic precision, enabling earlier detection of conditions such as cancer and coronary artery disease. Physicians express concerns about AI’s reliability, biases, and data privacy. While AI boosts efficiency, many emphasize the importance of human oversight in decision-making, especially in complex cases. Privacy concerns around health data and the need for stricter regulations are crucial. Lithuanian family physicians generally accept AI as a helpful tool for routine tasks but remain cautious regarding its trustworthiness. Job displacement concerns were not prevalent, with AI seen as a tool to augment rather than replace their role. Successful AI integration requires training, transparency, and ethical guidelines to build trust and ensure patient safety. Conclusions: AI enhances efficiency in family medicine but requires structured training and ethical safeguards to address concerns about data privacy, accountability, and bias. AI is viewed as supportive, not as a replacement. Full article

Background: Job satisfaction and optimal experiences, often linked to employee engagement and performance, are critical factors for organizational performance. This study investigated job satisfaction and the conditions enabling optimal experiences among employees within a Swedish governmental administration. This study sought to fill a critical gap in understanding job satisfaction within a governmental setting. Method: A mixed methods approach was utilized to collect both quantitative and qualitative data, combining survey data (n = 117) and workshop interviews (n = 14). The quantitative component included measures of job satisfaction, learning, and optimal experience. Results: Optimal experience was strongly associated with job satisfaction and the positive use of knowledge and skills at work. The results also indicated high levels of job satisfaction among participants and frequent opportunities for optimal experience in daily work. The qualitative findings revealed that while employees often felt supported in their roles, organizational constraints and limited autonomy could hinder the consistent occurrence of optimal experience. Participants emphasized the importance of clear communication, prioritization, and a supportive work environment. Conclusion: This study contributed to the understanding of workplace dynamics in governmental organizations, emphasizing the interplay between job satisfaction, knowledge and skills, and optimal experience. The findings underscore the need for addressing organizational barriers to optimal employee experiences within a bureaucratic setting. Full article

The preservation of historic irrigation infrastructure is vital for sustainable water management, especially in regions grappling with rural depopulation, land degradation, and wildfire risk. This study presents a rehabilitation framework for the Acequia del Diablo (Teruel, Spain), a centuries-old gravity-fed canal that supported 60 hectares of agriculture and contributed to ecological connectivity. Its deterioration—following landslides in 1992 and water source loss in 2020—has led to land abandonment, biodiversity decline, and increased wildfire vulnerability. The proposed solution, centered on restoring the original intake at the Azud de Fonseca and stabilizing damaged sections, reestablishes water autonomy and integrates heritage conservation into water governance. A multi-criteria analysis identified this gravity-based alternative as the most technically, economically, and environmentally viable. Drawing from precedents in the literature, the conservation and rehabilitation of historical irrigation systems play a crucial role in sustainable water management in rural areas; this initiative offers a replicable model for other Mediterranean and semi-arid areas. However, challenges include engineering complexity in unstable terrain, administrative delays, and long-term maintenance. Despite these, this intervention enhances rural resilience, wildfire prevention, and biodiversity, while aligning with circular economy principles and European Green Deal objectives. Full article

Medical assistance in dying (MAID) remains a sensitive and evolving issue in Europe, frequently linked with discussions about human freedom, life dignity, and healthcare policy. While national consensus in Italy is absent, the Region of Tuscany has enacted Law No. 16/2025, which establishes a MAID procedure based on recent Constitutional Court rulings. The commentary aims to provide a preliminary analysis of the new law, addressing ethical, medico-legal, and social issues that emerge in relation to the Italian and global debate on the topic. The law establishes a three-stage process based on four eligibility criteria: irreversible disease, psycho-physical suffering, life-support dependence, and informed consent. However, Tuscany’s model poses medico-legal and ethical concerns, particularly about the boundaries of regional legislative competence, the duties of healthcare professionals, and the possibility of intra-national inequity or “health migration.” In addition, critical organisational implications derived from informed consent and lethal drug self-administration impede clinical implementation in some individuals with mental or neurological disorders. The lack of clarity in the different steps of the procedure, the uncertain supervision system, and the potential consequences for specific categories of vulnerable people underline the need for comprehensive national regulation. A future regulatory framework must balance procedural clarity with individual autonomy and equitable access, bringing Italy in line with larger European context for end-of-life care. Full article

