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Abstract Objective: To describe the implementation of a multi-step antimicrobial stewardship program in a haemato-oncology and stem cell transplantation program unit. Methods: Pre-post quasi-experimental study with two interrupted time-series analyses, conducted between 01/01/2019 and 31/12/2022 in the Paediatric Haemato-Oncology Unit of the Padua Paediatric Hospital. The interventions were: (1) 02/2020: dissemination of febrile neutropenia clinical pathways, (2) April 2021: provision of the clinical pathways via a customized App (Firstline.org) and implementation of a twice-a-week prospective audit and feedback. The main outcome was antibiotic consumption measured by days of administered therapy (DOTs)/1000 patients’ days for all antibiotics and most used molecules. Results: The first intervention (clinical pathways) resulted in a decrease in the overall antibiotic use by the haemato-oncology unit, with an abrupt reduction of 3-gen cephalosporins in favor of piperacillin-tazobactam, as indicated by the clinical pathways. Meropenem and glycopeptide use did not vary. The second intervention (antimicrobial stewardship) further decreased total antibiotic consumption, and a significant decline in meropenem, amikacin, and glycopeptides was achieved. Conclusions: Multi-step stewardship based on guidelines dissemination, multidisciplinary team intervention and collaboration (“handshake” stewardship) was highly effective in optimizing guidelines adherence and reducing overprescriptions in a fragile patient cohort.

Abstract In this work our aim was to identify early biomarkers in plasma samples associated with mortality in children with perinatal HIV treated early in life, to potentially inform early intervention targeting this vulnerable group. 20/215 children (9.3%) with perinatal HIV, enrolled within 3 months of age died prematurely within the first year of the study, despite early ART initiation. Using a propensity score, we selected 40 alive study participants having similar clinical and virological records compared to the deceased group. 13 HIV unexposed (HU) healthy children were additionally used as controls. Baseline plasma samples were analyzed using a targeted proteomic approach, and to assess pathogen-associated and damage-associated molecular patterns (PAMPs, DAMPs) levels. Data from deceased participants were compared to both control groups, with multivariate logistic regression models used to evaluate the association between mortality and plasma proteins. We developed a machine learning model to predict mortality risk, finding that IL-6 and CXCL11 not only were higher in deceased children than Matched-children with HIV (p

Abstract The significant impact of acute respiratory tract infections on healthcare systems is well-documented, given their contribution to emergency department admissions, hospitalizations, and increased use of antibiotics and other medications. However, further research is needed to understand the burden of acute respiratory tract infections in pediatric community care to develop effective public health interventions and improve child health outcomes. Real-world data were retrieved from Pedianet, an Italian network of over 200 family pediatricians. Acute respiratory tract infection visits were identified and analysed using an infection-duration algorithm to extract individual cases. The number of follow-up visits per 100 cases was calculated to assess the burden on the Italian National Health Service. Comparisons were made overall and stratified by type of acute respiratory tract infections and epidemiological season. A total of 1,402,953 acute respiratory infections-related visits were recorded, with an overall rate of 12 visits per 100 cases. Upper respiratory tract infections had an average of 9 visits per 100 cases. Lower respiratory tract infections exhibited a higher burden, with 29 visits per 100 cases. Pneumonia showed a declining trend in the pre-pandemic era (62 to 48 visits) but rebounded in the post-COVID-19 years (32 to 42 visits). This study underscores the importance of monitoring and managing acute respiratory infections, especially lower respiratory tract infections, in pediatric care.

