Search

PurposeVaccinating adults who are involved with the carceral system, particularly those aged 55 or older, is crucial to containing the COVID-19 pandemic in the USA, particularly as variants continue to emerge and spread. In this Viewpoint, the authors discuss the reasons why improving access to COVID-19 vaccine and boosters among community supervised adults, especially the aging population, is critical to mitigating the public health consequences of the COVID-19 pandemic. This study concludes by providing recommendations to enhance vaccine and booster uptake in this population, as the pandemic continues.Design/methodology/approachThis is a Viewpoint paper regarding mitigating the spread of COVID-19 by improving access to vaccine and boosters among community supervised adults, especially the aging population.FindingsA key population that has been overlooked in vaccination efforts are older adults involved in the carceral system who are living in the community (i.e. "community supervised" or people on probation or parole). Older adults on probation and parole are at high risk for SARS-CoV-2 transmission and severe disease due to numerous factors at the individual, community, social and structural levels.Originality/valueImplementation of recommendations presented in this Viewpoint will mitigate COVID-19 risk among a population that has been marginalized and overlooked, yet has been the epicenter of the COVID-19 pandemic.

BackgroundPeople with HIV experiencing homelessness have low rates of viral suppression, driven by sociostructural barriers and traditional care system limitations. Informed by the capability-opportunity-motivation-behavior (COM-B) model and patient preference research, we developed POP-UP, an integrated drop-in (nonappointment-based) HIV clinic with wrap-around services for persons with housing instability and viral nonsuppression in San Francisco.MethodsWe report HIV viral suppression (VS;

The Atti Chiari project, collecting the first large Italian corpus of judicial acts, presents strict legal requirements as well as many peculiarities in terms of language and content; to meet them, a number of processes and tools have been designed and implemented. The first issue is the requirement to remove any personal data from the documents, without however destroying their linguistic form, nor compromising their readability. To this end, a pseudonymisation procedure has been created based on a preliminary annotation stage, which adds information right in order to remove it in different ways, according to different purposes (linguistic analysis, legal analysis, etc.). At the same time, this light annotation provides data useful not only for pseudonymization, but also for the conversion of documents, from their original presentational format into a semantic one based on TEI. Once documents have been prepared in this way, they are then centralized in a corpus, ready to be indexed for linguistic research. Given the multiple search criteria that must be combined, whatever their origin and model, a new type of search engine, designed primarily in the philological field, has been used here to obtain the required openness and granularity of metadata.

Background/settingIn San Francisco, HIV viral suppression is 71% among housed individuals but only 20% among unhoused individuals. We conducted a discrete choice experiment at a San Francisco public HIV clinic to evaluate care preferences among people living with HIV (PLH) experiencing homelessness/unstable housing during the COVID-19 pandemic.MethodsFrom July to November 2020, we conducted a discrete choice experiment among PLH experiencing homelessness/unstable housing who accessed care through (1) an incentivized, drop-in program (POP-UP) or (2) traditional primary care. We investigated 5 program features: single provider vs team of providers; visit incentives ($0, $10, and $20); location (current site vs current + additional site); drop-in vs scheduled visits; in-person only vs optional telehealth visits; and navigator assistance. We estimated relative preferences using mixed-effects logistic regression and conducted latent class analysis to evaluate preference heterogeneity.ResultsWe enrolled 115 PLH experiencing homelessness/unstable housing, 40% of whom lived outdoors. The strongest preferences were for the same provider (β = 0.94, 95% CI: 0.48 to 1.41), visit incentives (β = 0.56 per $5; 95% CI: 0.47 to 0.66), and drop-in visits (β = 0.47, 95% CI: 0.12 to 0.82). Telehealth was not preferred. Latent class analysis revealed 2 distinct groups: 78 (68%) preferred a flexible care model, whereas 37 (32%) preferred a single provider.ConclusionsWe identified heterogeneous care preferences among PLH experiencing homelessness/unstable housing during the COVID-19 pandemic, with two-thirds preferring greater flexibility and one-third preferring provider continuity. Telehealth was not preferred, even with navigator facilitation. Including patient choice in service delivery design can improve care engagement, particularly for marginalized populations, and is an essential tool for ending the HIV epidemic.

