CONSORT 2010 checklist of information to include when reporting a randomised trial* Section/Topic Item No Checklist item Reported on page No Title and abstract 1a Identification as a randomised trial in the title Yes, page 1 1b Structured summary of trial design, methods, results, and conclusions (for specific guidance see CONSORT for abstracts) Yes, page 4

Increased use of annual payments to land managers for ecological outcomes indicates a growing interest in exploring the potential of this approach. In this viewpoint, we drew on the experiences of all schemes paying for biodiversity outcomes/results on agricultural land operating in the EU and EFTA countries with the aim of reviewing the decisive elements of the schemes' design and implementation as well as the challenges and opportunities of adopting a results-based approach. We analysed the characteristics of results-based schemes using evidence from peer-reviewed literature, technical reports, scheme practitioners and experts in agri-environment-climate policy. We developed a typology of the schemes and explored critical issues influencing the feasibility and performance of results-based schemes. The evidence to date shows that there are at least 11 advantages to the results-based approach not found in management-based schemes with similar objectives, dealing with environmental efficiency, farmers' participation and development of local biodiversity-based projects. Although results-based approaches have specific challenges at every stage of design and implementation, for many of these the existing schemes provide potential solutions. There is also some apprehension about trying a results-based approach in Mediterranean, central and eastern EU Member States. We conclude that there is clear potential to expand the approach in the European Union for the Rural Development programming period for 2021-2028. Nevertheless, evidence is needed about the approach's efficiency in delivering conservation outcomes in the long term, its additionality, impact on the knowledge and attitudes of land managers and society at large, development of ways of rewarding the achievement of actual results, as well as its potential for stimulating innovative grassroots solutions.

The article focuses on the role of Localized Agri-food Systems (LAFS) in the provision of environmental and social benefits (ESBs) in peripheral areas, by comparing two case studies in Italy: bergamot production in Grecanic area (Calabria region) and a basket of local products in Garfagnana area (Tuscany region). On the basis of the evidence collected through semi-structured interviews with key stakeholders, the paper shows the different mechanisms by which LAFS may stimulate the provision of ESBs in such areas. In both case studies the provision of ESBs was the result of the interplay among three different types of drivers: markets factors, the set of policies implemented in the specific territorial context and collective actions performed by local actors to promote new governance patterns and new institutions. The article shows that in peripheral areas LAFS, alongside food production, have a strong potential in delivering a broad range of environmental and social benefits, which are highly valued by local communities and consumers. However, this potential varies to large extent according to the socio-economic and institutional settings, as well as on the type of interactions of market drivers with public policies and collective action.

Diversification has been increasingly recognized as a rewarding farm strategy through which farmers produce on-farm non-agricultural goods and services. In doing so, farmers employ farm inputs (capital, labor, and land) in products other than agricultural goods, with the aim to sell them in the market and increase their income. While a significant body of literature has explored the drivers affecting the adoption of diversification activities, so far little attention has been given to the impact of such adoption on the technical and financial performance of farms. This article intends to provide empirical evidence on the impact of on-farm non-agricultural diversification on the financial performance of family farms in Italy, by using a nation-wide sample of agricultural holdings based on the Farm Accountancy Data Network (FADN) data. We estimated a fixed effects-instrumental variable panel model to deal with two potential sources of bias: self-selection in the diversification strategy and simultaneity, due to the fact that farmers often decide to diversify with outcome expectations in mind. Our findings show that in Italy the diversification strategy has a positive impact on the financial performance of family farms, which is second in magnitude only to that of land growth strategy. Our results also confirm the positive impact of efficiency and clarify that education has a positive return to investment when it is specialized in agriculture.

From a centralistic, technocratic perspective a landscape of local and regional institutions which were set up to deal with local problems are often regarded as "chaotic". But this labeling is wrong. In fact, the capacity of associations set up by responsible citizens to find solutions for real problems is outstanding and more human.

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Background: The number of patients undergoing joint arthroplasty is increasing worldwide. An Enhanced Recovery After Surgery (ERAS) pathway for hip and knee arthroplasty was introduced in an Italian high-volume research hospital in March 2018. Methods: The aim of this mixed methods observational study is to perform a health technology assessment (HTA) of the ERAS pathway, considering 938 procedures performed after its implementation, by means of a hospitalbased approach derived from the EUnetHTA (European Network for Health Technology Assessment) Core Model. The assessment process is based on dimensions of general relevance, safety, efficacy, effectiveness, economic and financial impact, equity, legal aspects, social and ethical impact, and organizational impact. A narrative review of the literature helped to identify general relevance, safety and efficacy factors, and a set of relevant sub-dimensions submitted to the evaluation of the professionals who use the technology through a 7-item Likert Scale. The economic and financial impact of the ERAS pathway on the hospital budget was supported by quantitative data collected from internal or national registries, employing economic modelling strategies to identify the amount of resources required to implement it. Results: The relevance of technology under assessment is recognized worldwide. A number of studies show accelerated pathways to dominate conventional approaches on pain reduction, functional recovery, prevention of complications, improvements in tolerability and quality of life, including fragile or vulnerable patients. Qualitative surveys on clinical and functional outcomes confirm most of these benefits. The ERAS pathway is associated with a reduced length of stay in comparison with the Italian hospitalization average for the same procedures, despite the poor spread of the pathway within the country may generate postcode inequalities. The economic analyses show how the resources invested in training activities are largely depreciated by benefits once the technology is permanently introduced, which may generate hospital cost savings of up to 2054,123.44 € per year. Conclusions: Galeazzi Hospital's ERAS pathway for hip and knee arthroplasty results preferable to traditional approaches following most of the HTA dimensions, and offers room for further improvement. The more comparable practices are shared, the before this potential improvement can be identified and addressed.