Background: Urinary tract infections (UTIs) are the most common bacterial infections in children. The high variability in pathogen susceptibility rates leads to the lack of clear guidelines for empiric and targeted therapies. In this view, local microbiological surveillance and locally adapted stewardship interventions need to be implemented. Objective: The study aims to describe the results of a pediatric antimicrobial stewardship program on antibiotic prescriptions for UTIs over 8 years in a pediatric general ward of a tertiary center. Design: This quasi-experimental study was conducted between 2015 and 2022, with two different implementations, one in 2018 and one in 2021. Methods: Demographic, clinical, microbiological, and therapeutic data were retrieved from the electronic clinical records of included patients. The primary outcomes were adherence to local guidelines for empiric therapies and the adequacy of targeted therapy. Secondary outcomes were evaluating antibiotic prescription patterns stratified by antibiotics during hospital stay and at discharge, and assessing the microbiological characteristics of UTI episodes. Results: During the study period, 7038 patients were admitted to the pediatric acute care unit (PACU), and 264 (3.7%) were included in this study. Adherence to local guidelines was highest immediately after the interventions, and it slightly decreased thereafter. Use of cephalosporins remained high throughout the 8 years but the changing microbiological scenario observed led to changing recommendations within the study period. An increase in E. coli strains resistant to co-amoxiclav was observed in the last years. Oral second-line agent consumption remained high but was adequate considering the prevalence of resistant bacteria. Conclusion: The variability of antimicrobial consumption reflects the changing resistance patterns for UTIs pathogens, underlying the importance of locally adapted, persevering antimicrobial stewardship interventions.

IntroductionThis study aimed to establish normative data for the Self-Administered Tasks Uncovering Risk of Neurodegeneration (SATURN), a brief computer-based test for global cognitive assessment through accuracy and response times on tasks related to memory, attention, temporal orientation, visuo-constructional abilities, math (calculation), executive functions, and reading speed.MethodsA sample of 323 Italian individuals with Montreal Cognitive Assessment (MoCA) equivalent score ≥1 (180 females; average age: 61.33 years; average education: 11.32 years), stratified by age, education, and sex, completed SATURN using PsychoPy, and a paper-and-pencil protocol consisting of Mini-Mental State Examination (MMSE) and MoCA. Data analyses included: (i) correlations between the total accuracy scores of SATURN and those of MMSE and MoCA; (ii) multiple regressions to determine the impact of sex, age, and education, along with the computation of adjusted scores; (iii) the calculation of inner and outer tolerance limits, equivalent scores, and the development of correction grids.ResultsThe mean total time on tasks was 6.72 ± 3.24 min. Age and education significantly influence the SATURN total accuracy, while sex influences the total time on tasks. Specific sociodemographic characteristics influence subdomain accuracies and times on task differently. For the adjusted SATURN total score, the outer limit corresponds to 16.56 out of 29.00 (cut-off), while the inner limit is 18.57. SATURN significantly correlates with MMSE and MoCA.DiscussionIn conclusion, SATURN is the first open-source digital tool for initial cognitive assessment in Italy, showing potential for self-administration in primary care, and remote administration. Future studies need to assess its sensitivity and specificity in detecting pathological cognitive decline.

Municipal solid waste (MSW) landfills release different gaseous compounds in ambient air, including greenhouse gases and VOCs, with relevant effects in terms of contribution to global warming and odour annoyance. The accurate characterization and monitoring of these emissions is thus of fundamental importance to avoid negative impacts and for identifying and evaluating the effectiveness of mitigation measures. Currently, different and no universally accepted and standardized methods have been validated for the measurement of these emissions from landfill (landfill gas, LFG). The most widely-used techniques for the identification of emission rates from areal sources are known as “hood methods”. However, these methods are not particularly accurate for sampling LFG. Moreover, conventional approaches for LFG sampling frequently neglect the evaluation of fugitive emissions from crucial points of biogas network (i.e.: wells, drains, pipeline), which can be also interested by leakages and can thus result in significant emission of LFG into the atmosphere. For the abovementioned reasons, the development of specific methods for the assessment of the LFG emissions is of great interest to overcome the related issues. In the present work, an integrated and advanced approach for the monitoring and mapping of MSW landfill gas emissions has been presented and validated. The proposed procedure integrates multiple approaches to provide a complex and polyvalent survey of the landfill, also including the evaluation of the landfill terrain morphology and the presence of possible non-homogeneous areas. The experimental activities were carried out at a complex MSW landfill located in Central Italy (Lazio Region) and were organized into four steps: (i) identification and characterization of the fugitive emissions from landfill cover, by Flux Chamber device in different points of a geo-localized grid on landfill body; (ii) characterization of landfill terrain morphology and of possible fugitive emissions from biogas wells and other points considered relevant in the network, by using remote sensing with surveys implemented with drone equipped with RGB, multispectral and thermal cameras together with topographic measurements with GNSS receivers; (iii) integration of the geo-referenced results, including the Digital Terrain Model (DTM), the Normalized Difference Vegetation Index (NDVI), the thermographic mapping and the point monitoring results on landfill cover; (iv) elaboration of maps of the emissions levels for the different investigated compounds and the identification of critical points/areas. The results were elaborated and discussed (i) for the evaluation of the emissions from the investigated landfill, (ii) for proving the accuracy of the proposed procedure with cross-validation approaches and (iii) for extending the proposed procedure to a wider application for different types of landfills.

