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TIME AND RESILIENCE. EVIDENCE FROM A NEW SURVEY OF REFUGEES AND ASYLUM SEEKERS IN ITALY
No full textMigration studies agree that resilience is a crucial dimension for migrants, refugeesand asylum seekers; however, how resilience differs across age groups and its association with the integration process remainpoorly understood. This study aims to investigate the role of time on resilience. Particularly,whether resilience differs by age and whether it is related to the length of time spent in the hostcountry. Our analysis benefits from the ItRAS (Italian Refugees and Asylum Seekers Survey), the first nationally representative survey of asylum seekers and beneficiaries of refugee statusor other forms of international protection. The survey was conducted in 2024 and included individuals who had resided in Italy for at least six months but not before 2011. We exploredthe interplay of time and resilience, controlling for the main individual socio-demographic characteristics. The analysis was grounded in an ordinal logit regression to explain variations in the intensity of refugees’ adapting capacity (ego-resilience). Among older individuals, the probability of being highly resilient is higher than among the younger. On the contrary, there is no significantevidence of the association between the length of stay in Italy and resilience. By providing insights into the role of time in studies on resilience, this paper debunks the view of older people as more vulnerable and in need of support per se, drawing our attention to the need for an accurate vulnerability assessment that does not proceed by stereotyped macro-category
Safety and equity in scaling minimally invasive surgery worldwide in 109 countries using cholecystectomy as a tracer procedure: a prospective cohort study
No full textBackground: Minimally invasive surgery is rapidly expanding globally, yet there is insufficient knowledge of how to scale this technology safely and equitably across diverse health systems. We aimed to identify health-system factors associated with safe implementation of minimally invasive surgery globally, using minimally invasive cholecystectomy as a tracer procedure. Methods: We conducted a multicentre, prospective cohort study of consecutive adults undergoing cholecystectomy between July 31 and Nov 19, 2023, in 1218 hospitals across 109 countries. Data were collected by more than 10 000 health-care workers using a core measurement set mapped to the WHO Health System Building Blocks and the Global Patient Safety Action Plan. The primary outcome was 30-day procedure-specific complications, with multilevel logistic regression used to examine associations between health-system features and patient outcomes. This study is registered on ClinicalTrials.gov (NCT06223061). Findings: Among 52 187 included patients, the adjusted procedure-specific complication rate varied 40-fold between hospitals, from 0·3% in the lowest risk quintile to 12·1% in the highest risk quintile. Despite large structural differences across income groups in access to minimally invasive surgery, diagnostics, and emergency services, country income level was not independently associated with complication rates (adjusted odds ratio [OR] 0·81 [95% CI 0·59-1·10] for upper-middle income vs high income and 0·99 [0·70-1·39] for lower-middle income or low income vs high income). Three modifiable hospital-level factors were strongly associated with safer outcomes: establishment of local simulation-based training facilities (adjusted OR 0·78 [0·71-0·86]; p<0·0001), adoption of intraoperative safety and communication strategies (0·87 [0·79-0·96]; p=0·0046), and on-site CT diagnostics (0·79 [0·65-0·97]; p=0·0220). Training facilities showed the greatest benefit in hospitals with limited infrastructure and an inexperienced workforce: the number needed to treat to prevent a procedure-specific complication was 21 (95% CI 14-35; p<0·0001). Interpretation: Safe implementation of minimally invasive surgery varies widely worldwide but is not defined by national income level; differences in outcomes reflect the ability of health systems to adopt and safely deploy new surgical techniques. We identified for the first time that the presence of local simulation-based training facilities is independently associated with improved patient outcomes. Simulation appears to be fundamental to the safe delivery of minimally invasive surgery, particularly in resource-constrained settings. Together with safety systems and diagnostic capacity, these findings offer actionable targets for health systems seeking to equitably scale up essential surgical technologies. Funding: NIHR Global Health Research Unit and Wellcome Leap SAVE Programme
Clinical Frailty Scale as a Predictor of Early Treatment Discontinuation in Elderly Patients With Chronic Lymphocytic Leukemia Treated With Zanubrutinib: A Multicenter Real‐World Study
No full textABSTRACT
The management of chronic lymphocytic leukemia (CLL) in older patients requires careful balancing of therapeutic efficacy
with the risks of treatment intolerance. Frailty assessment is increasingly recognized as a critical determinant of clinical outcomes, but its specific role in guiding therapy with second‐generation Bruton tyrosine kinase inhibitors remains poorly defined.
