Search Results (1,777)

Background: Education is a cornerstone of antimicrobial stewardship, yet evidence on its impact across the entire hospital workforce remains limited. This study aimed to assess knowledge, attitudes, and practices regarding antibiotic use and AMR among workers employed at an Italian tertiary-care hospital, and to explore the association between questionnaire performance and participation in antibiotic-related training activities. Methods: A repeated cross-sectional survey was conducted in 2024 and 2025 at a large Italian tertiary-care hospital (Padua, Northern Italy). A structured questionnaire adapted from an ECDC-validated instrument was distributed through the institutional email system to all hospital employees, including healthcare professionals and non-healthcare workers. The questionnaire investigated demographic and professional characteristics, participation in antibiotic-related training activities, and knowledge, attitudes and practices regarding antibiotic use and AMR. Questionnaire performance was assessed using both a binary scoring system and a partial credit scoring system. Multivariable linear regression analysis was performed to identify independent predictors of performance. Results: A total of 3193 participants completed the survey (1928 and 1265 in 2024 and in 2025, respectively). The mean (SD) total score was 5.75 ± 2.25 out of 15 points, with the lowest performance observed in the practice domain. No significant differences were found between the two survey years (2024 and 2025). Participants who attended antibiotic-related training performed significantly better than untrained participants (6.23 vs. 5.01; p < 0.001), with prior training emerging as the strongest independent predictor of questionnaire performance (β = 4.8; p < 0.001). Younger age was associated with better performance, while longer seniority (>30 years) was associated with lower scores. Among healthcare professionals, modestly higher scores were observed in 2025 compared with 2024, particularly in the practice domain. Conclusions: Persistent opportunities for improvement remain in AMR-related knowledge, attitudes and particularly practices across the hospital workforce. Participation in antibiotic-related training activities was associated with improved questionnaire performance, supporting the role of structured and continuous educational interventions within hospital AMS programs. Repeated institutional educational initiatives may contribute to strengthening stewardship-related awareness and practices over time. Full article

Flavescence dorée (FD) is a severe grapevine disease associated with FD phytoplasmas (FDp), mainly transmitted by the insect vector Scaphoideus titanus and occurring also in symptomless reservoir plants. This study assessed the genetic variability of putative effector-coding genes (hp) in FDp and FDp-related strains from Northern Italy, assigned to epidemic (M54, M38, M50, M51) and non-epidemic (M39, M43, M78) map genotypes. Based on the reference genome of FDp strain CH, 20 hp loci were selected and analyzed through a multi-locus sequence typing approach. Sixteen loci were amplified in at least one genotype, while four loci failed to amplify under the conditions used. Sequence comparisons showed complete conservation of all amplified hp genes within M54 strains, whereas other genotypes displayed different divergence levels, with the greatest heterogeneity observed in the M50 genotype, including also intra-genotype variation. Several loci exhibited substantial strain-level variability, suggesting locus- and strain-dependent diversification. However, this variability was not consistently associated with biological or epidemiological traits of FDp strains, such as host plant or epidemic status, and its functional relevance therefore remains unresolved. Overall, these results provide a first characterization of sequence diversity in candidate virulence-related loci across FDp genetic backgrounds, revealing additional genetic diversity beyond conventional FDp typing markers and supporting further functional investigation of their possible role in host or vector interactions. Full article

Remote sensing is widely recognized as a key technology across a wide range of technical and scientific domains, especially in agriculture. Although satellite data have long supported crop monitoring, their limitations in spatial resolution, revisit frequency and cloud coverage have often constrained their applications. High-resolution satellites, available from the beginning of the 2000s, have improved performance, particularly in the field of precision agriculture, but they remain expensive and inflexible. Unmanned Aerial Vehicles perform better in precision agriculture, offering flexibility and high levels of detail; however, their limited operational areas and short endurance flight times constrain their effectiveness. In this evolving landscape, High Altitude Pseudo Satellites (HAPSs), particularly high-altitude balloons, are emerging as a promising new technology that could fill the gaps between satellite and drone remote sensing. These platforms provide large area coverage with high-resolution imagery and long endurance flights at low operational expenses and ease of deployment. This study investigates the operational characteristics, strengths, and geometric limitations of data acquired by the CubeHAPS^® platform, a high-altitude pseudo-satellite system, as a prerequisite for its application in precision agriculture. Focusing on experimental campaigns conducted in northern Italy in summer 2024 and 2025, the research characterizes platform stability, image block consistency, and photogrammetric quality through internal metrics. The results demonstrate measurable improvements between the two campaigns, attributed to the introduction of a stabilization system in 2025 and establishing the conditions under which the platform can support reliable photogrammetric reconstruction. Full article