ObjectiveHomelessness is the greatest risk factor for HIV viremia in San Francisco. Innovative care models for people with HIV (PWH) with homelessness or unstable housing (HUH) are needed to address this inequity. We developed a novel low-barrier clinic-based program for PWH-HUH in an urban safety-net clinic ('POP-UP') and report outcomes on care engagement and viral suppression.DesignA prospective cohort study.SettingSan Francisco General Hospital HIV Clinic (Ward 86).ParticipantsWe enrolled PWH who are HUH, viraemic and for whom usual care is not working (at least one missed primary care appointment and at least two drop-in visits at Ward 86 in the last year).InterventionPOP-UP provides drop-in comprehensive primary care, housing assistance and case management, financial incentives and patient navigation with frequent contact.Main outcome measuresWe describe uptake of eligible patients into POP-UP, and cumulative incidence of antiretroviral therapy (ART) initiation, return to care and virologic suppression 6 months post-enrolment, estimated via Kaplan--Meier.ResultsOut of 192 referred patients, 152 were eligible, and 75 enrolled. All 75 were off ART and viraemic; 100% had a substance use disorder; and 77% had a mental health diagnosis. Over three-quarters restarted ART within 7 days of enrolment, and 91% returned for follow-up within 90 days. The cumulative incidence of viral suppression at 6 months was 55% (95% confidence interval 43-68).ConclusionA novel care model for PWH-HUH demonstrates early success in engaging viraemic patients in care and improving viral suppression. Low-barrier, high-contact primary care programmes offering comprehensive services and incentives may improve outcomes for this vulnerable population.

Job loss and evictions tied to the Coronavirus Disease 2019 (COVID-19) pandemic are expected to increase homelessness significantly in the coming months. Reciprocally, homelessness and the many vulnerabilities that inevitably accompany it are driving COVID-19 outbreaks in US shelters and other congregate living situations. Unless we intervene to address homelessness, these co-existing and synergistic situations will make the current public health crisis even worse. Preventing homelessness and providing permanent affordable housing has reduced the ravages of the HIV epidemic. We must take the lessons learned in 40 years of fighting HIV to respond effectively to the COVID-19 crisis. Housing is an investment that will curb the spread of COVID-19 and help protect all of us from future pandemics.

Coronavirus disease-2019 (COVID-19) threatens to further worsen HIV outcomes among people experiencing homelessness. We conducted an interrupted time-series analysis of care engagement and viral suppression among unhoused individuals in the 'POP-UP' low-barrier, high-intensity HIV primary care program during COVID-19. Among 85 patients, care engagement and viral suppression did not decrease in the 5 months following implementation of San Francisco's 'shelter-in-place' ordinance. Low-barrier, in-person HIV care for homeless individuals may be important for maintaining HIV outcomes during COVID-19.

Snow in the mountains is essential for the water cycle in cold regions. The complexity of the snow processes in such an environment makes it challenging for accurate snow and runoff predictions. Various snow modelling approaches have been developed, especially to improve snow predictions. In this study, we compared the ability to improve runoff predictions in the Överuman Catchment, Northern Sweden, using different parametric representations of snow distribution. They included a temperature-based method, a snowfall distribution (SF) function based on wind characteristics and a snow depletion curve (DC). Moreover, we assessed the benefit of using distributed snow observations in addition to runoff in the hydrological model calibration. We found that models with the SF function based on wind characteristics better predicted the snow water equivalent (SWE) close to the peak of accumulation than models without this function. For runoff predictions, models with the SF function and the DC showed good performances (median Nash–Sutcliffe efficiency equal to 0.71). Despite differences among the calibration criteria for the different snow process representations, snow observations in model calibration added values for SWE and runoff predictions. HIGHLIGHTS Models with a snow distribution based on wind and topography in addition to precipitation and temperature improved snow predictions.; Models with a snow distribution based on wind and topography could use snow information and perform similarly to models with a depletion curve for runoff.; The robustness of model calibration increased by including spatially distributed snow observations in addition to runoff data.;

