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Over a quarter of the individuals diagnosed with tuberculosis [TB] in the European Union region are born outside of the area and the proportion has been increasing steadily. Italy is a low TB incidence country with over 50% of TB cases in the foreign-born population primarily due to the high numbers of migrants entering the country via land or sea. As a case study to evaluate the value of screening in newly arrived migrants, the EDETECT-TB project in Italy implemented and evaluated active TB screening in the migrant population at first reception centres to ensure early diagnosis to avoid further spread. Based on a cost-effectiveness analysis from a program provider perspective, a decision tree model allowed the assessment of the value for money of case finding by estimating the cost per case of active TB detected compared with the status quo of no screening. The analysis confirmed that early case detection is a cost-effective intervention in areas with migrants arriving from high TB risk settings. Targeted post-arrival early screening of high TB risk vulnerable new entrants to Italy has a potential role in reducing the spread of TB among migrants.

Background In Tanzania, maternal and neonatal mortality is still high, mainly due to poor quality of Antenatal Care (ANC) and Post Natal Care (PNC) services. PANDA (Pregnancy And Newborn Diagnostic Assessment) is a telemedicine system that uses mobile technology to perform adequate ANC/PNC visits according to WHO recommendations. Two pilot studies showed that PANDA is efficient in providing high-quality ANC and facilitating the continuity of care for underserved communities. This project aims at testing the impact of PANDA in Tanzania for improving the adherence to both ANC and PNC WHO protocols. Methods This case-control study is conducted in two different areas of the Mufindi district, Tanzania. The PANDA system includes: - solar backpack containing instrumentation for communicable and non-communicable diseases screening; smartphone with an icon-based application, including 5 modules: socio-demographic information, medical history, clinical screening, health education and birth plan, postnatal care;hospital database with the data collected during the visits. Results At present, 405 women (1,066 ANC visits) were recruited in the implementation site and 200 in the control site. The preliminary results show that 60% of women attended ≥ 2 ANC visits in the implementation site. In this area, 52 women were found positive for HIV and 4 for syphilis. Data collection in both the sites is ongoing. Conclusions PANDA system allows the creation of electronic patient records and the identification of the high-risk pregnancies. The collection of population data is useful for health planning policies. The easy-to-use and easy-to-understand graphic interface overcomes language and literacy barriers and facilitates comprehension of women and compliance to visits. This can improve the quality of ANC/PNC services with an expected reduction in maternal and neonatal mortality. Key messages PANDA system increases access to high-quality ANC for pregnant women in low-income countries, improving the adherence to WHO recommendations. The telemedicine system PANDA is a useful tool for public health policy-makers, as it allows the collection of previously unavailable population data.

Innovative migrant-friendly tools are needed to assist health personnel manage the high number of pregnancies within reception centers. This study tests functionality and acceptability of a new mHealth system in providing antenatal care amongst migrants. The study, carried out between 2014 and 2016, involved 150 pregnant women residing in the largest European migrant reception center in Sicily. A ticket tracking system assessed the system's functionality and a questionnaire assessed women's acceptability. The system facilitated the collection of clinical data, enabling the creation of electronic patient records and identifying 10% of pregnancies as high-risk. The application's digital format increased health providers' adherence to antenatal-care recommendations, while the graphic interface facilitated women's engagement and retention of the health education modules. The study recorded a 91.9% patient satisfaction rate. The system was efficient in providing comprehensive and high-quality antenatal care amongst migrants, facilitating the continuity of care for a population undergoing frequent relocations.

Internet of Things (IoT) is pushing the Internet to the next level, bringing the number of connected devices to an unprecedented amount, creating new services and improving old services like the metering system. The advanced meter infrastructure (AMI) measures, collects and analyzes the distribution and consumption of utilities such as water, electricity, and gas, which are of vital importance for the implementation of smart cities. In this paper, we employ LoRa, which is a low power wide area network technology (LPWAN), for the communication of meter devices and network server, and we study the coexistence of two kinds of messages: regular and alarm events. Our focus is on the analysis of the alarm events, which can be characterized by emergency situations and require ultra-reliability. We investigated the feasibility of the alarms for a smart metering scenario through simulation campaigns and a mathematical model. By assigning a different spreading factor (SF) to the device depending on whether the event is regular or alarm, we assessed the system performance. We evaluate the availability, reliability, and quantity of alarms that satisfy the restricted requirements of alarms events and do not compromise the performance of regular events. The best performance for regular events at SF-7 was obtained when alarm events are allocated to SF-8, whereas the other combinations are affected for a stronger interference.