Sandy littorals are highly dynamic coastal ecosystems but remain poorly studied as wintering habitats for waterbirds in Mediterranean regions. We analysed mid-winter International Waterbird Census data collected along the 100 km sandy littoral of the province of Venice, northern Adriatic Sea (Italy), between 1994 and 2022. The dataset included 28 winter censuses, 70 species, and 150,083 individuals. The assemblage was rich but highly uneven: the Yellow-legged Gull Larus michahellis, Dunlin Calidris alpina, Black-headed Gull Chroicocephalus ridibundus, and Great Cormorant Phalacrocorax carbo accounted for most individuals. Total abundance was stable, despite strong interannual variability, whereas species richness increased significantly. Eco-functional guilds showed contrasting trends: benthic feeders and diving piscivores increased moderately, omnivores declined moderately, whereas the trends of the remaining four guilds were classified as uncertain. The Community Temperature Index did not show a significant directional trend, either for the whole assemblage or after excluding dominant species, suggesting that the observed changes cannot be interpreted as progressive thermophilisation. Overall, the Venetian sandy littoral supports a diverse and functionally heterogeneous wintering bird assemblage, whose long-term changes reflect shifts in community structure and the changing use of open-coast, nearshore, and artificial roosting habitats. The results provide a long-term evidence base for identifying conservation-relevant shoreline sectors, protecting feeding and high-tide roosting habitats, regulating disturbance and beach-management practices, and maintaining continued IWC monitoring of open-coast waterbird assemblages. Full article

Springs are biodiversity hotspots and climate refugia, yet they remain among the most overlooked and threatened freshwater ecosystems, largely absent from regional monitoring programs. In the Emilia-Romagna Region (Northern Apennines, Italy), where more than 8400 springs are documented but most persist as unmonitored “ghost springs”, we developed and tested an ecohydrogeological framework to support their long-term monitoring and conservation. Twenty-five springs were selected as representatives of five strategic zones, which we identify, defined by aquifer type (Ophiolites, Turbiditic Sandstones, Shallow Marine Sandstones, Triassic Gypsum, and lowland Fontanili) and characterized through integrated hydrogeological, hydrochemical, and biological sampling. Benthic diatoms (393 species in 69 genera) growing on three different substrates (epibryon, epilithon and epipelon) per spring, vegetation, and physical and chemical parameters were analyzed. Diatom assemblage composition differed significantly among zones (PERMANOVA, p < 0.001), structured primarily by electrical conductivity between sites (community level) and by discharge regime between substrates (microhabitat level); the proportion of aerial diatoms (88 species) proved a useful indicator of discharge fluctuations, inferable from a single biological sample. Threatened taxa (41% of evaluated species) concentrated in the ridge zones. Although calibrated in the Northern Apennines, the five-zone framework offers a biologically validated and transferable tool to other regions for spring conservation as sentinel ecosystems under climate change and anthropogenic exploitation. Full article

We address the challenging problem of predicting the biological quality of a water body based on a set of environmental and management-related drivers. While modelling approaches for predicting water quality from hydrological and pollution-load variables are well established, analogous tools for predicting biological status remain less consolidated. Both components are nevertheless required within the Water Framework Directive to assess ecological status (ES) and support restoration planning. This paper concentrates on the latter challenge by presenting an experience developed over four heavily impacted rivers in Regione Lombardia (Northern Italy). Rutinary environmental, hydromorphological and biological data were systematized to develop a predictive framework linking management-related pressures to the macroinvertebrate component of ecological status. A rule-based classifier, denominated MacroSimply, was developed and compared with alternative statistical and machine learning approaches: logistic regression, a classification tree (CHAID), and a multilayer perceptron neural network. The tested models exhibited different strengths and weaknesses: Logistic regression provided a good balance between predictive performance and interpretability; the classification tree generated transparent threshold-based decision rules; and the neural network captured potentially complex non-linear relationships, albeit with reduced interpretability. MacroSimply achieved predictive performance comparable to the alternative approaches, and performing even higher reliability, while maintaining full transparency of the structure and a direct connection between predictors and management actions. The proposed framework was subsequently implemented in a spreadsheet-based tool to be easily used in restoration planning exercises. Although the obtained model should not be considered the definitive modelling solution even for our particular case, the results suggest that the adopted rule-based approach represents a working, valuable option preferrable to more complex data-driven methods when interpretability, reproducibility and practical applicability are key requirements for environmental management. Full article