BACKGROUND:Homelessness and unstable housing (HUH) negatively impact care outcomes for people living with HIV (PLWH). To inform design of a clinic program for PLWH experiencing HUH, we quantified patient preferences and trade-offs across multiple HIV-service domains using a discrete choice experiment (DCE). METHODS:We sequentially sampled PLWH experiencing HUH presenting at an urban HIV clinic with missed primary care visit and viremia in the last year to conduct a DCE. Participants chose between two hypothetical clinics varying across five service attributes: care team "get to know me as a person" versus not; receiving $10, $15 or $20 gift cards for clinic visits; drop-in versus scheduled visits; direct phone communication to care team versus front-desk staff; staying 2 versus 20 blocks from the clinic. We estimated attribute relative utility (i.e., preference) using mixed-effects logistic regression and calculated the monetary trade-off of preferred options. RESULTS:Among 65 individuals interviewed, 61% were >40 years-old; 45% white; 77% male; 25% heterosexual; 56% lived outdoors/emergency housing, and 44% in temporary housing. Strongest preferences were for patient-centered care team (β = 3.80; 95%CI 2.57-5.02) and drop-in clinic appointments (β = 1.33; 95%CI 0.85-1.80), with a willingness to trade $32.79 (95%CI 14.75-50.81) and $11.45 (95%CI 2.95-19.95) in gift cards/visit, respectively. CONCLUSION:In this DCE, PLWH-HUH were willing to trade significant financial gain to have a personal relationship with and drop-in access to their care team rather than clinic proximity and gift cards. These findings informed Ward 86's "POP-UP" program for PLWH-HUH and can inform "Ending the HIV Epidemic" efforts.

Introduction Chronic rhinitis (CR) represents a widespread inflammation with a high incidence in the general population. Although it is generally considered a benign condition, CR has a relevant impact on quality of life and requires a specific treatment approach.

Purpose of reviewSingular interventions targeting vulnerable populations of people living with HIV (PLWH) are necessary for reducing new infections and optimizing individual-level outcomes, but extant literature for PLWH who experience homelessness and unstable housing (HUH) has not been compiled. To inform implementation of clinic-based programs that improve care outcomes in this population, we present a synthetic review of key studies examining clinic-based interventions, specifically case management, patient navigation, financial incentives, and the use of mobile technology.Recent findingsResults from unimodal interventions are mixed or descriptive, are limited by inability to address related multi-modal barriers to care, and do not address major challenges to implementation. Multi-component interventions are needed, but gaps in our knowledge base may limit widespread uptake of such interventions before further data are compiled. Future research evaluating interventions for PLWH experiencing HUH should include implementation outcomes in order to facilitate adaptation across diverse clinical settings.

While poverty is an established barrier to achieving success at each step of the HIV care continuum, less is known about specific aspects of poverty and how they overlap with behavior in exceptionally low-income individuals who live in well-resourced areas. We considered unsuppressed viral load over 3 years among women living with HIV in San Francisco who used homeless shelters, low-income hotels and free meal programs. One-hundred twenty study participants were followed; 60% had > 1 unsuppressed viral load and 19% were unsuppressed at every visit. Across six-month intervals, the odds of unsuppressed viral load were 11% higher for every 10 nights spent sleeping on the street [Adjusted Odds Ratio (AOR) 1.11, 95% CI 1.02-1.20]; 16% higher for every 10 nights spent sleeping in a shelter (AOR/10 nights 1.16, 95% CI 1.06-1.27); 4% higher for every 10 nights spent sleeping in a single-room occupancy hotel (AOR/10 nights 1.04, 95% CI 1.02-1.07); and over threefold higher among women who experienced any recent incarceration (AOR 3.56, 95% CI 1.84-6.86). Violence and recent use of outpatient health care did not significantly predict viral suppression in adjusted analysis. While strategies to promote retention in care are important for vulnerable persons living with HIV, they are insufficient to ensure sustained viral suppression in low-income women experiencing homelessness and incarceration. Results presented here in combination with prior research linking incarceration to homelessness among women indicate that tailored interventions, which not only consider but prioritize affordable housing, are critical to achieving sustained viral suppression in low-income women living with HIV.

BackgroundPeople living with HIV (PLWH) who experience homelessness and unstable housing (HUH) often have fragmented health care. Research that incorporates granular assessments of housing status and primary care visit adherence to understand patterns of acute care utilization can help pinpoint areas for intervention.MethodsWe collected self-reported living situation, categorized as stable (rent/own, hotel/single room occupancy), unstable (treatment/transitional program, staying with friends), or homeless (homeless shelter, outdoors/in vehicle) at an urban safety-net HIV clinic between February and August 2017 and abstracted demographic and clinical information from the medical record. Regression models evaluated the association of housing status on the frequency of acute care visits-urgent care (UC) visits, emergency department (ED) visits, and hospitalizations-and whether suboptimal primary care visit adherence (

