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Intra-abdominal infections (IAIs) are common surgical emergencies and are an important cause of morbidity and mortality in hospital settings, particularly if poorly managed. The cornerstones of effective IAIs management include early diagnosis, adequate source control, appropriate antimicrobial therapy, and early physiologic stabilization using intravenous fluids and vasopressor agents in critically ill patients. Adequate empiric antimicrobial therapy in patients with IAIs is of paramount importance because inappropriate antimicrobial therapy is associated with poor outcomes. Optimizing antimicrobial prescriptions improves treatment effectiveness, increases patients’ safety, and minimizes the risk of opportunistic infections (such as Clostridioides difficile) and antimicrobial resistance selection. The growing emergence of multi-drug resistant organisms has caused an impending crisis with alarming implications, especially regarding Gram-negative bacteria. The Multidisciplinary and Intersociety Italian Council for the Optimization of Antimicrobial Use promoted a consensus conference on the antimicrobial management of IAIs, including emergency medicine specialists, radiologists, surgeons, intensivists, infectious disease specialists, clinical pharmacologists, hospital pharmacists, microbiologists and public health specialists. Relevant clinical questions were constructed by the Organizational Committee in order to investigate the topic. The expert panel produced recommendation statements based on the best scientific evidence from PubMed and EMBASE Library and experts’ opinions. The statements were planned and graded according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) hierarchy of evidence. On November 10, 2023, the experts met in Mestre (Italy) to debate the statements. After the approval of the statements, the expert panel met via email and virtual meetings to prepare and revise the definitive document. This document represents

In the last decade, the index-based weather products (also called weather derivatives) have been gaining attention in the climate resilience discussion. Weather derivatives are designed to help companies hedging against climate variability. These products, that can be market-traded or over-the-counter, compensate individuals based on a pre-defined weather index. Thus, pay-offs of a weather derivative depend on a weather index and not, as with traditional types of insurance, on the actual amount of money lost due to adverse weather. One of the major drawbacks that may prevent weather derivatives to catch on is the impact of the Geographical Basis Risk (GBR), that is the deviation of weather conditions at different locations. In fact, when the reference weather station is not located in the immediate vicinity of the site of interest the hedging effectiveness may be reduced. In this paper, we contribute to the existing literature on GBR by proposing an optimization method that may help in offering a tailored solution, while at the same time keeping a standardized instrument as a reference. Using a historical record of Italian temperatures, strikes for temperatures are the choice variables of a penalty function containing pay-offs of a reference station and all other stations. Further, altitude and latitude of meteorological stations are shown to be relevant predictors to explain GBR. This can be an interesting starting point for the design of weather derivatives, since, from a unique station where the “reference” derivative is priced, all the other stations may be easily settled.

Over the next 30 years, temperatures are expected to increase in hot semi-arid zones. Despite increasing studies on urban heat, cooling measures suitable for this climate zone remain poorly investigated. The proposed method is innovative because it focuses on significant landscape metrics for determining the land surface temperature (LST) and evaluating cooling measures. Recurrence of warm spells was identified analysing the daily air temperatures. Daytime and night-time LST data acquired from space were correlated with landscape metrics extracted from very high-resolution satellite imagery. Stepwise linear regression was used to identify the significant metrics that affected it. Cooling measures were selected considering implementation leeway; performance of existing measures; strengths, weaknesses, opportunities, and threats, equity analyses. Although the method was tested in Niamey, Niger, it can be applied to any city or town in hot semi-arid Global South, requiring decision-making support on cooling policies. • Landscape metrics are consistent with development standard and general requirements. • Evaluation of measures to reduce land surface temperature includes experts. advice. • Equity of measures to reduce land surface temperature is considered.

Meniere s disease MD is a severe inner ear condition known by debilitating symptoms including spontaneous vertigo fluctuating and progressive hearing loss tinnitus and aural fullness or pressure within the affected ear Prosper Meniere first described the origins of MD in the 1860s but its underlying mechanisms remain largely elusive today Nevertheless researchers have identified a key histopathological feature called Endolymphatic Hydrops ELH which refers to the excessive buildup of endolymph fluid in the membranous labyrinth of the inner ear The exact root of ELH is not fully understood Still it is believed to involve several biological and bioenvironmental etiological factors such as genetics autoimmunity infection trauma allergy and new theories such as saccular otoconia blocking the endolymphatic duct and sac Regarding treatment there are no reliable and definitive cures for MD Most therapies focus on managing symptoms and improving the overall quality of patients life To make significant advancements in addressing MD it is crucial to gain a fundamental understanding of the disease process laying the groundwork for more effective therapeutic approaches This paper provides a comprehensive review of the pathophysiology of MD with a focus on old and recent theories Current treatment strategies and future translational approaches with low level evidence but promising results related to MD are also discussed including patents drug delivery and nanotechnology that may provide future benefits to patients suffering from MD