Background: The movement of endemic diseases from tropical and disadvantaged areas is gradually spreading to developed countries as well. Amoebiasis, in particular, represents a significant threat to public health, amplified by globalization and increasing contact between humans and animals or vectors. In this way, atypical diseases may emerge in our country, also through an unusual mode of transmission—likely sexual, as “sexually transmitted enteric (STE) diseases”. Objective: We report and discuss the clinic approach to a rare case of dual human infestations by ecto- and endo-parasites with multiple liver abscesses presentation in a young truck driver residing in Northern Italy. Methods: The patient underwent a comprehensive screening with laboratory and microbiological tests, and CT images. Results: In July, the patient was admitted to our hepatology unit following the ultrasound identification of two hypoechoic lesions in the right lobe of the liver. In his medical history, in April, after a seemingly harmless infestation of body lice, effectively treated, he suffered from a prolonged and debilitating episode of acute diarrhea, lasting a month. This status was also accompanied by intestinal cramps, weight loss, and recurring fever episodes. Afterwards also appeared a Quincke’s-like angioedema involving the lips and mouth mucosa, with evening time exacerbation. Conclusions: The differential diagnosis of this complex and unusual clinical picture, together with the temporal evolution of the patient’s signs and symptoms, led us to hypothesize the presence of concomitant infections. These were most likely borreliosis and a STE disease, the latter ultimately diagnosed as amebiasis with hepatic invasion, allowing appropriate treatment and a favorable clinical outcome. Full article

Sudden outbreaks of exudative epidermitis (EE) are managed with antibiotics. This retrospective observational study evaluated the antimicrobial susceptibility of Staphylococcus (S.) hyicus strains isolated in Northern Italy between January 2022 and April 2025. Isolates were recovered from clinical cases submitted to IZSLER diagnostic laboratories. To ensure data independence, only one isolate per pig farm or strains from the same farm isolated at least 6 months apart were included in the final analysis. Strains resulted from bacteriological examinations on skin swabs (65) and synovial fluid (1) of pigs with EE. Antimicrobial susceptibility was assessed by determining the MIC of 16 antimicrobials in broth microdilution. MIC₅₀ and MIC₉₀ values were determined, and strains were classified as wild-type (WT) or non-WT according to EUCAST ECOFFs. Each antimicrobial showed different sub-populations with reduced susceptibility. MIC₅₀ and MIC₉₀ values were identical or differed by one dilution for most antimicrobials. The highest ratios of non-WT strains were penicillin (97%), tetracycline (91%), and clindamycin (90%). Conversely, non-WT strains ranged between 3 and 6% for oxacillin, cefazolin, ceftiofur, and rifampin. Full article

This study presents a multidisciplinary investigation of the fluvial evolution of the northern meander of the Calore River at Cellarulo locality, near Benevento (southern Italy). The research integrates archaeological evidence, geological and geomorphological data, historical cartography, remote sensing imagery and geophysical surveys in a Geographic Information System (GIS) environment. Multi-temporal analysis of historical maps, aerial photographs and satellite images from 1824 to 2022 allowed the reconstruction of channel migration patterns and the identification of abandoned meanders and paleochannel traces. Stratigraphic data derived from boreholes revealed the presence of a channel of the Calore River dated at least in the Bronze Age (3900 years ago), abandoned in the nineteenth century. Geoelectrical investigations provided detailed information on subsurface resistivity anomalies, highlighting the presence of buried structures and possible ancient anthropogenic features located at shallow depths between 1 and 1.5 m. The combined interpretation of geomorphological, archaeological and geophysical data demonstrates significant data on the unveiling of an ancient river channel and its abandonment during the last 150 years, suggesting a strong interaction between natural fluvial dynamics and human occupation. The results confirm the effectiveness of an integrated multidisciplinary approach for reconstructing fluvial landscape evolution and for identifying buried archaeological and geomorphological features in complex floodplain environments. Full article