BackgroundStaphylococcus aureus is a leading cause of bacteremia, yet there remains a significant knowledge gap in the identification of relevant biomarkers that predict clinical outcomes. Heterogeneity in the host response to invasive S. aureus infection suggests that specific biomarker signatures could be utilized to differentiate patients prone to severe disease, thereby facilitating earlier implementation of more aggressive therapies.MethodsTo further elucidate the inflammatory correlates of poor clinical outcomes in patients with S. aureus bacteremia, we evaluated the association between a panel of blood proteins at initial presentation of bacteremia and disease severity outcomes using 2 cohorts of patients with S. aureus bacteremia (n = 32 and n = 124).ResultsWe identified 13 candidate proteins that were correlated with mortality and persistent bacteremia. Prognostic modeling identified interleukin (IL)-8 and CCL2 as the strongest individual predictors of mortality, with the combination of these biomarkers classifying fatal outcome with 89% sensitivity and 77% specificity (P < .0001). Baseline IL-17A levels were elevated in patients with persistent bacteremia (P < .0001), endovascular (P = .026) and metastatic tissue infections (P = .012).ConclusionsThese results demonstrate the potential utility of selected biomarkers to distinguish patients with the highest risk for treatment failure and bacteremia-related complications, providing a valuable tool for clinicians in the management of S. aureus bacteremia. Additionally, these biomarkers could identify patients with the greatest potential to benefit from novel therapies in clinical trials.

Housing instability negatively impacts outcomes in people [living] with human immunodeficiency virus (PLHIV), yet the effect of diverse living arrangements has not previously been evaluated. Using 6 dwelling types to measure housing status, we found a strong inverse association between housing instability and viral suppression across a spectrum of unstable housing arrangements.

Staphylococcus aureus bacteremia (SAB) is a tremendous health burden. Previous studies examining the association of vancomycin MIC and outcomes in patients with SAB have been inconclusive. This study evaluated the association between vancomycin MICs and 30- or 90-day mortality in individuals with SAB. This was a prospective cohort study of adults presenting from 2008 to 2013 with a first episode of SAB. Subjects were identified by an infection surveillance system. The main predictor was vancomycin MIC by MicroScan. The primary outcomes were death at 30 and 90 days, and secondary outcomes included recurrence, readmission, or a composite of death, recurrence, and readmission at 30 and 90 days. Covariates included methicillin susceptibility, demographics, illness severity, comorbidities, infectious source, and antibiotic use. Cox proportional-hazards models with propensity score adjustment were used to estimate 30- and 90-day outcomes. Of 429 unique first episodes of SAB, 11 were excluded, leaving 418 individuals for analysis. Eighty-three (19.9%) participants had a vancomycin MIC of 2 μg/ml. In the propensity-adjusted Cox model, a vancomycin MIC of 2 μg/ml compared to

Advances in hydrological modeling and numerical weather forecasting have allowed hydro-climate services to provide accurate impact simulations and skillful forecasts that can drive decisions at the local scale. To enhance early warnings and long-term risk reduction actions, it is imperative to better understand the hydrological extremes and explore the drivers for their predictability. Here, we investigate the seasonal forecast skill of streamflow extremes over the pan-European domain, and further attribute the discrepancy in their predictability to the local river system memory as described by the hydrological regimes. Streamflow forecasts at about 35 400 basins, generated from the E-HYPE hydrological model driven with bias-adjusted ECMWF SEAS5 meteorological forcing input, are explored. Overall the results show adequate predictability for both hydrological extremes over Europe, despite the spatial variability in skill. The skill of high streamflow extreme deteriorates faster as a function of lead time than that of low extreme, with a positive skill persisting up to 12 and 20 weeks ahead for high and low extremes, respectively. A strong link between the predictability of extremes and the underlying local hydrological regime is identified through comparative analysis, indicating that systems of analogous river memory, e.g. fast or slow response to rainfall, can similarly predict the high and low streamflow extremes. The results improve our understanding of the geographical areas and periods, where the seasonal forecasts can timely provide information on very high and low streamflow conditions, including the drivers controlling their predictability. This consequently benefits regional and national organizations to embrace seasonal prediction systems and improve the capacity to act in order to reduce disaster risk and support climate adaptation.

