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Beneath the City: Micromorphological Insights into Etruscan Urban Life, Infrastructure, and Ritual Practices from Tarquinia, Central Italy
No full textDuring the late Bronze and Early Iron Age, population dynamics in central Italy gave rise to nucleated settlements that
went on to become some of western Europe’s earliest and most powerful cities. Between 1000 and 500 BCE, these centres
transformed from village agglomerations into organised urban settlements as part of a regional political system. While
the key archaeological features and architectural transformations that characterise this period are well established, site
formation processes and the intra-settlement spaces and activities underpinning them are less defined, especially for the
earliest phases. To gain new insights on the transformation into urban settlements in a Mediterranean context, this research
systematically investigates – for the first time – the micromorphology of archaeological sediments of an urban settlement
of the first half of the first millennium BCE. Here we present a micro-contextual analysis from Tarquinia (central
Italy), one of the most important sites for understanding central Mediterranean urbanisation and community formation, a
prominent pre-Roman city and centre of the Etruscan religion and political activity. On-going excavations have unravelled
an extensive part of the city and yielded important evidence of ritual activity around the so-called ‘monumental complex’
(1st millennium BCE). Targeting 4 areas with high preservation of deposits of the city’s early formative processes,
this work integrates archaeological soil micromorphology, physico-chemical and geochemical analyses to reconstruct the
depositional and post-depositional processes of the archaeological layers across the ‘monumental complex’ of Tarquinia.
This study sheds new light on fills of earthen pits, linking them to the dumping of occupational and production debris
and accumulation of animal penning residues. It also adds detailed insights into the composition of traffic surfaces and
highlights the integration of ritual spaces within urban formation processes. Results demonstrate the variability of sedimentary
microfacies that can occur in protohistoric sites of Central Italy and adds significant micro-contextual evidence
to the understanding of urban, ritual, and socio-economic across Etruscan settlements, ultimately highlighting the critical
role of archaeological sediments in tracing shifting phases of use at the emergence of early urbanisation in the Mediterranean
region
VERSO UNA SANITÀ VALUE-BASED: IL RUOLO DELLA DIGITALIZZAZIONE E DELLA TELEMEDICINA
No full textLa tesi esplora come la sanità digitale, e in particolare la telemedicina, possa contribuire alla realizzazione di una sanità orientata al valore, integrando la prospettiva della Value-Based Health Care con un framework di co-creazione di valore adattato al contesto digitale. L’obiettivo generale è analizzare e rendere operativo questo modello, comprendendo come antecedenti, attività manageriali e outcome si combinano per generare valore personale, tecnico, allocativo e sociale per pazienti, professionisti, organizzazioni e comunità.
Sul piano teorico, il lavoro sviluppa un framework di co-creazione in sanità digitale che distingue tre blocchi principali: antecedenti (fattori relativi a utente, professionista, erogatore e servizio), attività manageriali (pianificazione, accountability, gestione di pazienti e professionisti) ed esiti (per paziente, professionista, erogatore e comunità), collocati all’interno di un ecosistema abilitato dalla tecnologia. Questo framework viene messo in relazione con le quattro dimensioni del valore della VBHC, attraverso una matrice che incrocia i blocchi del framework con il valore personale, tecnico, allocativo e sociale, utilizzata come griglia di lettura dei casi empirici.
Metodologicamente, la tesi adotta un disegno multi-metodo e multi-stakeholder, combinando indagini quantitative, sviluppo di strumenti di misurazione, progettazione di soluzioni digitali e analisi configurazionale. Cinque case study principali e alcuni progetti aggiuntivi coprono diversi attori e setting: una survey nazionale su pazienti e professionisti (case study A) e una survey multicentrica su studenti di medicina e specializzandi (case study B) analizzano gli antecedenti digitali dell’adozione della telemedicina; un esperimento di telehomecare pediatrica (case study C) esamina la co-creazione digitale tra paziente, caregiver e team clinico; una piattaforma di business intelligence per una rete di servizi diagnostici (case study D) e un sistema di indicatori per il percorso chirurgico in una azienda sanitaria pubblica (case study E) mostrano come i dati possano abilitare una gestione per esiti e costi. I progetti aggiuntivi riguardano la telehealth e l’intelligenza artificiale, lo sviluppo di percorsi digitali con monitoraggio remoto e la messa a punto di metodologie per sfruttare nuove fonti informative.