Background: Palliative care is a clinically, relationally and emotionally demanding field. Continuous exposure to suffering and death exposes professionals to compassion fatigue, vicarious trauma and grief, and burnout, while also offering opportunities for compassion satisfaction and meaning-making. How professionals cope is central to sustaining the supporting role in diseases with a poor prognosis. Objectives: To explore the emotional and experiential dimensions of palliative care work and the coping strategies, individual and team-based, that professionals deploy when accompanying patients and families at the end of life. Methods: Reflexive thematic analysis of 16 semi-structured interviews with palliative care professionals (5 physicians, 7 nurses, 3 psychologists, and 1 social-health worker; 14 women and 2 men) recruited from hospices, hospital wards and home-based services in Northern Italy. Sample size was guided by an information power model. Reporting follows the COREQ checklist. Results: Four themes were constructed: (1) the unsustainability of the workload; (2) the pleasure of care between empathic relationship, listening and welcoming; (3) the holistic role of the professional; and (4) the awareness of death. Across themes, participants mobilised a layered repertoire of problem-, emotion- and meaning-focused coping. Narratives fitting a structured moral-distress pattern were comparatively limited in participants’ accounts. Conclusions: Sustaining supporting roles in poor-prognosis care may require more than individual resilience; it depends on organisational support—structured supervision, reflective spaces, and communication and emotional training—that makes professionals’ largely informal coping work a shared and sustainable resource. Full article

Background: Healthcare-associated infections (HAIs) remain a major patient safety issue, and hand hygiene (HH) is a key preventive measure. Technologies providing immediate visual feedback may support HH training by allowing objective assessment of hand-rubbing technique. Methods: A multicenter quality improvement project was conducted in three hospitals in northern Italy to assess scanner-measured HH performance over time after a standardized HH training program supported by an automated visual feedback scanner, the Semmelweis Hand Hygiene System^®. Nurses and nurse aides performed scanner assessments before training (T0) and up to 6–9 months after training (T1–T4). Data included demographic variables, baseline HH knowledge, ring detection, and scanner pass/fail outcomes. Longitudinal changes were analyzed using adjusted generalized estimating equation (GEE) logistic regression models. Results: A total of 292 healthcare professionals participated in the project (69.2% nurses; mean age 42 years; 81.1% female). At baseline, 44.2% failed the scanner assessment, with dorsum areas being the most frequently insufficiently covered, and 36.0% wore rings. Across 2422 scanner assessments, pass rates improved over time. In adjusted GEE models, each additional scheduled month from baseline was associated with higher odds of passing the scanner assessment (OR = 1.18, 95% CI 1.13–1.24, p < 0.001). This association remained significant in the first-scan-only sensitivity analysis (OR = 1.16, 95% CI 1.11–1.21, p < 0.001). The association was also confirmed in a completers-only sensitivity analysis. Ring detection was associated with lower odds of passing, whereas baseline HH knowledge was not independently associated with scanner performance. Conclusions: Scanner-based immediate feedback was associated with improved scanner-measured HH technique over time. However, the quality improvement design, absence of a control group, use of the scanner as both feedback tool and outcome measure, and declining retention across follow-up assessments limit causal interpretation. Scanner-supported feedback may represent a useful adjunct to traditional HH education, but further controlled studies are needed to assess sustainability and real-world HH compliance. Full article

This research investigates the development of integrated knowledge systems for built heritage located in Italian Inner Areas, marginal territories characterised by socio-economic fragility and the progressive weakening of traditional settlement systems. Within these contexts, built heritage is deeply interconnected with the landscape as a result of long-standing interaction processes between man and territory. Yet it is often affected by limited, fragmented information and inadequate digital management frameworks. This study addresses these issues by developing a methodological approach grounded in multidisciplinary, multiscalar, transcalar, and diachronic principles to reconnect territorial and architectural dimensions within a unified interpretative framework. The Alpine municipality of Dosso del Liro (Northern Italy) was selected as a representative case study for testing the applicability of an integrated H-GIS-BIM workflow under conditions typical of marginal contexts. The research combines desk-based and field-based investigations. Information was organised with regard to the historical and diachronic features of assets and then integrated into a digital environment developed using GIS, HBIM, and conversion workflows. The results demonstrate the accessibility of H-GIS-BIM strategies through a methodological approach and their support for enriching analyses of diffuse heritage, while also highlighting current limitations regarding workflow, interoperability, semantic preservation, and dynamic data updating. Full article