We conducted a prospective, multicenter investigation of 326 consecutive CLL patients aged 65 years or older who received
zanubrutinib across 52 Italian centers, aiming to evaluate whether the Clinical Frailty Scale (CFS) could predict treatment
discontinuation in real‐world practice. The cohort was characterized by advanced age (median 78.1 years, range 65.1–94.5), with
over half of the patients presenting with Binet stage C disease. Two‐thirds were treated in the frontline setting, while the
remainder received zanubrutinib as salvage therapy. After a median follow‐up of 8 months, 48 patients (14.7%) discontinued
treatment, most commonly due to toxicity or disease progression. Receiver operating characteristic curve analysis identified a
CFS of 3 as the optimal threshold for predicting discontinuation, with an area under the curve of 0.65 (95% CI 0.56–0.73,
p < 0.001). At 12 months, the discontinuation rate was significantly higher among patients with a CFS > 3 (29.2%) compared
with those with a CFS ≤ 3 (8.8%) (p < 0.001); among conventional prognostic variables, only relapsed/refractory disease
demonstrated an independent association with TTD. These findings highlight the CFS as a simple yet powerful clinical tool that
provides incremental prognostic information beyond standard disease‐related factors. Incorporating frailty assessment into
treatment planning may enhance patient selection and optimize therapeutic strategies for elderly CLL patients in daily practice
Soil Organic Carbon Regulates Nitrogen Mineralization and Uptake from Citrus Sewage Sludge in a Wheat Cropping System
No full textThe need for more sustainable agriculture less dependent on mineral fertilizers has intensified the interest in the reuse of agro-industrial by-products as alternative nutrient sources. This study investigates the agronomic potential of citrus sewage sludge (CSS), derived from citrus wastewater treatment, as a nitrogen (N) source for wheat cultivation. An experiment was conducted using two Mediterranean soils with contrasting physicochemical properties, comparing a non-fertilized control (CTR), inorganic N fertilization (NH4NO3) (CTR + N), and CSS; fertilizers were applied once at 30 mg of N per plant. Differences in soil organic carbon availability and C/N ratio, together with carbonate-related properties, influenced N dynamics in the soil–plant system. In the soil with higher oxidizable organic C and a more
favorable C/N ratio (S1), CSS increased soil ammonium concentrations by about 70% compared with the control and by nearly 50% compared with the soil characterized by lower organic C availability (S2). In S2, the lower concentrations of both NH4+ and NO3− indicate reduced microbial mineralization and nitrification, consistent with its lower availability
of readily degradable organic carbon. Moreover, wheat grown with CSS exhibited a total biomass about 40% higher than that of the CTR. The Mineral Fertilizer Replacement Value (MFRV) reached 73% in S1 and 46% in S2, confirming the potential of CSS as a sustainable N source, particularly in soils where organic C availability supports microbial activity and N transformations. Future strategies should focus on improving CSS use through specific soil management practices
New insights on active geodynamics of Iberia and Northwestern Africa from seismic stress and geodetic strain-rate fields
No full textThe convergence between Eurasia and Africa during Alpine orogeny drives complex geodynamic processes, involving multiple crustal blocks. In the Atlantic-Mediterranean transition zone, the geodynamics is controlled by the two main plates, the former Iberian microplate and the Alboran Domain. Nowadays, these crustal domains, composed of continental and oceanic crust of varying ages, show distinct deformation behaviors under the current regional stress regime. Through analysis of an enhanced earthquake focal mechanism catalog and updated GNSS velocity field, we constrained the crustal stress–strain fields with unprecedented resolution. Three key findings emerged. First, the different crustal blocks interacting in the region determine the stress–strain fields along the plate boundary, allowing us to define four sectors: Atlantic, Gibraltar, Alboran, and Algero-Balearic. Second, in the Atlantic sector, stresses are directly transferred between Africa and Eurasia, while westward they are absorbed by the thinned continental crust of the Alboran Domain and the continental margins of the Gibraltar Arc and Tell Cordillera. This framework, combined with the oblique Eurasia-Africa convergence relative to the Southwestern Iberian margin, could facilitate the clockwise rotation of Iberia. Finally, intraplate regions with low horizontal strain-rates still show tectonic activity influenced by regional compression and other geodynamic processes driven by vertical stresses. This study highlights the value of combined grid-based stress and strain-rate field analysis for understanding geodynamic processes in complex plate boundary regions
Green synthesis of ZnO and CuO nanoparticles and ZnO-CuO nanocomposites: Characterization and photocatalytic dyes removal efficiency's determination