Several studies focused on the role of vitamin D (vitD) in pain chronification. This study focused on vitD level and pain chronification and extension in headache disorders. Eighty patients with primary headache underwent neurological examination, laboratory exams, including serum calcifediol 25(OH)D, and headache features assessment along with three questionnaires investigating depression, anxiety, and allodynia. The 86.8% of the population had migraine (48% episodic and 52% chronic). The 44.1% of patients had extracranial pain, and 47.6% suffered from allodynia. A vitD deficit, namely a serum 25(OH)D level

Posterior reversible encephalopathy cases are increasingly being reported in patients affected by COVID-19, but the largest series so far only includes 4 patients. We present a series of 6 patients diagnosed with PRES during COVID-19 hospitalized in 5 Centers in Lombardia, Italy. 5 out of the 6 patients required intensive care assistence and seizures developed at weaning from assisted ventilation. 3 out of 6 patients underwent cerebrospinal fluid analysis which was normal in all cases, with negative PCR for Sars-CoV-2 genome search. PRES occurrence may be less rare than supposed in COVID-19 patients and a high suspicion index is warranted for prompt diagnosis and treatment.

Il contributo presenta e commenta i risultati di una sperimentazione didattica condotta nell’anno scolastico 2017/2018 in due classi terze di una scuola primaria della provincia di Viterbo, un’area caratterizzata da un’elevata incidenza di alunni stranieri sul totale degli iscritti in tutti gli ordini scolastici. La sperimentazione, ispirata al progetto Osservare l’interlingua, si è concentrata sull’apprendimento della scrittura descrittiva e narrativa e sui problemi incontrati da alunni con differenti difficoltà di apprendimento. Il contributo dà conto di come gli alunni e soprattutto le insegnanti hanno valutato la sperimentazione. Teaching of writing to primary school’s pupils in multilingual classes. Results of an experimentation This paper presents and comments on the results of an educational experience conducted during the 2017/2018 school year in two third-grade classes at a primary school in the province of Viterbo, in an area characterized by a high incidence of foreign students enrolled in both primary and secondary school levels. Modelled after the Osservare l’interlingua Project, the experience focused on the learning of descriptive and narrative writing and the problems faced by students with different learning difficulties. The paper briefly reports the students’ and especially the teachers’ comments.

Background: The diagnosis of benign paroxysmal positional vertigo (BPPV) involving the lateral semicircular canal (LSC) is traditionally entrusted to the supine head roll test, also known as supine head yaw test (SHYT), which usually allows identification of the pathologic side and BPPV form (geotropic vs. apogeotropic). Nevertheless, SHYT may not always allow easy detection of the affected canal, resulting in similar responses on both sides and intense autonomic symptoms in patients with recent onset of vertigo. The newly introduced upright head roll test (UHRT) represents a diagnostic maneuver for LSC-BPPV, supplementing the already-known head pitch test (HPT) in the sitting position. The combination of these two tests should enable clinicians to determine the precise location of debris within LSC, avoiding disturbing symptoms related to supine positionings. Therefore, we proposed the upright BPPV protocol (UBP), a test battery exclusively performed in the upright position, including the evaluation of pseudo-spontaneous nystagmus (PSN), HPT and UHRT. The purpose of this multicenter study is to determine the feasibility of UBP in the diagnosis of LSC-BPPV.Methods: We retrospectively reviewed the clinical data of 134 consecutive patients diagnosed with LSC-BPPV. All of them received both UBP and the complete diagnostic protocol (CDP), including the evaluation of PSN and data resulting from HPT, UHRT, seated-supine positioning test (SSPT), and SHYT.Results: A correct diagnosis for LSC-BPPV was achieved in 95.5% of cases using exclusively the UBP, with a highly significant concordance with the CDP (p < 0.000, Cohen's kappa = 0.94), regardless of the time elapsed from symptom onset to diagnosis. The concordance between UBP and CDP was not impaired even when cases in which HPT and/or UHRT provided incomplete results were included (p < 0.000). Correct diagnosis using the supine diagnostic protocol (SDP, including SSPT + SHYT) or the sole SHYT was achieved in 85.1% of cases, with similar statistical concordance (p < 0.000) and weaker strength of relationship (Cohen's kappa = 0.80).Conclusion: UBP allows correct diagnosis in LSC-BPPV from the sitting position in most cases, sparing the patient supine positionings and related symptoms. UBP could also allow clinicians to proceed directly with repositioning maneuvers from the upright position.

