For my own reading purposes I style <em> as dark red, I find it difficult to discern italicised text when its just a few words in the middle of a sentence. I don't read on E-ink devices.
But that's the easy part, finding the right <i>s and changing them to <em>s is the hard part. Sometimes I bother, often I don't. I find it easier to find them in a word processor than in an ePub editor - then all I have to do is bend the word processor's Emphasis style into an epub <em> style during conversion.
BR
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