Purpose: Considering the case study presented, the purpose of this paper is to analyse the impact of the pandemic in local services for homeless people. Drawing from the concept of ontological security, it will be discussed how different services’ levels of “housing adequacy” shaped remarkably different experiences of the pandemic for homeless people and social workers in terms of health protection and agency. Design/methodology/approach: This paper focuses on a case study concerning homeless services for people during the COVID-19 pandemic in the metropolitan and suburban area of Turin, in Northern Italy. In-depth interviews with social workers and participant observation during online meetings of workers from the shelters constitute the empirical data that have been collected during the first wave of the pandemic in Italy. Findings: According to the findings, the pandemic showed shelters as unsafe places that reduce homeless people’s decision power and separate them from the rest of the citizenship. Instead, Housing First projects emerged as imore inclusive and safermore inclusive and safer spaces, able to enhance people’s power over their own lives. The pandemic did not create emerging issues in the homeless services system or discontinuities: rather, it amplified pre-existing problematic aspects. Originality/value: The case study presented provides empirical insights to recognise at the political and organisational level the importance of housing as a measure of individual and collective security, calling for an intervention to tackle homelessness in terms of housing policies rather than exclusively social and emergency treatment.

This paper contributes to the existing literature in proposing an integrated approach to water management and energy renewable production in a fragile environment. After the 2004 tsunami, in many outer islands in The Republic of Maldives, the lens freshwater natural reservoir was deeply damaged. Currently, the populations of rural atolls use rainwater and water in plastic bottles imported from the mainland for drinking. To provide safe and sustainable drinking water, we analyze the feasibility of two different actions: a desalination system fed by a diesel plant or by a photovoltaic (PV) plant with batteries. The current situation (business as usual, (BAU)) is also evaluated and taken as a benchmark. After illustrating the technical and economic features of desalination and PV plants, a financial and environmental analysis is conducted on the two alternatives plus BAU, showing that the desalination fed by the PV plant results in optimization both on the financial and the environmental side. The levelized cost of water (LCOW) and the CO2 levelized emissions of water (LEOW) are calculated for each alternative. The case study is developed in Magoodhoo Island, Faafu Atoll and can be extended to other islands in The Republic of Maldives and in general to small island developing states (SIDS).

This paper focuses on weather derivatives as efficient risk management instruments and proposes a more advanced approach for their pricing. An “hybrid” contract is introduced, combining insurance properties, specifically tailored for the region under study and introducing Value-at-Risk (VaR) and Expected Shortfall (ES) as appropriate measures for the strike price. The numerical results show that VaR and ES are both efficient ways for managing the so-called Tail Risk; further, being ES more conservative than VaR and due to its subadditivity property, it can be seen that seasonal contracts are generally better off than monthly contracts in reducing global risk.

The Jovian InfraRed Auroral Mapper (JIRAM) onboard the NASA Juno mission monitored the evolution of Jupiter’s polar cyclones since their first observation ever in February 2017. Data acquired by JIRAM have revealed cloudy cyclones organized in a complex, yet stable geometrical pattern at both poles. Several studies have investigated the dynamics and the structure of these cyclones, to understand the physical mechanisms behind their formation and evolution. In this work, we present vorticity maps deduced from the wind fields for the region poleward of ∼ -80°, which has been extensively covered over the last four years of observations. The cyclonic features related to the stable polar cyclones are embedded in a slightly, but diffused anticyclonic circulation, in which short-living anticyclones emerge with respect to the surroundings. Although the general stability of both the cyclones and the whole system is strongly confirmed by this work, variations in the shape of the vortices, as well as changes in the local structures, have been observed.

Management of patients with infections caused by multidrug-resistant organisms is challenging and requires a multidisciplinary approach to achieve successful clinical outcomes. The aim of this paper is to provide recommendations for the diagnosis and optimal management of these infections, with a focus on targeted antibiotic therapy. The document was produced by a panel of experts nominated by the five endorsing Italian societies, namely the Italian Association of Clinical Microbiologists (AMCLI), the Italian Group for Antimicrobial Stewardship (GISA), the Italian Society of Microbiology (SIM), the Italian Society of Infectious and Tropical Diseases (SIMIT) and the Italian Society of Anti-Infective Therapy (SITA). Population, Intervention, Comparison and Outcomes (PICO) questions about microbiological diagnosis, pharmacological strategies and targeted antibiotic therapy were addressed for the following pathogens: carbapenem-resistant Enterobacterales; carbapenem-resistant Pseudomonas aeruginosa; carbapenem-resistant Acinetobacter baumannii; and methicillin-resistant Staphylococcus aureus. A systematic review of the literature published from January 2011 to November 2020 was guided by the PICO strategy. As data from randomised controlled trials (RCTs) were expected to be limited, observational studies were also reviewed. The certainty of evidence was classified using the GRADE approach. Recommendations were classified as strong or conditional. Detailed recommendations were formulated for each pathogen. The majority of available RCTs have serious risk of bias, and many observational studies have several limitations, including small sample size, retrospective design and presence of confounders. Thus, some recommendations are based on low or very-low certainty of evidence. Importantly, these recommendations should be continually updated to reflect emerging evidence from clinical studies and real-world experience.