No full textThis study reports the green biogenic synthesis of zinc oxide (ZnO) and copper oxide (CuO) nanoparticles, as well as ZnO–CuO nanocomposites, using an aqueous extract of Capparis spinosa L. leaves. The prepared nanomaterials were extensively characterized, and their photocatalytic performance was assessed under simulated solar light irradiation and ambient conditions for the degradation of anionic (Rose Bengal) and cationic (Rhodamine B) dyes as model of wastewater pollutants. The crystal structure of the photocatalysts was examined using X-ray diffraction (XRD) analysis, scanning electron microscopy (SEM) was employed to disclose the powder's morphology, and Fourier-transform infrared spectroscopy (FTIR) highlighted the role of plant-derived biomolecules as capping and stabilizing agents. Thermogravimetric analysis (TGA) allowed the evaluation of the nanoparticles’ stability, while optical and electrochemical measures were performed to study the electronic behavior of the photocatalysts. After 2 h of irradiation in the presence of 0.3 g/l of ZnO, CuO, or ZnO–CuO, the conversion of Rose Bengal reached 97.1 %, 87.8 %, and 99.9 %, respectively, while 27.5 %, 17.8 %, and 33.9 % were the values obtained for Rhodamine B. This finding demonstrates the effectiveness of our synthesis method as a green and sustainable approach in developing highly active photocatalysts for environmental remediation
Unmet needs in hepatology: The guidance of the Italian association for the study of the liver (AISF)
No full textIn the last decades, the world of hepatology has widely changed. Although relevant advances have be achieved (e.g. the way toward eradication of hepatitis C virus), many challenges are far to be won. Patients with liver disease continue to face noteworthy barriers to early diagnosis and effective disease management. In response to these tasks, the Italian Association for the Study of the Liver formed a multidisciplinary commission to address the unmet needs of people affected by liver diseases. We analyzed the state of the art of the following consolidated unmet needs: stigma (with particular attention to alcohol-related disease and obesity), specific criticisms of elderly, socioeconomic barriers that patients with liver disorders can face, gender gap in many aspects of liver disease and, finally, the complex issue of quality of life. For each unmet need, we proposed a key-message task and some concrete future perspectives. Preserving a holistic vision and using both multidisciplinary and interdisciplinary method, represent the only effective approach to take on the many unmet needs of patients with liver disorders
Mapping the discourse of environmental sustainability in intensive care nursing: a lexicometric exploration of professional meaning-making
No full textIntroduction: Intensive Care Units (ICUs) are among the most resource-intensive hospital environments,
contributing substantially to healthcare’s environmental footprint. While sustainable practices are increasingly
recognized as essential, little is known about how critical care nurses linguistically frame and make sense of
sustainability within their professional culture and daily work.
Aim: To explore how critical care nurses construct and articulate meanings of environmental sustainability in
their professional discourse.
Methods: Semi-structured interviews were conducted with 29 critical care nurses across diverse hospital settings.
Narratives were analyzed using Automatic Analysis of Textual Data (IRaMuTeQ) with similarity analysis to map
term relationships and uncover semantic clusters. Statistical associations (χ2 ≥ 3.84; p < 0.05) guided identification
of lexical hubs and thematic subnetworks. Computational findings were integrated with qualitative
interpretation to ensure contextual depth and rigor.
Results: The central lexical hub, sustainability, connected clusters reflecting reflective engagement, collaborative
responsibility, organizational structures, and systemic gaps. Secondary hubs included environment (ecological
impact and cost considerations), practice (behavioral integration), patient (embedded in bedside care), and waste
(material handling, energy use, lifecycle awareness). Nurses framed sustainability as both a professional duty and
systemic challenge, mediated by organizational support, personal commitment, and environmental constraints.
Conclusions: ICU nurses’ discourse reveals sustainability as a multidimensional construct bridging ethics, operational
practice, and systemic limitations. Lexicometric mapping provides a structured view of how sustainability
is embedded in professional narratives, offering insights to inform targeted educational and organizational
strategies.
Implications for clinical practice: Integrating sustainability into professional identity enhances patient care and
environmental responsibility. These findings deepen understanding of which dimensions of environmental sustainability
can be meaningfully enacted through professional culture and organizational alignment, rather than
through the direct imposition of fixed behavioural routines