Interference Alignment (IA) is a technique for mitigating the interference in wireless networks. While previous studies have mainly focused on theoretical gains and algorithms, this paper goes a step further, by assessing IA incorporated to a Coordinated Multi-Point (CoMP)-like network. IA algorithms have been well studied in terms of transmissions performance and signaling cost, albeit for fixed number of users. In the current paper we evaluate the IA technique in more realistic scenarios, in which a scheduling policy is required towards providing service for a whole population of users while the sheer number of involved channels change all the time. The IA performance is shown to be in between the joint processing and conventional transmission schemes, which are distinguished by the coordination (or the lack of it) among the transmitters. By analyzing the impact of different scheduling policies based on distances between subspaces, it is concluded that the channel gains should not be disregarded by the schedulers when trying to improve system capacity.

Background Despite many efforts, maternal mortality remains a major burden in most developing countries. Mobile health (mHealth) has the potential to improve access to obstetric care through apps that help patients and providers. Objective This study aimed to use mHealth to provide antenatal care (ANC) to 1446 pregnant women in a rural area in Madagascar and evaluate the quality of ANC provided by an mHealth system designed to change the behaviors of providers and patients. Methods We included 1446 women who attended ANC visits in rural Madagascar from 2015 to 2019 using an mHealth system called Pregnancy and Newborn Diagnostic Assessment (PANDA). This cross-sectional study used data from different participants, with information collected over several years, to analyze the outputs related to the quality of ANC over time. Specifically, we examined the timing of the first ANC visit, the relationship between the visit duration and the risk factors among pregnant women, and the number of ANC visits per woman. Results Following the implementation of the mHealth system in 2015, we observed that women started to come earlier for their first ANC visit; more women attended their first ANC visit in the second trimester of pregnancy in 2019 than in the previous years (P35 years; 25.0 min, 95% CI 24.0-25.9), educational level (longer visit for women with lower than primary education and for women who attended university and shorter for women with primary school–level education; 40.7 min, 95% CI 30.2-51.3 and 25.3 min, 95% CI 24.4-26.3 vs 23.3 min, 95% CI 22.9-23.8; P=.001), experience of domestic violence during pregnancy, gravidity, parity, infectious diseases (HIV, malaria, and syphilis), and level of anemia. Statistically significant associations were observed for all quality indicator variables. We observed a statistically significant increase in the number of ANC visits per woman over time from 2015 to 2017; the number of ANC visits per woman then became stable after the third year of implementing the PANDA mHealth system. Conclusions This study shows the potential of an mHealth system to improve the quality of ANC, change provider behavior by standardizing ANC visits, and change patient behavior by increasing the willingness to return for subsequent visits and encouraging ANC attendance early in pregnancy. As this is an exploratory study, further studies are necessary to better understand how mHealth can change behavior and identify the conditions required for behavioral changes to persist over time.

This paper analyzes the feasibility of the coexistence of telemetry and alarm messages employing Long-Range Wide-Area Network (LoRaWAN) technology in industrial environments. The regular telemetry messages come from periodic measurements from the majority of sensors while the alarm messages come from sensors whose transmissions are triggered by rarer (random) events that require highly reliable communication. To reach such a strict requirement, we propose here strategies of allocation of spreading factor, by treating alarm and regular (telemetry) messages differently. The potential of such allocation strategies has also been investigated under retransmission and diversity of gateways. Both indoor industrial plant and open-field scenarios are investigated. We compare the proposed solution with a benchmark scenario&mdash, where no alarm is considered&mdash, by using system level simulation. Our results show that it is possible to achieve high reliability with reasonably low delay for the alarm messages without significantly affecting the performance of the regular links.