Benchmark datasets have become increasingly widespread in the scientific community as a method of comparison, validation, and improvement of theories and techniques thanks to more affordable means for sharing. While this especially holds for test sites and data collected above the water, publicly accessible benchmark activities for geospatial analyses in the underwater environment are not very common. Applying geomatic techniques underwater is challenging and expensive, especially when dealing with deep water and offshore operations. Moreover, benchmarking requires ground truth data for which, in water, several open issues exist concerning geometry and radiometry. Recognizing this scientific and technological challenge, the NAUTILUS (uNder And throUgh waTer datasets for geospatIaL stUdieS) project aims to create guidelines for new multi-sensor/cross-modality benchmark datasets. The project focuses on (i) surveying the actual needs and gaps in through and under-the-water geospatial applications through a questionnaire and interviews, (ii) launching a unique publicly available database collecting already existing datasets scattered across the web and literature, (iii) designing and identifying proper test site(s) and methodologies to deliver to the extended underwater community a brand-new multi-sensor/cross-modality benchmark dataset. The project outputs are available to researchers and practitioners in underwater measurements-related domains, as they can now access a comprehensive tool providing a synthesis of open questions and data already available. In doing so, past research efforts to collect and publish datasets have received additional credit and visibility.

Abstract Background The COVID-19 pandemic has put the provision of health services globally at risk. In Sub-Saharan Africa, it had a major impact on HIV services. However, there is a lack of data on the post-pandemic period. This study aims to evaluate the resumption of HIV services and retention in care for adolescents and young people in the period following the COVID-19 pandemic. Methods A retrospective cohort study was conducted using interrupted time series analysis. Three periods were considered: pre-pandemic (form June 2019 to March 2020), pandemic (form April 2020 to March 2022) post-pandemic (from April 2022 to March 2023). Six outcome measures were considered: number of outpatient visits, HIV tests, HIV positivity ratio, the antiretroviral treatment (ART) non-adherence ratio, recall ratio, and the return ratio for adolescent and young adults on ART. Results During the study period, 447,515 outpatient visits and 126,096 HIV tests were recorded. After a reduction at the beginning of the pandemic period, both visits and tests increased during the pandemic (p

The presence in seawater of low-molecular-weight polyethylene (PE) and polydimethylsiloxane (PDMS), synthetic polymers with high chemical resistance, has been demonstrated in this study for the first time by developing a novel methodology for their recovery and quantification from surface seawater. These synthetic polymer debris (SPD) with very low molecular weights and sizes in the nano- and micro-metre range have escaped conventional analytical methods. SPD have been easily recovered from water samples (2 L) through filtration with a nitrocellulose membrane filter with a pore size of 0.45 μm. Dissolving the filter in acetone allowed the isolation of the particulates by centrifugation followed by drying. The isolated SPD were analysed by 1H nuclear magnetic resonance spectroscopy (1H NMR), identifying PE and PDMS. These polymers are thus persisting on seawater because of their low density and the ponderal concentrations were quantified in mg/m3. This method was used in an actual case study in which 120 surface seawater samples were collected during two sampling campaigns in the Mediterranean Sea (from the Gulf of Salerno to the Gulf of Policastro in South Italy). The developed analytical protocol allowed achieving unprecedented simplicity, rapidity and sensitivity. The 1H and 13C NMR structural analysis of the PE debris indicates the presence of oxidised polymer chains with very low molecular weights. Additionally, the origin of those low molecular weight polymers was investigated by analysing influents and effluents from a wastewater treatment plant (WWTP) in Salerno as a hot spot for the release of SPD: the analysis indicates the presence of low molecular weight polymers compatible with wax-PE, widely used for coating applications, food industry, cosmetics and detergents. Moreover, the origin of PDMS debris found in surface seawater can be ascribed to silicone-based antifoamers and emulsifiers.