During the COVID-19 outbreak, the Neurology and Stroke Unit (SU) of the hospital of Varese had to serve as a cerebrovascular hub, meaning that the referral area for the unit doubled. The number of beds in the SU was increased from 4 to 8. We took advantage of the temporary suspension of the out-patient clinic and reshaped our activity to guarantee the 24/7 availability of recombinant tissue Plasminogen Activator (rtPA) intravenous therapy (IVT) in the SU, and to ensure we were able to admit patients to the SU as soon as they completed endovascular treatment (EVT). In 42 days, 46 stroke patients were admitted to our hospital, and 34.7% of them underwent IVT and/or EVT, which means that we treated 0.38 patients per day; in the baseline period from 2016 to 2018, these same figures had been 23.5% and 0.23, respectively. The mean values of the door-to-first CT/MRI and the door-to-groin puncture, but not of the onset-to-door and the door-to-needle periods were slightly but significantly longer than those observed in the baseline period in 276 patients. On an individual basis, only one patient exceeded the door-to-groin puncture time limit computed from the baseline period by about 10 min. None of the patients had a major complication following the procedures. None of the patients was or became SARS-CoV2 positive. In conclusion, we were able to manage the new hub-and-spoke system safely and without significant delays. The reshaping of the SU was made possible by the significant reduction of out-patient activity. The consequences of this reduction are still unknown but eventually, this emergency will suggest ways to reconsider the management and the allocation of health system resources.

In questo contributo si presenta il Laboratorio di Italiano Scritto Assistito dal computer (LISA!) dell’Università degli Studi della Tuscia, attivato con l’obiettivo di aiutare gli studenti a perfezionare le tecniche della scrittura al computer e a migliorare le capacità di pianificazione e di realizzazione di testi efficaci. Si offrono alcuni materiali selezionati tra le esercitazioni svolte nel corso di otto anni accademici, e si commentano i principali punti critici rilevati. Le osservazioni sono condotte a partire da alcune riflessioni sullo stato dell’italiano scritto, in continua evoluzione anche per l’influenza dei nuovi media, e sul ruolo che la scuola e l’università assumono nel consentire l’acquisizione di una solida competenza della scrittura. Let’s write: the experience of the laboratory LISA! This paper presents the Computer-assisted Written Italian Lab (LISA!) at the University of Tuscia, which aims to help students use computer writing tools correctly and plan and write effective texts. The main critical points, identified in a corpus collected over eight academic years, will be examined. The research was conducted starting from some reflections on the state of written Italian, which is constantly evolving also due to the influence of new media and on the role that schools and universities have in enabling the acquisition of solid competence in writing.

Scrivere oggi all’Università Atti del Convegno di studi –Università degli Studi di Milano 6-7 maggio 2019 A cura di Michela Dota, Giuseppe Polimeni, Massimo Prada

L’articolo fornisce i primi dati di una ricerca in corso sulle comunità di stranieri immigrati residenti nella provincia di Viterbo e sulla partecipazione a corsi di lingua italiana offerti, autonomamente o in appoggio alle strutture pubbliche, dalle associazioni di volontariato inserite nella rete “Scuolemigranti”. La mappatura, realizzata per la prima volta e aggiornata tramite il confronto con i dati statistici nazionali e regionali, consente di apprezzare il rilievo quantitativo dell’immigrazione nel Viterbese e il suo impatto sociolinguistico sul territorio, con particolare riguardo alla presenza di studenti stranieri nella scuola. Uno specifico approfondimento è dedicato all’analisi di uno dei manuali usati nella didattica dell’italiano L2 ad adulti, e nel paragrafo conclusivo si presenta un progetto didattico in corso di realizzazione in classi plurilingui di scuole primarie e medie di primo grado della provincia di Viterbo. Teaching Italian to immigrants in Viterbo: initial notes This paper introduces the initial results of a study currently being carried out on immigrant families residing in the province of Viterbo (Northern Latium), especially focused on Italian language classes (A1-A2 levels) offered by the “Scuolemigranti” Volunteer Network either independently or as a support to the National Education Curriculum. After creating a statistical survey, which is updated using national and regional data, this study highlights the resident migrant population in the area and aims to show how the Viterbo sociolinguistic community is affected by an intensive migration flow. In the first section, the scientific and juridical backgrounds are outlined, then national and regional migration statistics are examined, principally focusing on school populations, addressing the features of an Italian language textbook for adult Italian L2 learners. Finally a teaching project on writing skills within multilingual classes in primary and middle schools in the province of Viterbo is presented.