Background Antenatal care (ANC) has the potential to identify and manage obstetric complications, educate women about risks during pregnancy and promote skilled birth attendance during childbirth. The aim of this study was to assess women’s knowledge of obstetric danger signs and factors associated with this knowledge in Ambanja, Madagascar. It also sought to evaluate whether the participation in a mobile health (mHealth) project that aimed to provide comprehensive ANC to pregnant women in remote areas influenced women’s knowledge of obstetric danger signs. Methods From April to October 2015, a non-random, convenience sample of 372 women in their first year postpartum were recruited, including 161 who had participated in the mHealth project. Data were analyzed using bivariate and multivariate logistic regression. Results Knowledge of at least one danger sign varied from 80.9% of women knowing danger sign(s) in pregnancy, to 51.9%, 50.8% and 53.2% at delivery, postpartum and in the newborn, respectively. Participation in the mHealth intervention, higher household income, and receipt of information about danger signs during pregnancy were associated with knowledge of danger signs during delivery, in bivariate analysis; only higher household income and mHealth project participation were independently associated. Higher educational attainment and receipt of information about danger signs in antenatal care were associated with significantly higher odds of knowing danger sign(s) for the newborn in both bivariate and multivariate analysis. Conclusions Knowledge of obstetric danger signs is low. Information provision during pregnancy and with mHealth is promising. Trial registration This trial was retrospectively registered at the International Standard Randomized Controlled Trial Register (identifier ISRCTN15798183; August 22, 2015). Electronic supplementary material The online version of this article (10.1186/s12884-018-1664-x) contains supplementary material, which is available to authorized users.

In Italy over 50% of cases each year occurs in foreign-born persons. Although Tuberculosis (TB) diagnosis and treatment are offered for free to all people reporting to public hospitals regardless of their resident status, symptomatic migrants tend to report late, increasing transmission. We propose a multi-step (screen-test-refer for care) intervention which includes a questionnaire screening followed by on spot sputum collection and Xpert MTB/rif analysis. The TB screening was carried out at the Centro Accoglienza per Richiedenti Asilo di Mineo in Catania. Two clinicians performed door-to-door visit to screen all the available population for symptoms suggestive of TB by means of a standardized questionnaire. Sputum specimens were collected if any of the symptoms was reported. OMNIgene-sputum was added to the specimen for transport. Sputum samples were tested by smear-microscopy, GeneXpert (G4), XpertMTB/RIF-ULTRA and culture. A total of 1429 refugees agreed to participate in the screening. Out of 1429 patients interviewed 457 (31,9%) reported at least one of the symptoms. Among the 457 patients questionnaire’s positive, 192 underwent to further microbiological investigations. Three samples were culture positive so far, while we detected 4 G4-positive samples (only one of them confirmed by culture) and 12 ULTRA-positive samples (3 with culture confirmation). All the G4 positive samples were positive at ULTRA analysis too. Six of the ULTRA-positive samples scored “trace”. This preliminary set of data showed that ULTRA increases the number of positive from 4 to 12 compared to G4. More data are needed on how to interpret positive at “TRACE” level.

Background Madagascar’s maternal health mortality ratio in 2013 was 478 deaths per 100,000 live births. Most deaths are related to direct complications during pregnancy and childbirth and could be reduced by providing comprehensive antenatal care (ANC). Objective The objective of the study was to assess the usability and feasibility of a mobile health system (mHealth) to provide high-quality ANC, according to World Health Organization (WHO) recommendations. Methods PANDA (Pregnancy And Newborn Diagnostic Assessment) is an easy-to-use mHealth system that uses affordable communications technology to support diagnosis and health care worker decision-making regarding ANC. From January to March 2015, a cross-sectional pilot study was conducted in Ambanja District, Madagascar, in which ANC using PANDA was provided to 100 pregnant women. The collected data were transmitted to a database in the referral hospital to create individual electronic patient records. Accuracy and completeness of the data were closely controlled. The PANDA software was assessed and the number of abnormal results, treatments performed, and participants requiring referral to health care facilities were monitored. Results The PANDA system facilitated creation of individual electronic patient records that included socio-demographic and medical data for 100 participants. Duration of ANC visits averaged 29.6 min. Health care providers were able to collect all variables (100%) describing personal and medical data. No major technical problems were encountered and no data were lost. During 17 ANC visits (17%), an alert function was generated to highlight abnormal clinical results requiring therapy or referral to an affiliated hospital. Participants’ acceptability of the system was very high. Conclusion This pilot study proved the usability and feasibility of the PANDA mHealth system to conduct complete and standardised ANC visits according to WHO guidelines, thus providing a promising solution to increase access to high-quality and standardised ANC for pregnant women in remote areas.

