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Transformations inherently involve systems change and because of the political nature of change, are subject to contestation. A potentially effective strategy to further transformative change that builds on interdisciplinary, multiactor, and multiscalepractices and values is the use of foresight. Foresight covers a wide range of methods to systematically investigate the future. Foresight exercises offer collaborative spaces and have the potential to conceptualize and even initiate transformative change. But there is no clear understanding of the possibilities and limitations of foresight in this regard. This explorative paper builds on foresight and sociology and interrogates the role of foresight in transformative change, building on four cases. These cases are embedded in different contexts and characterized by different organizational approaches and constellations of actors. Nevertheless, they share the common goal of transformative food systems change. By reflecting on the processes that play a role in foresight workshops, we analyze what created conditions for transformative change in these four empirical cases. We have operationalized these conditions by distinguishing layers in the structuring processes that influence the impact of the foresight process. Based on this analysis, we conclude that there are three roles, ranging from modest to more ambitious, that foresight can play in transformative change: preconceptualization of change; offering an avenue for the creation of new actor networks; and creation of concrete strategies with a high chance of implementation. Furthermore, contributing to future design of foresight processes for transformative change, we offer some crucial points to consider before designing foresight processes. These include the role of leading change makers (including researchers), the risk of co-option by more regime-driven actors, and the ability to attract stakeholders to participate.

Mycotoxins are secondary metabolites produced by some filamentous fungi, which can cause toxicity in animal species, including humans. Because of their high toxicological impacts, mycotoxins have received significant consideration, leading to the definition of strict legislative thresholds and limits in many areas of the world. Mycotoxins can reduce farm profits not only through reduced crop quality and product refusal, but also through a reduction in animal productivity and health. This paper briefly addresses the impacts of mycotoxin contamination of feed and food on animal and human health, and describes the main pre- and post-harvest systems to control their levels, including genetic, agronomic, biological, chemical, and physical methods. It so highlights (i) the lack of effective and straightforward solutions to control mycotoxin contamination in the field, at pre-harvest, as well as later post-harvest; and (ii) the increasing demand for novel methods to control mycotoxin infections, intoxications, and diseases, without leaving toxic chemical residues in the food and feed chain. Thus, the broad objective of the present study was to review the literature on the use of ozone for mycotoxin decontamination, proposing this gaseous air pollutant as a powerful tool to detoxify mycotoxins from feed and food.

The development of synergies between rural and urban areas is one of the EU’s objectives to contribute to smart and inclusive growth. Effective governance of rural–urban links is essential for balanced development but often lacks policy coherence. This study examines the role of spatial planning and food policy integration in enhancing local food system sustainability and resilience, specifically in peri-urban areas. It investigates challenges and enablers in this integration through a Living Lab experiment in Lucca (Italy) as part of the ROBUST H2020 project. The Living Lab methodology entailed envisioning, experimenting, and experiencing phases to identify key rural–urban connections and assess governance arrangements, focusing on reclaiming abandoned land in peri-urban areas together with local stakeholders. By highlighting the strengths and limitations of a multi-year collaborative research approach, the research highlights a weak recognition of rural–urban linkages and the need for improved dialogue between rural stakeholders and urban planners. Key recommendations comprise formalising public–private partnerships and cross-sectoral projects linking agriculture with education, tourism, and landscape (e.g., agricultural parks).

The prevention of accidental falls in hospital is an important aspect of a healthcare management strategy, since they represent a relevant socio-economic problem. The Verso Vision System (VS) is an artificial intelligence-based system for accidental fall prevention and management, which uses computer vision algorithms to monitor environments and people in real time. The efficacy of VS monitoring in terms of reduction of accidentals falls was retrospectively evaluated in a group of 362 hospitalized patients at Humanitas Gavazzeni Hospital. Of the 362 patients included in the analysis, 580 statistical units, 228 monitored with VS and 355 without VS were obtained splitting the observation of each patient based on the presence of VS monitoring and the Stratify score. The mean age of the 362 patients was 75.3 years and 150 were females (41.4%). The crude incidence rates per 1,000 person-time was 2.85 (95% CI 0.92-6.63, 5 accidental falls) and 6.65 (95% CI 3.72-10.96, 15 accidental falls) in the monitored with VS and unmonitored groups, respectively. At multivariable Poisson regression model, a statistically significant reduction of the risk of accidental falls was found in the monitored group compared to the unmonitored group [incidence rate ratio (IRR) 0.21, 95% CI 0.12-0.38,  < 0.0001]. The positive impact was supported by sensitivity analysis (IRR 0.22, 95% CI 0.13-0.35,  < 0.0001). This analysis suggests that the VS can reduce the number of accidental falls in hospitalized patients. Nonetheless, further prospective analyses are needed to confirmed the efficacy of the VS.