Protected areas (PAs) are essential for conserving biodiversity and supporting sustainable development, particularly in ecologically rich yet administratively challenged regions like Romania. This study aims to understand how key stakeholders—local residents and protected area administrators—experience and interpret conservation management in the Southwestern Carpathians, one of Europe’s last remaining large-scale wilderness areas. Using Interpretative Phenomenological Analysis (IPA), the research offers an in-depth qualitative investigation into how individuals perceive, navigate, and negotiate conservation regulations, socio-economic pressures, and sustainable development goals. The findings highlight a deep emotional connection between residents and nature, juxtaposed with tensions over restrictions, perceived loss of autonomy, and limited compensation. Administrators, in turn, face challenges in enforcing regulations, managing tourism, and engaging communities amidst institutional fragmentation and resource constraints. Key findings emphasize the importance of environmental education, trust-building, and participatory governance in reconciling conservation aims with local development needs. The study underscores the need for inclusive, context-sensitive conservation strategies that integrate community perspectives and facilitate cooperation among local authorities, residents, and administrators. These insights contribute to a deeper understanding of stakeholder dynamics and policy implementation within protected areas, emphasizing the importance of co-produced knowledge and adaptive governance. Future research is encouraged to adopt participatory action approaches and expand stakeholder diversity to support more socially inclusive and ecologically resilient conservation practices. Full article

Contemporary human preservation technologies aim to preserve the structure of the body—and especially the brain—after legal death. Although it has not yet been demonstrated, some believe that this may act as a bridge to future medical technologies that could allow for the recovery of life, if this ever becomes feasible and humane. However, current death investigation practices impose two significant obstacles to high-quality preservation. The first and most common is ischemic delay—the period between legal death and initiation of preservation while the death is investigated, during which brain tissue progressively degrades. The second is involuntary autopsy, where tissue disruption can severely compromise preservation quality. Through analysis of legal precedents and the ethical principles of bodily autonomy, non-discrimination, and potential preservation of life, we argue that individuals should be allowed a way to prevent both ischemic delay and autopsy from affecting the quality of their preservation. We explore potential avenues to implement a right to immediate preservation, including administrative, legislative, and judicial approaches, aimed at balancing this right with the societal interest in performing death investigations. This narrative review has implications for individual autonomy, public policy, and the legal framework surrounding death investigation in the context of emerging preservation technologies. Full article

Background/Objectives: Elastomeric infusion pumps have emerged as a transformative tool in outpatient parenteral antimicrobial therapy (OPAT), enabling continuous intravenous administration outside hospital settings, enhancing patient autonomy, reducing healthcare costs, and playing a role in antimicrobial stewardship. This aim of this review is to update current evidence on antibiotic stability in elastomeric infusion pumps, analyzing environmental factors, clinical efficacy, and practical challenges associated with OPAT implementation. Methods: A narrative review was conducted using PubMed and the Cochrane Library, focusing on studies published between 2022 and 2025. Included studies assessed antibiotic stability in elastomeric pumps under real-world and laboratory conditions, examining factors such as temperature sensitivity, light exposure, and material interactions. Results: Findings indicate considerable variability in antibiotic stability, with some agents maintaining prolonged efficacy while others degrade rapidly under certain conditions. Antibiotics with greater stability are better suited for OPAT, whereas those prone to degradation present challenges for continuous infusion. Clinical studies report favorable treatment outcomes, including high cure rates and manageable adverse event profiles. However, discrepancies between laboratory-controlled conditions and real-world settings highlight the necessity for more comprehensive stability evaluations to ensure optimal antibiotic selection and administration in OPAT programs. Conclusions: Optimizing antibiotic formulations, standardizing stability protocols, and advancing elastomeric pump technologies are essential for enhancing OPAT effectiveness. Future research should focus on real-world simulation studies and refining device materials to expand the range of stable antibiotics, ensuring safer and more efficient outpatient antimicrobial therapy. Full article

The autonomy of transport systems presents a transformative opportunity to enhance logistics efficiency, improve safety, and support decarbonization. In the maritime sector, the International Maritime Organization (IMO) has been working since 2016 to develop a mandatory regulatory framework for Maritime Autonomous Surface Ships (MASSs), aiming to finalize a comprehensive code. Simultaneously, pilot projects are underway in national waters under the oversight of national administrations. Naval applications of autonomous ships demonstrate their potential, as emerging doctrines highlight their strategic and operational advantages. Although the military sector is not governed at the international level, safely managing interactions between military and commercial MASSs is crucial for ensuring safe navigation. Classification societies play a vital role in achieving high safety standards and ensuring regulatory compliance. This study aims to propose a framework for certifying maritime autonomous vessels. Through a thorough analysis of the existing literature and by identifying gaps, this study outlines a structured pathway to facilitate the certification and operation of MASSs, addressing key technical, operational, and safety considerations. This research contributes to designing a risk-informed approach for the development of autonomous surface vehicles. Full article