The paper builds up on the idea of separating, in the time dimension, between conventional uncoordinated MIMO and IA transmission. The former usually utilizes all available dimensions (antennas) to send useful information, while the latter mitigates inter-cell interference. Due to the multitude of users in cellular networks, the transmission schemes are suitable for different groups of users. Therefore, in order to take advantage of both schemes, the users are classified into two groups: one with those users that supposedly benefit from cooperation and the other with those that should not cooperate. The proposed method for grouping the users has the advantage of being based on a simple decision metric, which avoids having to calculate precoders for all different possible combinations. Since each group must apply the proper transmission scheme, a fraction of the temporal resources is dedicated to each type of transmission. An automatic reservation of the temporal resources and an adaptive adjustment of the grouping threshold for each user, which avoids having to empirically determine a single threshold, are also proposed. These proposed mechanisms are shown to provide performance gains of up to 30% over the conventional transmissions.

This chapter revisits many of the issues concerning radio resource management with a focus on the upcoming systems embodying the Coordinated Multipoint (CoMP) technology. Nowadays CoMP-based systems have attracted special attention due to their potential benefits in terms of spectral efficiency and coverage. As a part of 3GPP Long Term Evolution—Advanced, CoMP technology promises substantial improvement of the users’ experience at the expense of requiring a reliable and efficient connection among the evolved Node Bs (eNBs). If multiple users and eNBs are coordinated using a suitable technique, the concerns about interference can be greatly alleviated and, consequently, also the restrictions on sharing the radio resources. In this chapter, the grouping of users and eNBs is explored in two different occasions. First, coordinated strategies process the Channel State Information (CSI) for scheduling users in order to improve the system performance; afterwards, clustering of eNBs is described as an attractive approach to deal with the processing and signaling overheads brought by CoMP. The chapter presents an analysis of different algorithms, as well as case studies illustrating some key concepts through computer simulations.

Background: The aims of the study were to detect nosocomial and community-acquired Legionnaires’ disease among patients with pneumonia recovered in Italian hospitals, to improve knowledge on the disease frequency, and to characterise environmental, personal, genetic and immune risk factors associated with the disease appearance (case-control study). Methods: In six big hospitals, an active surveillance lasting four years was carried out to detect cases among recovered pneumonia. The protocol included the systematic detection of urinary L. pneumophila antigen (EIA), search of the microorganism in respiratory secretions, and seroconversion (IFA) as confirmation test. Cases were included, after obtaining informed consensus, in a case-control study to evaluate environmental, clinical and personal characteristics associated with the disease. As controls, both healthy subjects and patients affected by other pneumonia were recruited. Results: We detected 189 cases on 6,032 examined pneumonia (3.13%), 174 were community and 15 nosocomial-acquired. Prevalence varied between 1.5 and 6.1% according to the surveyed hospital. One hundred and twenty-six patients and 142 controls entered in the case-control design. Pre-existing immune-pathologies were associated with the disease, whereas higher smoking and co-morbidity were risk factors of all pneumonia. A significant decrease in CD16 (natural killer) cell number was found in patients compared with both control groups. Furthermore, significant alterations in iron metabolism and serum trace elements were found. Polymorphisms of the chemokines receptors genes (ccr5 and ccr2) were also evaluated. Conclusions: Our active clinical surveillance scheme was able to identify 189 cases between 2001 and 2004, contributing to increase reports in Italy, where about 600 cases for year are notified. The rate of infection in recovered pneumonia was about 3%, confirming results of other similar surveys. The preliminary results of the case-control study show that cases have peculiar, although not sufficiently studied, alterations in both immune and biochemical parameters, which deserve further investigations.

