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We aim to assess the state-of-the-art of Infection Prevention and Control (IPC) practices and their results in Italian healthcare facilities 6 years after the kick-off of the new National Plan for the Control of Antibiotic Resistance (PNCAR). This was a multicenter, cross-sectional, observational study conducted between January 1st, and December 31st, 2023, among Italian hospitals. Survey questions were readapted from the WHO IPC assessment framework (IPCAF), PNCAR and INSIEME group proposals, resulting in 155 questions grouped into six sections: IPC program, surveillance, control activities for healthcare-associated infections, antimicrobial stewardship (AMS) strategies, IPC training and education, and monitoring indicators. Thirty-eight acute care Hospitals completed the survey (response rate: 30%): 26.3% of hospitals did not define an annual program and 34.2% an AMS task force. Periodic microbiology reports were available for 57.9%, hospital alcohol-based hand rubs consumption per 1000 bed-days in 42.1% and defined daily dose of antimicrobials per 100 bed-days in 55.3% hospitals with a significant difference between Northern and Southern regions (90.9% vs 22.2%; P = 0.006 ). Active monitoring of hand hygiene and contact isolation compliance was implemented in only half of the hospitals. Structured HAI surveillance systems were implemented in fewer than 20% of hospitals. Components on IPC implementation activity, such as no-touch sanitizing systems, checklist for environmental cleaning, informatic flags, bundles for pathogens revealed the lowest score. The appropriateness of antibiotic therapy prescribing was assessed in 73.7% of facilities. Only 42.1% of hospitals had budget goals. This survey provides a baseline assessment and identifies key barriers to the implementation of IPC programs across Italian acute care hospitals. The findings highlight priority areas for intervention and will inform the next phase of the INSIEME project, which aims to develop and implement tailored strategies that address the specific needs of healthcare workers and institutions nationwide.

Convalescent plasma (CP) has been generally unsuccessful in preventing worsening of respiratory failure or death in hospitalized patients with COVID-19 pneumonia. To evaluate the efficacy of CP plus standard therapy (ST) vs ST alone in preventing worsening respiratory failure or death in patients with COVID-19 pneumonia. This prospective, open-label, randomized clinical trial enrolled (1:1 ratio) hospitalized patients with COVID-19 pneumonia to receive CP plus ST or ST alone between July 15 and December 8, 2020, at 27 clinical sites in Italy. Hospitalized adults with COVID-19 pneumonia and a partial pressure of oxygen-to-fraction of inspired oxygen (Pao2/Fio2) ratio between 350 and 200 mm Hg were eligible. Patients in the experimental group received intravenous high-titer CP (≥1:160, by microneutralization test) plus ST. The volume of infused CP was 200 mL given from 1 to a maximum of 3 infusions. Patients in the control group received ST, represented by remdesivir, glucocorticoids, and low-molecular weight heparin, according to the Agenzia Italiana del Farmaco recommendations. The primary outcome was a composite of worsening respiratory failure (Pao2/Fio2 ratio <150 mm Hg) or death within 30 days from randomization. Of the 487 randomized patients (241 to CP plus ST; 246 to ST alone), 312 (64.1%) were men; the median (IQR) age was 64 (54.0-74.0) years. The modified intention-to-treat population included 473 patients. The primary end point occurred in 59 of 231 patients (25.5%) treated with CP and ST and in 67 of 239 patients (28.0%) who received ST (odds ratio, 0.88; 95% CI, 0.59-1.33; P = .54). Adverse events occurred more frequently in the CP group (12 of 241 [5.0%]) compared with the control group (4 of 246 [1.6%]; P = .04). In patients with moderate to severe COVID-19 pneumonia, high-titer anti-SARS-CoV-2 CP did not reduce the progression to severe respiratory failure or death within 30 days. ClinicalTrials.gov Identifier: NCT04716556.