An $M_W=4.8$ earthquake occurred on 14 March 2025 in the Adriatic offshore from the coastal Lake of Lesina (northern Apulia, southern Italy). According to the National Institute of Geophysics and Volcanology (INGV) database, this event represents the main shock of a seismic sequence that developed within the upper continental crust of the Adria Plate, mainly during spring 2025. Focal mechanisms were calculated for the most energetic earthquakes, and the resulting solutions display consistent kinematic characteristics and similar nodal plane orientations. To investigate the possible seismogenic source, a three-dimensional regression analysis was applied to the spatial distribution of 91 hypocenters from this sequence. This analysis provides a three-dimensional visualization of a best-fit surface, defining its geometry and spatial attitude. The hypocentral distribution closely aligns with one of the two representative nodal planes derived from focal mechanisms. Based on these results and available literature data, a discussion is proposed on the potential seismogenic source. Considering that the Lesina coastal area was struck by a destructive tsunami in the seventeenth century, whose source remains debated, these new observations offer a valuable framework for future seismotectonic studies and improved regional seismic hazard assessment. Full article

Background: Founder mutations in MYBPC3 may contribute substantially to the genetic burden of hypertrophic cardiomyopathy (HCM) and provide important insights into genotype–phenotype correlations and population-specific disease mechanisms. In this study, we investigated two recurrent canonical splice-site variants, MYBPC3 c.1458-1G>A and c.3331-1G>A, identified in patients with HCM from the Emilia-Romagna region of Northern Italy. Methods: Ninety-one unrelated patients with HCM carrying either MYBPC3c.1458-1G>A or c.3331-1G>A were analyzed. Haplotype reconstruction was performed to assess a possible founder effect and estimate the approximate age of the shared ancestral allele. Functional characterization was carried out by RNA sequencing of myocardial tissue to evaluate the impact of the variants on splicing. Clinical and phenotypic data were compared with those of carriers of other truncating MYBPC3 variants or pathogenic variants in other sarcomeric genes. Results: Both variants, classified as pathogenic according to ACMG criteria, shared a conserved variant-specific core haplotype. Founder age was estimated at approximately 10.5 generations (~262 years), consistent with a regional founder effect. RNA sequencing demonstrated aberrant splicing for both variants, resulting in premature termination codons and presumably subsequent nonsense-mediated mRNA decay. Clinically, carriers showed delayed disease onset, with a mean onset in the fifth decade of life, and a comparatively milder phenotype, including a lower incidence of sudden cardiac death, than patients carrying other truncating MYBPC3 variants or pathogenic variants in other sarcomeric genes. Both variants exhibited partial penetrance (approximately 63–67%) and age-dependent variable expressivity. Conclusions:MYBPC3 c.1458-1G>A and c.3331-1G>A represent novel founder alleles associated with HCM in Northern Italy. Identification of these locally prevalent variants improves molecular diagnosis, family screening, and supports the development of variant-targeted therapeutic approaches. Full article

Background/Objectives: Family caregiving for people living with dementia is central to ageing and long-term care, but it is not only a practical arrangement but also a relational and structurally shaped experience. Care may be grounded in affection, responsibility, and connection, while still becoming difficult to refuse, share, or limit. Although caregiver burden is well documented, less is known about how former caregivers retrospectively appraise the caregiving role after active care has ended. This study examined role captivity among former family caregivers, focusing on constrained choice, subjective role engulfment, perceived support, and caregiver wellbeing. Methods: A retrospective cross-sectional mixed-methods survey was conducted among 180 former family caregivers of people living with dementia in Northern Italy. Quantitative analyses examined associations between role-captivity-related indicators and retrospective caregiving outcomes. Open-ended responses were analysed using theory-informed qualitative content analysis. Results: Constrained choice at caregiving uptake was reported by 22.2% of participants, and 56.1% met the criterion for subjective role engulfment. Overall, 60.0% would provide family care again, while only 28.3% would be willing to receive family care themselves. One in five reported caregiving-related health problems. In multivariable models, constrained choice was associated with lower willingness to provide care again (OR = 0.27, p = 0.002) and less positive retrospective appraisal (OR = 0.35, p = 0.036). Subjective role engulfment was independently associated with less positive appraisal (OR = 0.36, p = 0.008), while perceived support was associated with positive appraisal (OR = 6.31, p < 0.001) and perceived processing (OR = 2.68, p = 0.013). Qualitative findings showed that caregiving was often remembered as meaningful and relationally important, yet difficult to refuse, progressively all-consuming, and shaped by structural and informational barriers. Conclusions: Retrospective appraisal of family dementia caregiving depends not only on care demands, but also on whether care was experienced as chosen, bounded, shared, and supported. Role captivity helps identify when relationally meaningful care becomes difficult to sustain and highlights the need for caregiver-sensitive dementia care that protects agency, role boundaries, and access to timely support. Full article