Continuity of care is fundamental to the efficacy of primary healthcare, fostering trust, enhancing patient satisfaction, and improving health outcomes. However, the implementation of Ministerial Decree 77/2022, which advocates for team-based care in multidisciplinary Community Health Centers, presents challenges to these established principles. This article proposes strategies to maintain continuity and trust whilst supporting the reform objectives, specifically tailored to the unique linguistic and cultural context of the Autonomous Province of Bolzano—South Tyrol. A synthesis of regional healthcare reports, academic literature, and practical insights from implementing Ministerial Decree 77/2022 was performed to develop strategies addressing challenges such as ensuring continuity, minimizing administrative burdens, and promoting patient and general practitioner engagement. Strategies include establishing Community Health Centers as integration hubs, assigning primary providers within teams, formalizing personalized care contracts, leveraging digital tools for collaboration, and expanding the roles of nurses and care coordinators. Additional measures focus on building infrastructure for telemedicine and home-based care, engaging patients through transparent communication and feedback loops, and preserving GP autonomy through flexible participation models and incentives. Strategies adapted to accommodate South Tyrol’s demographic, cultural, and systemic characteristics can maintain continuity and trust during the transition to team-based care. By addressing key risks and fostering collaboration among stakeholders, these reforms can enhance healthcare delivery without compromising the principles of personalized, patient-centered care. Full article

In general, young people, and adolescents under protective measures, do not have the digital competence and autonomy necessary to successfully interact with public administrations. Children have the right to quality education that promotes listening, participation, equal access and opportunities, especially in the digital age. However, this remains a global challenge that cannot be waived. For this reason, the main objective of this study is to know the impact of the implementation of a Participatory Action Research (PAR) project carried out with young people living in four sheltered housing facilities in four cities in northwestern Spain. The aim of this project is to improve the digital literacy and autonomy of young people in carrying out procedures and formalities with public administrations and bodies, making them participants in their own learning process. The research was carried out using a qualitative methodology. In total, 44 subjects from different groups (30 adolescents and 14 social educators) participated. As results and conclusions, it is worth highlighting that the experience has improved the digital literacy and autonomy of the young people, observing their progress throughout the sessions. Likewise, the teenagers have actively participated in all the sessions, getting involved and learning through content of interest to them. The level of satisfaction has been very high. Full article

Background: The success of vaccination programs depends on a complex interplay of logistical, social, and structural factors. The objective of this study was to analyze the different approaches to vaccine administration implemented by several Italian regions since the onset of the SARS-CoV-2 pandemic. Methods: After careful qualitative review of information gathered from scientific articles, official reports (grey literature), contact with regional health authorities, and local health departments, five vaccination strategies across several Italian regions focusing on alternative vaccine providers and/or settings were identified. The innovative practices implemented by different actors covered specific topics and were then examined and described in detail. Results: In Veneto, where prevention departments were the main actor, herpes zoster vaccination coverage for the 65-year-old cohort increased from 44.4% to 54.9%; in Tuscany, family pediatricians administered 64% of all childhood vaccines; in Liguria, pharmacies delivered 70.1% of COVID-19 vaccines, while vaccinating in schools in Taranto led to higher human papilloma virus vaccination rates compared to regional and national averages. Finally, in all the regions, hospitals focused on vaccinating healthcare workers and vulnerable populations. Conclusions: The positive outcomes of these five experiences may, in a context of limited resources, encourage other national and international entities to adopt innovative practices, which offer new perspectives beyond the traditional delivery methods (i.e., local health authority vaccination centers for childhood and adolescent immunizations, and family doctors for adults and the elderly). These strategies suggest the efficacy of specific local approaches favored by regional autonomy in optimizing vaccine distribution and coverage. Full article

Background: Ministerial Decree (D.M.) 77/2022 aims to reform Italy’s primary care system by establishing community health centres and integrating digital tools to address healthcare access disparities and workforce shortages. This review focuses on frailty assessment tools, digital health innovations, and workforce challenges in the Autonomous Province of Bolzano, South Tyrol, emphasising interprofessional trust and collaboration issues. Methods: Using a narrative custom review approach guided by the SANRA checklist, this study synthesised findings from PubMed, official health websites, and regional surveys on frailty, workforce dynamics, interprofessional collaboration, and digital infrastructure in South Tyrol. Results: General practitioners (GPs) exhibited high professional motivation but expressed concerns about autonomy and administrative burdens in collaborative care models. Trust issues between GPs and specialists hinder workforce cohesion and care coordination, highlighting the need for structured inter-professional communication. Frailty assessments, such as the PRISMA-7 tool, identify over 33% of community-dwelling individuals aged 75 years and older as frail, necessitating targeted interventions. Digital health adoption, particularly electronic health records and telemedicine, is slow because of workforce shortages and infrastructure limitations. Conclusions: The successful implementation of D.M. 77/2022 in South Tyrol requires addressing workforce challenges, improving interprofessional trust, expanding digital infrastructure, and integrating frailty assessment findings into care strategies. These measures are critical for achieving a more resilient, equitable, and effective primary healthcare system. Full article