I risultati evidenziano, in primo luogo, che gli antecedenti digitali, in particolare alfabetizzazione digitale in ambito salute, familiarità con i servizi digitali e atteggiamenti verso la tecnologia, spiegano in modo più rilevante delle variabili socio-demografiche la propensione di utenti e futuri professionisti a utilizzare e co-produrre telemedicina. In secondo luogo, mostrano che la co-creazione digitale genera valore personale e sociale quando è sostenuta da attività manageriali coerenti: chiarezza di ruoli, formazione mirata di pazienti, caregiver e professionisti, canali di contatto strutturati, regole di ingaggio e responsabilità esplicite. In terzo luogo, i casi lato erogatore dimostrano che piattaforme interoperabili, cruscotti clinico–manageriali e insiemi di indicatori standardizzati permettono di misurare in modo integrato esiti clinici, esiti riferiti dai pazienti, processi e costi lungo il ciclo di cura, abilitando riallocazioni da low a high value care e rendendo concreta l’agenda della VBHC.
La tesi propone infine una lettura di governance in cui la telemedicina funziona come dispositivo di composizione delle tensioni tra valore personale e valore allocativo, assumendo il valore sociale come criterio di riferimento. L’interoperabilità dei dati, la presenza di un’infrastruttura socio-tecnica abilitante e l’investimento continuativo nelle capacità di pazienti e professionisti emergono come condizioni necessarie perché la digitalizzazione si traduca stabilmente in co-creazione di valore, anziché in semplice aggiunta di tecnologia. Il contributo complessivo è teorico (integrazione tra VBHC e co-creazione digitale in una prospettiva multi-stakeholder), metodologico (operazionalizzazione del framework tramite matrice framework × valore e sistemi di misurazione) e applicativo (implicazioni per governance, organizzazione, progettazione di piattaforme e percorsi di telemedicina orientati al valore).This thesis explores how digital health, and telemedicine in particular, can contribute to the realization of value-based healthcare, by integrating the Value-Based Health Care (VBHC) perspective with a co-creation of value framework adapted to the digital context. The general objective is to analyse and operationalize this model, understanding how antecedents, managerial activities and outcomes combine to generate personal, technical, allocative and social value for patients, professionals, organizations and communities.
At the theoretical level, the work develops a co-creation framework for digital health that distinguishes three main blocks: antecedents (factors related to user, professional, provider and service), managerial activities (planning, accountability, management of patients and professionals), and outcomes (for patients, professionals, providers and communities), all located within a technology-enabled ecosystem. This framework is linked to the four value dimensions of VBHC through a matrix that crosses the framework blocks with personal, technical, allocative and social value, used as an interpretive grid for the empirical cases.
Methodologically, the thesis adopts a multi-method and multi-stakeholder design, combining quantitative surveys, development of measurement tools, design of digital solutions and configurational analysis. Five main case studies and several additional projects cover different actors and settings: a national survey on patients and professionals (case study A) and a multicentre survey on medical students and residents (case study B) analyse the digital antecedents of telemedicine adoption; a telehomecare experiment in paediatrics (case study C) examines digital co-creation between patient, caregiver and clinical team; a real-time business intelligence platform for a diagnostic services network (case study D) and an indicator system for the surgical pathway in a public healthcare organization (case study E) show how data can enable management by outcomes and costs. The additional projects address telehealth and artificial intelligence, the development of digitally supported care pathways with remote monitoring, and the design of methods to exploit new data sources.