More and more Coordinated Multi-Point (CoMP) systems are attracting interest as a means to improve the performance of conventional cellular networks, particularly thanks to the joint processing approach. However, the large amount of signaling and computer operations required deserves special attention regarding both backhaul and radio resources constraints. Partitioning the set of transmission points into clusters is likely to reduce this coordination cost, but the search for the best formations of clusters may lead to expressive further computational efforts. Herein we introduce a novel approach, the Clustering-based Assignment Algorithm (CbAA), to cluster dynamically the transmission points on the downlink in order to transmit coherently to multiple users. When compared to static clustering, the proposed CbAA provided expressive gains in terms of system spectral efficiency. Compared to state-of-the-art dynamic clustering approaches, CbAA can waive the exhaustive search over all possible formations as well as the repetitive precoder calculations during the clustering procedure.

In the context of Long Term Evolution (LTE)-Advanced, the transmission points responsible for Coordinated Multi-Point (CoMP) transmission can be arranged in a distributed way and each one can be equipped with multiple antennas. In such scenario, efficient Radio Resource Allocation (RRA) strategies are required to exploit the available spatial degrees of freedom, coordinate the resources usage and manage the interference. This work provides system-level analyses for several RRA strategies in multi-antenna CoMP systems. The results show significant benefits in terms of system spectral efficiency for different spatial transmission strategies, including the combination of spatial multiplexing and spatial diversity.

This article considers the two-way bidirectional relaying scenario, in which it is crucial to improve the transmission efficiency to make up for the extra hop in the communication. Single-antenna two-way relaying can be implemented through a Self-Interference (SI) cancellation scheme known as Bidirectional Amplification of Throughput (BAT). This paper analyzes the impact that an imperfect cancellation has on the system performance. Additionally, some insights are provided on the achievable gains when multi-antenna relay stations are employed. An extension of the BAT concept to this multi-antenna case is formulated and compared to a Zero-Forcing (ZF) approach.

This study evaluated the prevalence of anti-legionella antibodies in workers at hospitals with a long-term history of legionella contamination. The hospitals are located in Milan and Turin, northern Italy, and in Naples and Bari, southern Italy. Antibody prevalence and titres of healthcare workers, medical and dental students and blood donors were assessed. In total 28.5% of subjects were antibody positive, most frequently to L. pneumophila serogroups 7-14. Major differences were observed in seroprevalence and type of legionella antibody in persons from different geographic areas. Healthcare workers had a significantly higher frequency of antibodies compared with blood donors in Milan (35.4 vs 15.9%, P

This article introduces a software development framework, which amasses object-oriented programming (OOP) concepts and designed procedures, intended to systematize the implementation of link-level simulation tools. This development framework is fully implemented in C++ programming language providing modularity and reusability (improving the coding activity). This framework then constitutes remarkable tool for quickly creating link-level applications. Aiming to evaluate the applicability of this software structure, the conversational service class transmitting at 12.2 kbps and over the Wideband CDMA (WCDMA) Downlink (DL) dedicated channel (DCH) is addressed as a case-study and therefore potential benefits of utilizing such development library are identified. It is shown that the development framework provides flexibility for the software development of link-level simulators remarkably reducing the design, programming and testing stages.

A cross-sectional multicenter survey of Italian hotels was conducted to investigate Legionella spp. contamination of hot water. Chemical parameters (hardness, free chlorine concentration, and trace element concentrations), water systems, and building characteristics were evaluated to study risk factors for colonization. The hot water systems of Italian hotels were strongly colonized by Legionella ; 75% of the buildings examined and 60% of the water samples were contaminated, mainly at levels of ≥10 3 CFU liter −1 , and Legionella pneumophila was the most frequently isolated species (87%). L. pneumophila serogroup 1 was isolated from 45.8% of the contaminated sites and from 32.5% of the hotels examined. When a multivariate logistic model was used, only hotel age was associated with contamination, but the risk factors differed depending on the contaminating species and serogroup. Soft water with higher chlorine levels and higher temperatures were associated with L. pneumophila serogroup 1 colonization, whereas the opposite was observed for serogroups 2 to 14. In conclusion, Italian hotels, particularly those located in old buildings, represent a major source of risk for Legionnaires' disease due to the high frequency of Legionella contamination, high germ concentration, and major L. pneumophila serogroup 1 colonization. The possible role of chlorine in favoring the survival of Legionella species is discussed.