Dual therapy (DT) with boosted protease inhibitors (bPIs) plus lamivudine has been shown to be superior to bPI monotherapy in virologically suppressed patients despite previous selection of the lamivudine resistance M184V mutation. We compared the virological efficacy of lamivudine-based DT in patients with and without a history of M184V detection. We retrospectively analyzed patients with HIV-RNA ≤50 copies/mL switching to DT with at least 1 previous resistance genotype in the ARCA database. Time to virological failure (VF; HIV-RNA ≥200 copies/mL or 2 consecutive HIV-RNA >50 copies/mL) and to treatment discontinuation (TD) was analyzed by survival analysis. Four hundred thirty-six patients switching to lamivudine plus bPIs (70%) or integrase inhibitors (30%) were included. Patients with M184V (n = 87) were older, had lower nadir CD4+ cell count, longer duration of antiretroviral therapy and of virologic suppression, and higher rate of hepatitis C virus infection compared with patients without M184V. The 3-year probability of remaining free from VF was 91.9% (95% confidence interval [CI], 86.6-97.2) without M184V and 87.8% (95% CI, 78.4-97.2) with M184V ( = .323). The time to TD did not differ between groups. Multivariate analysis adjusting for baseline variables differing between groups also did not detect M184V as being associated with VF or TD; however, the 3-year probability of remaining free of viral blips (isolated HIV-RNA 51-199 copies/mL) was 79.8% (95% CI, 67.8%-91.8%) with M184V vs 90.1% (95% CI, 84.0%-96.2%) without M184V ( = .016). Previous selection of M184V did not increase the risk of VF or TD with lamivudine-based DT but was associated with a higher probability of viral blips.

Fluconazole (800–1,000 mg iv) was administered to 14 consecutive patients with AIDS and cryptococcal meningitis. At 10 weeks the rate of clinical success was 54.5% (six of 11 patients responded to fluconazole); the Kaplan-Meier estimate of the response rate was 67.1%, and the overall mortality rate was 18.2% (two of 11 patients died). At the end of treatment, eight (72.7%) of 11 patients responded to fluconazole. The median time to the first negative cerebrospinal fluid (CSF) culture was 33.5 days (95% confidence interval, 18.3–67.3); the median time for patients with initial CSF cryptococcal antigen titers of ⩾1:1,024 was 66 days compared with 18 days for patients with initial CSF cryptococcal antigen titers of <1:1,024 (P = .06). The median time to the first negative CSF culture for patients with an isolate for which the minimum inhibitory concentration (MIC) was 4 µg/mL was 56 days compared with 16 days for patients with an isolate for which the MIC was <4 µg/mL (P = .11). The mean serum and CSF levels of fluconazole at steady state were 42.47 ± 26.31 µg/mL and 36.63 ± 21.08 µlmL, respectively(ratio of CSF:serum, 0.86). No treatment was interrupted and no dose was tapered because of side effects. High-dose fluconazole might be an effective and well-tolerated therapeutic option for patients with AIDS and acute cryptococcal meningitis.

In this work, we propose to study the collective behavior of different ensembles of neural networks. These sets define and live on complex manifolds that evolve through training. Each manifold is characterized by its intrinsic dimension, a measure of the variability of the ensemble and, as such, a measure of the impact of the different training strategies. Indeed, higher intrinsic dimension values imply higher variability among the networks and a larger parameter space coverage. Here, we quantify how much the training choices allow the exploration of the parameter space, finding that a random initialization of the parameters is a stronger source of variability than, progressively, data distortion, dropout, and batch shuffle. We then investigate the combinations of these strategies, the parameters involved, and the impact on the accuracy of the predictions, shedding light on the often-underestimated consequences of these training choices.

High-temporal-frequency monitoring of transport infrastructure is crucial to facilitate maintenance and prevent major service disruption or structural failures. Ground-based non-destructive testing (NDT) methods have been successfully applied for decades, reaching very high standards for data quality and accuracy. However, routine campaigns and long inspection times are required for data collection and their implementation into reliable infrastructure management systems (IMSs). On the other hand, satellite remote sensing techniques, such as the Multi-Temporal Interferometric Synthetic Aperture Radar (MT-InSAR) method, have proven effective in monitoring ground displacements of transport infrastructure (roads, railways and airfields) with a much higher temporal frequency of investigation and the capability to cover wider areas. Nevertheless, the integration of information from (i) satellite remote sensing and (ii) ground-based NDT methods is a subject that is still to be fully explored in civil engineering. This paper aims to review significant stand-alone and combined applications in these two areas of endeavour for transport infrastructure monitoring. The recent advances, main challenges and future perspectives arising from their mutual integration are also discussed.

The present study aims to develop and validate an Italian version of the Brief Self-Control Scale (BSCS). A large sample of Italian-speaking participants (N = 1139) completed the BSCS and measures of personality and individual dispositions. A clinical sample (N = 217) was administered the Italian version and an English-speaking sample (N = 274) completed the original version to test measurement invariance. Using confirmatory factor analysis, the best fit was observed for a shortened two-factor model (i.e., impulse control and self-discipline). Metric invariance across languages and partial strong invariance across genders, ages, and clinical status were demonstrated. Internal consistency and test-retest reliability for the total scale were adequate, and validity was established based on its correlations with related constructs and confirming that males and young individuals are more likely to have lower self-control. Results support the use of the shortened BSCS version to assess self-control in Italian-speaking individuals.