The results show, first, that digital antecedents (in particular digital health literacy, familiarity with digital services and attitudes towards technology) explain more than socio-demographic variables the propensity of users and future professionals to use and co-produce telemedicine. Second, they show that digital co-creation generates personal and social value when it is supported by coherent managerial activities: clear roles, targeted training for patients, caregivers and professionals, structured communication channels, explicit rules of engagement and responsibilities. Third, the provider-side cases demonstrate that interoperable platforms, clinical–managerial dashboards and sets of standardized indicators make it possible to measure, in an integrated way, clinical outcomes, patient-reported outcomes, processes and costs along the care cycle, thereby enabling reallocations from low- to high-value care and making the VBHC agenda operational.
The thesis finally proposes a governance view in which telemedicine functions as a device to compose tensions between personal and allocative value, taking social value as the key reference criterion. Data interoperability, the presence of an enabling socio-technical infrastructure and sustained investment in the capabilities of patients and professionals emerge as necessary conditions for digitalization to translate into stable co-creation of value, rather than into a mere addition of technology. Overall, the thesis provides a theoretical contribution (integration of VBHC and digital co-creation in a multi-stakeholder perspective), a methodological contribution (operationalization of the framework through a framework × value matrix and measurement systems), and a practical contribution (implications for governance, organization, and the design of platforms and telemedicine pathways oriented to value)
Amniotic mesenchymal stromal/stem cell–derived extracellular vesicles for equine chronic degenerative endometritis treatment
No full textBackground: Equine chronic degenerative endometritis (CDE) is a progressive process characterized by endometrial fibrosis that could be responsible for alterations of uterine environment and foetal-maternal communication. Objectives: The aim of this study was to try to restore this communication by intrauterine administrations of amniotic cell-derived extracellular vesicles (AMC-EVs) in a case series. Study design: Twelve mares were selected on the basis of their reproductive history of early embryonic loss or abortion and clinical suspicion of CDE subsequently verified with histopathological examination of endometrial biopsies. Methods: Gynaecological and ultrasound examinations and histopathological examination of endometrial biopsies were performed. Mares were divided into two groups: Seven mares in Group 1 received a single treatment cycle (corresponding to two intrauterine AMC-EV administrations), whereas five mares of Group 2 received two treatment cycles (corresponding to four intrauterine AMC-EV administrations). Each administration was of 20 billion AMC-EVs diluted in 50 mL of sterile saline solution. Results: Eleven mares were able to establish pregnancy after the treatment with AMC-EVs without significant difference in pregnancy outcomes between one or two treatment cycles (six out of seven mares of Group 1 and all mares of Group 2 were pregnant), suggesting that one cycle may be sufficient. The histological condition of their endometrium did not show any improvement in Kenney-Doig classification, meaning AMC-EVs did not exert regenerative activity but probably contributed to re-establishing a functional paracrine interaction between embryo and maternal tissues. Main limitations: This study has the limitation of the small number of animals enrolled and the lack of a control group. However, considering the large number of past artificial insemination attempts for each animal enrolled in this study, each mare could be considered self-control. Conclusions: It would seem possible that AMC-EVs supported and enhanced foetal-maternal communication that was compromised by CDE
ULTRA-PROCESSED FOODS:FROM NUTRITIONAL CHARACTERISTICS TO THE IMPACT ON HUMAN HEALTH
No full textHistorically, nutritional science has focused on individual nutrients or bioactive compounds as determinants of health. While this reductionist approach led to major discoveries, such as the prevention of nutrient deficiencies, it proved inadequate for addressing complex chronic diseases, where the effects of foods depend on the interactions between multiple components and the broader dietary context. Consequently, the field has shifted toward studying whole foods, and more recently the overall dietary pattern, intended as adequate portion and frequencies of consumption of foods. It has been argued that the issue from the point of human health is not nutrients nor foods, as the type, degree and purpose of processing. In this context, the NOVA classification introduced the concept of “ultra-processed foods”. Although this framework has been widely adopted, its scientific robustness and reproducibility remain under debate. This PhD thesis aimed to explore the role of food processing, serving sizes, and UPFs in shaping food-based dietary guidelines (FBDGs) and influencing human health. The research comprised four main components.