Despite legionellosis surveillance is active in Italy since many years, the disease notification appears still undervalued. A multicentric survey was carried out among 5 big Italian hospitals. It examined 11,435 discharge forms (1999-2001), reporting pneumonia diagnosis. Legionellosis (II class of notify system for infectious disease) was studied among pneumonia diagnosis by discharge forms. According to the ICD9-CM, there's no specific code for legionellosis (this disease is included among "others gram-negative pneumonia"). So the presumed pneumonia imputable to Legionella spp were the 2.7% of the whole number of analyzed discharge forms. Besides, the data regarding the other pneumonia showed that the etiological agent was specified only in the 11.2% of the case. This situation could be rectified both introducing adequate discharge forms codes and promoting the etiological diagnosis during the hospital stay.

An outbreak of nosocomial legionnaires' disease in a hospital of Northern Italy is described, together with the epidemiological survey and the control measures adopted. Two patients developed Legionella pneumophila (serogroup 1) pneumonia, one (immunodepressed) died. The Task Group organised by the Health Service excluded other previous nosocomial infections, and made controls on patients and personnel of at risk units (all negative). An intensive programme of environmental sampling and educational activities on personnel have been carried out. The environmental surveillance revealed that the centralised hot water distribution system of the hospital was colonised with Legionella. Shock heating and hyperchlorination of water were applied, which reduced the number of contaminated sites short term, but recolonisation took place two months later. We underline the difficulties encountered to control Legionella by active surveillance of water quality; once the system is contamined, Legionella eradication may be difficult and expensive, and cases of hospital-acquired legionnaieres' disease are likely to occur.

The incidence of legionella infection in Europe overall in 1997 was 3.9 cases per million population, with the lowest rates reported by Malta and Norway and the highest by Denmark. Ninety cases were reported in Italy (1.5 cases/million), 20% of which were

We investigated Legionella and Pseudomonas contamination of hot water in a cross-sectional multicentric survey in Italy. Chemical parameters (hardness, free chlorine, and trace elements) were determined. Legionella spp. were detected in 33 (22.6%) and Pseudomonas spp. in 56 (38.4%) of 146 samples. Some factors associated with Legionella contamination were heater type, tank distance and capacity, water plant age, and mineral content. Pseudomonas presence was influenced by water source, hardness, free chlorine, and temperature. Legionella contamination was associated with a centralized heater, distance from the heater point >10 m, and a water plant >10 years old. Furthermore, zinc levels of 50 microg/L appeared to be protective against Legionella colonization [corrected]. Legionella species and serogroups were differently distributed according to heater type, water temperature, and free chlorine, suggesting that Legionella strains may have a different sensibility and resistance to environmental factors and different ecologic niches.

Wetness of the host surface is a critical environmental factor for the development of foliar fungal diseases, but it is difficult to estimate the wetness durations required by pathogens for infection when only few experimental data are available. In this paper, we propose a method to estimate wetness duration requirements of foliar fungal pathogens when precise experimental data are not available. The proposed method is based on approximate Bayesian computation. It only requires lower and upper bounds of wetness duration requirements for one or fewer temperatures. We describe the method, show how to apply it to an infection model, and then present a case study on Mycosphaerella nawae, the causal agent of circular leaf spot of persimmon. In this example, the parameters of a simple infection model were estimated using experimental data found in the literature for the pathogen, and the model was applied to assess the risk in a Spanish area recently affected by the disease. The results showed that the probability of successful infection was higher than 0.5 for 32% of the on-site wetness durations recorded in the affected area. Results obtained with simulated data showed that our method was able to improve the estimation of wetness duration requirement. Given the flexibility of the proposed method, we expect it to become adopted for assessing the risk of introduction of exotic fungal plant pathogens.