Abstract Optical fiber technology is gaining increasing importance in all those fields requiring reliable, miniaturized, compact, and plug‐and‐play devices, with a special relevance in life science applications. Here, optical fibers are adopted to measure the fluids viscosity, by detecting the transit time (related to viscosity) of a steel bead moving through the tested fluid in a microfluidic channel under constant pressure. The proposed optofluidic system is designed by defining a theoretical model, here experimentally validated in the viscosity range of 5–110 cP, well resembling main blood flow features. The achieved results demonstrate the capability to work in multi‐point and single‐point detection modalities with a trade‐off between resolution (minimum of 10−1 and 1 cP respectively) and measurement time (tens of seconds and milliseconds range, respectively). An optimum accuracy close to 1.5% has been achieved, with room for further optimization by reducing bead size uncertainty. The proposed platform features simple, low‐cost, reliable, and fast measurements and ensures the integration with microfluidics chip in a miniaturized and disposable system. The low volumes required (scalable down to µL range) and the ease of use enable the translation of the proposed platform in clinical scenarios involving real‐time blood and plasma viscosity measurements under physiological conditions.

Abstract This mixed-methods study examines how men and women of different ages engaged in agriculture in Kilifi and Kiambu counties in Kenya define empowerment and describe empowerment pathways, and how empowered people are perceived by their families and communities. It also examines how emic understandings of empowerment—definitions which originate from within a given cultural context—compare to quantitative empowerment measures based on externally defined indicators from the Project-level Women’s Empowerment in Agriculture Index (pro-WEAI). The study design used mixed methods, with qualitative data collected through focus group discussions, life histories, and community profiles, and quantitative data collected through the pro-WEAI survey tool. Although Pro-WEAI results indicated that women and men in the study communities have achieved gender parity and experience a similar level of empowerment, qualitative findings suggest that experiences of empowerment don’t necessarily fit with Index scores. Rather, conceptualizations of empowerment by people of different ages and genders are highly diverse. Participants of all genders suggested that women’s empowerment is more limited than men’s, as women who are not. Subordinate to men risk being rejected or stigmatized by their communities. Qualitative findings suggest that empowered men are seen as “desirable” by their communities, whereas empowered women are “openly admired” and “treated as a threat/feared” in equal turn. Furthermore, results revealed that the under-involvement of men in empowerment initiatives has contributed to feelings of resentment and neglect. These findings suggest that capturing and accounting for multiple and diverse emic definitions of empowerment for different social groups, which lies beyond the scope of standardized quantitative measures, is essential to measuring and supporting empowerment in ways that are valuable and recognizable to the target group(s) of a given development initiative. Finally, results show that to support the effective empowerment of women and men, there is a need to include men, integrate safeguards for backlash against empowered women, and transform norms that hinder the acceptance of empowered women by their families and communities.

Abstract Background Guidelines about febrile neutropenia in paediatric patients are not homogeneous; the best empiric treatment of this condition should be driven by local epidemiology. The Weighted-Incidence Syndromic Combination Antibiogram (WISCA) addresses the need for disease-specific local susceptibility evidence that could guide empiric antibiotic prescriptions based on outcome estimates of treatment regimens obtained as a weighted average of pathogen susceptibilities. This study developed a WISCA model to inform empirical antibiotic regimen selection for febrile neutropenia (FN) episodes in onco-haematological paediatric patients treated at two Italian paediatric tertiary centres. Methods We included blood cultures from patients with a bloodstream infection and neutropenia admitted to the Paediatric Haematology-Oncology wards in Padua and Genoa Hospitals from 2016 to 2021. WISCAs were developed by estimating the coverage of 20 antibiotics as monotherapy and of 21 combined regimens with a Bayesian probability distribution. Results We collected 350 blood cultures, including 196 g-negative and 154 g-positive bacteria. Considering the most used antibiotic combinations, such as piperacillin–tazobactam plus amikacin, the median coverage for the pool of bacteria collected in the study was 78%. When adding a glycopeptide, the median coverage increased to 89%, while the replacement of piperacillin–tazobactam with meropenem did not provide benefits. The developed WISCAs showed that no monotherapy offered an adequate coverage rate for the identified pathogens. Conclusions The application of WISCA offers the possibility of maximizing the clinical utility of microbiological surveillance data derived from large hospitals to inform the choice of the best empiric treatment while contributing to spare broad-spectrum antibiotics.