The first section of the work included a global scoping review of 100 national FBDGs. This first review revealed large variability in how countries define serving sizes and consumption frequencies, ranging from quantitative to purely qualitative formats, with limited harmonization. These inconsistencies hinder effective public health communication and cross-country comparability. The second review of this first section consisted in the analysis of terminology and wording related to food processing in worldwide FBDGs. In total, 75 national guidelines were investigated. Among the 89% of documents referring to processing, 25% mention UPFs and fewer cite the NOVA system, reflecting conceptual ambiguity and uneven integration of processing-related terminology in policy documents. In view to the fact that industrial foods are often perceived with a lower nutritional quality and safety with respect to home-made preparations, the second section of this work is a comparative experimental analysis of home-made versus industrially produced foods (plum cake, fish sticks, tomato sauce, cereal bars). This study demonstrated that when the same ingredients and methods are used, nutritional composition and contaminants levels (e.g., acrylamide) are largely comparable. These findings challenge the assumption that industrial foods are intrinsically less healthy or less safe than home-made equivalents. Moreover, based on the consideration that most current evidence on UPF derives from observational studies, in the third section of this thesis a systematic review of randomized controlled trials on UPF consumption was performed. The analysis revealed heterogeneous methodologies and inconclusive results, though some studies suggested higher energy intake and adverse changes in body composition with UPF-rich diets supporting that nutritional quality of diet play a pivotal role in determining the effect on human health. Finally, in the last section, the PROMENADE randomized controlled crossover trial evaluated the inclusion of five daily UPF servings within an isocaloric Mediterranean diet (MD) in overweight adults. Preliminary data showed no adverse effects on anthropometric, or lipid parameters after 12 weeks, suggesting that moderate UPF inclusion in a balanced MD does not impair short-term cardiometabolic health. In conclusion, this thesis highlights that the health impact of a diet cannot be fully explained by the degree of processing alone. Instead, the overall dietary context, quality, and balance play a pivotal role. Therefore, further well-designed and rigorously conducted research is essential to inform future food policies, as relying solely on broad or unobjective classifications of food processing risks fostering confusion and misinterpretation rather than promoting clear, evidence-based public health guidance
Treatment response after induction therapy in advanced thymic tumors: results from the Italian nationwide TYME database
No full textBackground: Induction therapy (IT) prior to surgery is a key strategy to improve resectability in advanced thymic tumors (ATTs). This study aimed to assess prognostic factors and the impact of IT on clinical outcomes. Material and methods: We retrospectively analyzed 64 patients with TNM-stage II–IV ATTs treated with IT and surgery between January 2002 and December 2024, using data from the TYME multicenter Italian database. Radiological response (RR) was defined by RECIST v1.1. Statistical comparisons were performed using Chi-square, t-test, or Wilcoxon rank-sum test. Univariate and multivariate logistic models evaluated associations between variables and outcomes. Results: Mean age was 52 years; 58 % were male. Most tumors (83.4 %) were stage III–IV, with thymoma as the predominant histology (79.7 %). Radiological signs of mediastinal or vascular invasion and tumor diameter > 5 cm were present in over 86 % of cases. Platinum-based chemotherapy was administered in 96.9 %, with CAP regimen used in 62.5 %. Partial response was achieved in 69 % (Responders, RE), while 31 % had stable/progressive disease (Non-responders, NRE). Extended surgery was performed in 84.4 %, with R0 resection in 76.3 %. Adjuvant therapy was administered in 66.7 % of cases. Relapse