Multi-Temporal Interferometric Synthetic Aperture Radar (MT-InSAR) techniques are gaining momentum in the assessment and health monitoring of infrastructure assets. Amongst others, the Persistent Scatterers Interferometry (PSI) technique has proven to be viable for the long-term evaluation of ground scatterers. However, its effectiveness as a routine tool for certain critical application areas, such as the assessment of millimetre-scale differential displacements in airport runways, is still debated. This research aims to demonstrate the viability of using medium-resolution Copernicus ESA Sentinel-1A (C-Band) SAR products and their contribution to improve current maintenance strategies in case of localised foundation settlements in airport runways. To this purpose, “Runway n.3” of the “Leonardo Da Vinci International Airport” in Fiumicino, Rome, Italy was investigated as an explanatory case study, in view of historical geotechnical settlements affecting the runway area. In this context, a geostatistical study is developed for the exploratory spatial data analysis and the interpolation of the Sentinel-1A SAR data. The geostatistical analysis provided ample information on the spatial continuity of the Sentinel 1 data in comparison with the high-resolution COSMO-SkyMed data and the ground-based topographic levelling data. Furthermore, a comparison between the PSI outcomes from the Sentinel-1A SAR data—interpolated through Ordinary Kriging—and the ground-truth topographic levelling data demonstrated the high accuracy of the Sentinel 1 data. This is proven by the high values of the correlation coefficient (r = 0.94), the multiple R-squared coefficient (R2 = 0.88) and the Slope value (0.96). The results of this study clearly support the effectiveness of using Sentinel-1A SAR data as a continuous and long-term routine monitoring tool for millimetre-scale displacements in airport runways, paving the way for the development of more efficient and sustainable maintenance strategies for inclusion in next generation Airport Pavement Management Systems (APMSs).

Health monitoring of ballast in railway infrastructure is crucial to assure long-term structural stability. An efficient and sustainable management of maintenance operations is therefore fundamental for asset owners in setting up strategic and effective action plans. Amongst the available methods to assess the conditions of railway infrastructure, non-destructive technologies (NDT) are gaining popularity due to their capability to overcome main drawbacks from conventional routine methods, such as digging trenches and visually inspecting sections along the track. The present study reports an overview on the use of the ground penetrating radar (GPR) and the interferometric synthetic aperture (InSAR) technologies for a sustainable monitoring of railway infrastructure. Main conventional and non-destructive methods utilised for maintenance of railway ballast materials are presented, with a special focus on their sustainability. A review about research methods on the use of GPR and InSAR technologies for railway infrastructure monitoring is also reported, including main investigations carried out in the laboratory and the real-life environments. Furthermore, a conceptual framework based on an integrated approach between satellite-based and ground-based investigations is proposed, where network- and local-level information can be merged for a more effective detection of critical sections and the implementation of an advanced predictive maintenance system.

The termination of cover crops in conventional no-till systems is mostly conducted mechanically in combination with herbicides. Combining flaming and roller crimpers could be a viable solution to avoid using herbicides for cover crop termination in farming systems where herbicides are banned, or at least to reduce their use in an integrated management approach. This research tested the effects of flaming used in combination with three different types of roller crimpers to terminate a fall-sown cover crop mixture of winter pea and barley. The cover crop termination rate was visually assessed in terms of percentage of green cover provided by cover crop plants at different intervals from the termination date, and estimated using a log-logistic non-linear regression model with four parameters. Machine performance data are also reported. The results show that, irrespective of the roller type, flaming significantly boosted the effect of the roller crimpers. In fact, an economic threshold for cover crop suppression of 85% was reached only when the rollers were used in combination with flaming. Nevertheless, none of the methods were able to reach the 100% of cover crop suppression. In some case, the combined use of flaming and roller crimpers allowed reaching the 90% of cover crop devitalisation, which happened six weeks after the termination date. More importantly, the use of flaming in combination with rollers shortened the time needed to achieve the estimated levels of devitalisation, compared with the rollers used alone. We conclude that flaming is an effective tool to increase the effectiveness of roller crimpers. Nevertheless, further research is needed to identify solutions to overcome the barrier of the high operational costs of flaming, which is constraining its wider adoption by farmers. Future studies could focus, for instance, on the development of a new prototype of combined machine for crimping and flaming the cover crops simultaneously, which could potentially reduce the operational costs.