ObjectivesTo evaluate sex differences in baseline clinical characteristics, analgesic response, safety profiles and treatment variations among cancer patients initiating WHO step III opioid therapy.Methods and analysisThis post hoc analysis used data from a four-arm, multicentre, randomised, comparative, superiority phase IV trial in cancer patients with moderate-to-severe pain requiring WHO step III opioids. The study was conducted across 44 specialist palliative care centres in Italy. Overall, 498 patients were evaluated, including 277 men (55.6%) and 221 women (44.4%). Eligible participants had locally advanced or metastatic tumours and persistent moderate-to-severe pain. Patients were centrally randomised (1:1:1:1) to morphine, oxycodone, buprenorphine or fentanyl around the clock. Follow-up lasted 28 days, with assessments on days 1 day, 3 days, 7 days, 14 days, 21 days and 28 days. Physicians could adjust opioid doses, add adjuvants or switch opioids as clinically indicated. Adverse drug reactions (ADRs) were recorded. Baseline assessments included oncological history, comorbidities, Karnofsky performance status and self-reported psychological status. Pain intensity (PI) was measured on a 0–10 Numerical Rating Scale for average PI (API) and worst pain over the previous 24 hours at each visit. Analgesic response was classified per Farrar’s criteria as non-responders (no improvement or worsening), poor responders (<30% PI reduction) or responders (≥30% reduction). Responders with final API ≤4 were also classified as responders per Corli’s criteria; others were non-responders. Statistical analyses included χ2 and Fisher’s exact tests, t-tests, Mann-Whitney tests, linear mixed models and logistic regression.ResultsPI did not differ significantly between sexes. However, in the fentanyl group, dose increased over time differently between sexes (sex-by-time interaction: p=0.0026). Opioid switching from buprenorphine was more often due to inadequate pain control in men, and due to uncontrollable ADRs in women. Among patients with colorectal cancer, women showed greater pain reduction of the worst pain according to Farrar’s criteria (91.3% vs 61.8%, p=0.022). ADRs incidence was higher in women than in men for transdermal buprenorphine (93.2% vs 77.9%, p=0.016). Higher baseline emotional tension was negatively associated with analgesic response (OR 0.64, 95% CI 0.41 to 1.00). Other efficacy and safety outcomes were not statistically significant.ConclusionsOverall pain reduction did not differ by sex; however, men and women exhibited distinct patterns in dose escalation, opioid switching and ADR profiles. Accounting for sex differences may support more tailored and effective opioid selection in cancer pain management.Trial registration numberNCT01809106.

The contradictions between food poverty affecting a large section of the global population and the everyday wastage of food, particularly in high income countries, have raised significant academic and public attention. All actors in the food chain have a role to play in food waste prevention and reduction, including farmers, food manufacturers and processors, caterers and retailers and ultimately consumers. Food surplus redistribution is considered by many as a partial solution to food waste reduction and food poverty mitigation, while others criticize charitable initiatives as inadequate responses, that inhibit governments from responsibly protecting the citizens right to food. This paper frames food assistance as “hybrid systems”, situating at the intersection of territorial food, public welfare and third sector voluntary systems. Based on available literature and reflections on previous research examining food banks in Italy, we develop a system dynamics conceptual mapping. The aim is to model a set of relations and dynamic mechanisms associated with variables relevant to food waste generation, food recovery for social purposes and food poverty alleviation. The analysis of feedback interactions highlights the (actual and potential) vulnerabilities of food assistance systems that occur when addressing food poverty by reducing food surplus. In summary, as the awareness on food poverty and food surplus arises, incentives to food recovery and redistribution strengthen the role of (voluntary) food assistance actors, increasing their exposure to drivers of change, such as retailers’ standards for food surplus prevention. This paper contributes to the current academic debate on charitable food assistance, with insights for policy makers and other systems’ actors.

This article focuses on the question of how a shift from a narrow economic perspective to a wider sustainable wellbeing focus in regional development strategies and actions might change rural–urban relations. A brief review of relevant research and discourses about economic development models provides the foundation for the analysis. The review leads to the development of an analytical framework that puts the notion of sustainable wellbeing at its center. The criteria included in the analytical framework are then used to assess the current situation, challenges and perceived ways forward based on data and analyses from 11 European regions. The focus of the analysis is on different expressions of a sustainable wellbeing economy, and aspects of territorial development that are consistent with the basic features of a wellbeing economy are identified. Development dynamics and tensions between different development goals and resource uses, strategies and actions that are in favor of sustainable wellbeing goals, and conditions for more mutually beneficial rural–urban relationships are discussed. The article concludes with the implications for local government, and governance and policy frameworks. Reference is made to current high-level strategic policy frameworks and the European Green Deal.