occurred in 78.6 % (local) and 21.4 % (distant). No significant differences were found between RE and NRE in clinical, radiological, or pathological features. Five-year OS (88 % vs 93 %) and RFS (45 % vs 43 %) were similar between groups. ECOG performance status was the strongest independent predictor of better RFS (OR 7.18), while ASA score was associated with RR (OR 0.20). Conclusion: The TYME database analyses revealed no significant outcome differences between RE and NRE following IT in ATTs, underscoring the complexity of predicting long-term outcomes based on RR alone. This study also suggests the prognostic value of physical status via ASA score and ECOG PS. Further studies with varied chemo regimens are needed to improve response rates in multimodal ATT therapy. Accepted as poster presentation at ESMO Congress 2025, October 17-21, 2025 – Berlin
Applicazione dell’Intelligenza Artificiale nella predizione delle complicanze postoperatorie nella chirurgia tiroidea: una revisione sistematica e meta-analisi della letteratura
No full textLa chirurgia tiroidea, pur garantendo elevati standard di sicurezza, può essere gravata da complicanze come ipoparatiroidismo,
lesioni del nervo laringeo ricorrente, emorragie e infezioni. L’avvento dell’intelligenza artificiale (AI) e del machine
learning (ML) offre nuove prospettive nella predizione personalizzata del rischio e nella prevenzione delle complicanze chirurgiche.
È stata condotta una revisione sistematica secondo le linee guida PRISMA 2020, analizzando articoli pubblicati tra
gennaio 2023 e settembre 2025 nei database PubMed, Scopus eWeb of Science. Sono stati inclusi studi originali, prospettici,
retrospettivi, revisioni e meta-analisi in lingua inglese o cinese che descrivono modelli di AI per la predizione di complicanze
postoperatorie dopo tiroidectomia, con coorti di almeno 100 pazienti. Le evidenze più recenti mostrano che reti neurali
artificiali e modelli di deep learning raggiungono valori di AUC compresi tra 0,71 e 0,78 per la predizione di complicanze
chirurgiche maggiori, e fino a 0,93 per modelli radiomici e radiopatologici. Sistemi basati su Support Vector Machines,
Decision Trees e Random Forest hanno ottenuto accuratezze superiori al 90% nella stratificazione del rischio di recidiva
del carcinoma tiroideo. L’integrazione di dati clinici, biologici e radiomici consente una predizione multidimensionale e
individualizzata del rischio di complicanze e recidiva. L’AI consente una stratificazione prechirurgica più accurata e l’identificazione
intraoperatoria delle strutture critiche, migliorando la sicurezza e riducendo la variabilità operatore-dipendente.
Tuttavia, la traduzione clinica è limitata da eterogeneità metodologica, dataset monocentrici e assenza di validazioni multicentriche
su popolazioni etnicamente diverse. L’adozione di modelli trasparenti e spiegabili (explainable AI) rappresenta il
prossimo passo per garantire affidabilità, tracciabilità e accettabilità clinica
Effects of a Glycosylated Form of Active Vitamin D Combined with Natural Triterpenes on Sow Productive Performance, Mineral Homeostasis, Immune Biomarkers and Serum Proteome
No full textThis study evaluated the effects of the dietary administration of a glycosylated form of active vitamin D (calcitriol, 1,25(OH)2D3) combined with ursolic acid (UA) and oleanolic acid (OA) triterpenes on sow health and productivity. Twenty-four third-parity Landrace × Large White sows were allocated at day 108 of gestation into three groups: a control group receiving 1800 IU/kg of vitamin D3, and two treatment groups receiving the control diet supplemented with either 0.64 μg/kg (ACTD1) or 0.96 μg/kg (ACTD2) of glycosylated 1,25(OH)2D3 plus 140 or 210 μg/kg of UA + OA (4:1 ratio), respectively. Diets were administered from late gestation through the end of lactation. Farrowing duration, sow bodyweight, backfat thickness, and litter growth were recorded. Blood samples collected at key physiological stages were analyzed for pro-inflammatory cytokines, mineral homeostasis, endocrine markers, and serum proteome. Farrowing time was reduced in both treatment groups compared with the control (p < 0.05). Treated sows exhibited lower backfat thickness at the end of lactation and