Background: Skin and soft-tissue infections (SSTIs) are common infectious syndromes in children. Overusing broad-spectrum antibiotics has contributed to rising antibiotic resistance, complicating treatment outcomes. To address this issue, antimicrobial stewardship programs (ASPs) have been implemented to optimize antibiotic use. This study evaluated the impact of a multifaceted ASP on antibiotic prescribing practices for SSTIs in a pediatric acute care setting over eight years. Methods: We conducted a quasi-experimental study at the Pediatric Acute Care Unit of the Padua University Hospital, including children admitted with SSTIs from October 2014 to September 2022, to evaluate the impact of a multifaceted ASP implemented in October 2015. The study was divided into three periods: pre-implementation (October 2014–September 2015), post-implementation (October 2015–March 2020), and COVID-19 (April 2020–August 2022). Data on antibiotic prescriptions and microbiological results were collected and analyzed. Results: The implementation of the ASP led to a significant reduction in the use of broad-spectrum antibiotics, particularly third-generation cephalosporins (from 40.4% to 9.8%) and glycopeptides (from 21.1% to 1.6%). There was a notable increase in the prescription of Access antibiotics, from 30% in the pre-implementation to over 60% in the post-implementation and 80% during COVID-19. No increase in the hospital length of stay was observed. Microbiological results showed no significant changes in bacterial profiles over time. Conclusions: The use of the ASP effectively improved antibiotic prescribing practices, reducing reliance on broad-spectrum antibiotics even during the COVID-19 pandemic. These findings highlight the value of ongoing stewardship efforts and suggest the need for similar programs in ambulatory settings to further address antibiotic resistance.

This Special Issue focuses on recent advances and applications in distributed monitoring technologies, which have progressively gained in popularity due to the growing demand for continuous measurements of large structures or areas, such as cultivated fields, pipelines, tunnels, viaducts, and so on [...]

BackgroundChildhood obesity is a significant public health problem representing the most severe challenge in the world. Antibiotic exposure in early life has been identified as a potential factor that can disrupt the development of the gut microbiome, which may have implications for obesity. ObjectiveThis study aims to evaluate the risk of developing obesity among children exposed to antibiotics early in life. MethodsAn Italian retrospective pediatric population-based cohort study of children born between 2004 and 2018 was adopted using the Pedianet database. Children were required to be born at term, with normal weight, and without genetic diseases or congenital anomalies. We assessed the timing of the first antibiotic prescription from birth to 6, 12, and 24 months of life and the dose-response relationship via the number of antibiotic prescriptions recorded in the first year of life (none, 1, 2, and ≥3 prescriptions). Obesity was defined as a BMI z score >3 for children aged ≤5 years and >2 for children aged >5 years, using the World Health Organization growth references. The obese incidence rate (IR) × 100 person-years and the relative 95% CI were computed using infant sex, area of residence, preschool and school age, and area deprivation index, which are the covariates of interest. A mixed-effect Cox proportional hazards model was used to estimate the hazard ratio and 95% CI for the association between antibiotic exposure in early life and child obesity between 24 months and 14 years of age, considering the family pediatricians as a random factor. Several subgroup and sensitivity analyses were performed to assess the robustness of our results. ResultsAmong 121,540 children identified, 54,698 were prescribed at least an antibiotic within the first year of life and 26,990 were classified as obese during follow-up with an incidence rate of 4.05 cases (95% CI 4.01-4.10) × 100 person-year. The risk of obesity remained consistent across different timings of antibiotic prescriptions at 6 months, 1 year, and 2 years (fully adjusted hazard ratio [aHR] 1.07, 95% CI 1.04-1.10; aHR 1.06, 95% CI 1.03-1.09; and aHR 1.07, 95% CI 1.04-1.10, respectively). Increasing the number of antibiotic exposures increases the risk of obesity significantly (P trend