Introduction Cancer patients are frail individuals, thus the prevention of SARS‐CoV‐2 infection is essential. To date, vaccination is the most effective tool to prevent COVID‐19. In a previous study, we evaluated the immunogenicity of two doses of mRNA‐based vaccines (BNT162b2 or mRNA‐1273) in solid cancer patients. We found that seroconversion rate in cancer patients without a previous exposure to SARS‐CoV‐2 was lower than in healthy controls (66.7% vs. 95%, p = 0.0020). The present study aimed to evaluate the clinical efficacy of the vaccination in the same population. Methods This is a single‐institution, prospective observational study. Data were collected through a predefined questionnaire through phone call in the period between the second and third vaccine dose. The primary objective was to describe the clinical efficacy of the vaccination, defined as the percentage of vaccinated subjects who did not develop symptomatic COVID‐19 within 6 months after the second dose. The secondary objective was to describe the clinical features of patients who developed COVID‐19. Results From January to June 2021, 195 cancer patients were enrolled. Considering that 7 (3.59%) patients tested positive for SARS‐CoV‐2 and 5 developed symptomatic disease, the clinical efficacy of the vaccination was 97.4%. COVID‐19 disease in most patients was mild and managed at home; only one hospitalization was recorded and no patient required hospitalization in the intensive care unit. Discussion Our study suggests that increasing vaccination coverage, including booster doses, could improve the prevention of infection, hospitalization, serious illness, and death in the frail population of cancer patients. Prevention of SARS‐CoV‐2 infection is crucial for cancer patients given their frailty and vaccination is the most effective method to achieve this goal. The present study aimed to evaluate the clinical efficacy of the first two doses of anti‐SARS‐CoV‐2 vaccines in treated solid cancer patients. The clinical efficacy was 97.4%. COVID‐19 disease in most patients was mild and managed at home; only one hospitalization was recorded and no patient required hospitalization in the intensive care unit.

Opioids are often used to relieve moderate to severe pain, but their analgesic response may vary. We focused on the absolute lack of analgesic response immediately after beginning opioid treatment, quantifying the proportion of patients with unchanged or worse pain on day 3 (defined as early non-responders (ENRs)) and day 7. This is a post-hoc analysis from a randomized controlled trial involving 498 cancer patients with pain, starting to receive WHO step III opioids. On days 1, 3 and 7 pain intensity (PI) was measured. On day 3, 68 (13.7%) patients were ENRs, 53 no change and 15 greater PI compared to baseline. The relationships between pain and clinical characteristics showed no significant differences between ENRs and Early responders (ERs), except for PI at baseline, which was significantly lower in ENRs. ENRs on day 3 were re-assessed on day 7 to explore the patterns of analgesic response: 31.7% of patients remained NRs, 48.3% had become responders, and 20.0% were poor responders. Adverse drug reactions were similar in ERs and ENRs at each visit. The complete lack of early response to opioids in cancer patients is clinically important and more frequent than expected. Better definition of the mechanism will allow better pain management in cancer and non-cancer patients.

Background: the prognostic significance of tumor infiltrating lymphocytes (TILs) in intermediate/thick primary cutaneous melanoma (PCM) remains controversial, partially because conventional evaluation is not reliable, due to inter-observer variability and diverse scoring methods. We aimed to assess the prognostic impact of the density and spatial distribution of immune cells in early stage intermediate/thick PCM. Materials and Methods: digital image acquisition and quantitative analysis of tissue immune biomarkers (CD3, CD4, CD8, CD68, PD-L1, CD163, FOX-P3, and PD-1) was carried out in a training cohort, which included patients with primary PCM ≥ 2 mm diagnosed, treated, and followed-up prospectively in three Italian centers. Results were validated in an independent Italian cohort. Results: in the training cohort, 100 Stage II–III melanoma patients were valuable. At multivariable analysis, a longer disease free survival (DFS) was statistically associated with higher levels of CD4+ intratumoral T-cells (aHR [100 cell/mm2 increase] 0.98, 95%CI 0.95–1.00, p = 0.041) and CD163+ inner peritumoral (aHR [high vs. low] 0.56, 95%CI 0.32–0.99, p = 0.047). A statistically significant longer DFS (aHR [high-high vs. low-low] 0.52, 95%CI 0.28–0.99, p = 0.047) and overall survival (OS) (aHR [high-high vs. low-low] 0.39, 95%CI 0.18–0.85, p = 0.018) was found in patients with a high density of both intratumoral CD8+ T-cells and CD68+ macrophages as compared to those with low density of both intratumoral CD8+ T-cells and CD68+ macrophages. Consistently, in the validation cohort, patients with high density of both intratumoral CD8+ and CD3+ T-cells were associated to a statistically better DFS (aHR[high-high vs. low-low] 0.24, 95%CI 0.10–0.56, p < 0.001) and those with high density of both intratumoral CD8+ and CD68+ were associated to a statistically longer OS (aHR[high-high vs. low-low] 0.28, 95%CI 0.09–0.86, p = 0.025). Conclusion: our findings suggest that a specific preexisting profile of T cells and macrophages distribution in melanomas may predict the risk of recurrence and death with potential implications for the stratification of stage II–III melanoma patients.