improved litter weights at farrowing, after cross-fostering, and at weaning (p < 0.05). Plasma pro-inflammatory cytokines (TNF-α, IL-1α, and IL-1β) were reduced at the end of lactation in ACTD1 and ACTD2 sows, with TNF-α and IL-1β already decreased after farrowing (p < 0.05). Treated sows also displayed decreased plasma parathormone concentrations at the end of lactation, along with increased circulating 1,25(OH)2D3 and calcium concentrations after farrowing and at lactation end (p < 0.05), while plasma phosphate levels remained unchanged. Proteomic analysis supported the systemic availability of the supplemented compounds and their involvement in metabolic and inflammatory pathways rather than calcium transport or vitamin D binding mechanisms. Overall, this nutritional strategy influenced the immune modulation while maintaining mineral homeostasis via modest endocrine adaptations. Larger-scale trials are warranted to confirm these results and to evaluate their practical applicability under commercial production conditions
Exploring Italian nursing staff in anticoagulation clinics: a cluster-based description of current practice, nurse self-efficacy, job satisfaction, and interprofessional collaboration
No full textThis study aimed to describe the competence profiles, practices, job satisfaction, and interprofessional collaboration among nurses working in Italian anticoagulation clinics (ACs) affiliated with the Italian federation of centres for the surveillance of anticoagulant therapy (FCSA). Data were collected via a web survey from December 2023 to May 2024. The information was condensed into two stochastic components using the t-distributed stochastic neighbour embedding (t-SNE) algorithm as part of the hierarchical clustering procedure, revealing two distinct clusters labelled "substandard profile" (n = 21 nurses) and "proficient profile" (n = 38 nurses). Results indicated significant variability in nursing practices, with differences in educational activities, self-reported competence, and levels of interprofessional collaboration between the two clusters. The findings underscore the importance of tailored interventions to enhance nursing practices, nursing education, and interprofessional collaboration within ACs. Future corroboration of the emerging results is warranted with longitudinal studies
Trends in GVHD Epidemiology, Prophylaxis and Management: The Gruppo Italiano per il Trapianto di Midollo Osseo, Cellule Staminali Emopoietiche e Terapia Cellulare (GITMO) GVHD24 Study
No full textCompared to historical reports, both aGVHD and cGVHD appeared to have decreased in the recent transplant era, possibly due to the extension of T-cell depletion, the availability of effective second-line approaches in SR/D GVHD and improved anti-infectious prophylaxis and treatments
Better safe than sorry: discriminability and response bias in adult food neophobia
No full textFood neophobia, the reluctance to try novel or unfamiliar foods, is thought to involve both uncertainty-related processes and avoidance tendencies under perceived risk. These components have largely been studied separately. This study integrates both using the Signal Detection Theory framework to examine how adults decide whether a food item is edible or inedible under conditions of uncertainty and risk. 57 young French adults (32 females; M = 20.9 years, SD = 4.23) completed validated measures of food neophobia and food disgust sensitivity, and performed a Go/no-Go task in which familiar and unfamiliar foods, presented with or without visual cues of spoilage. Results showed that higher levels of food neophobia were associated with poorer discriminability in distinguishing safe from unsafe food. Individuals with higher food neophobia also exhibited a cautious response bias, favoring “inedible” responses even at the cost of missing edible items, particularly unfamiliar foods. These findings extend previous research in children, highlighting the importance of considering both components to fully understand food neophobia in adults. Interventions aiming to increase acceptance of healthier or more sustainable foods, perceived as new by consumers, should address both reduced discriminability and cautious response tendencies