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Background Growing concerns regarding the adverse effects of antibiotics during the first days of life and the marked reduction in the incidence of early-onset sepsis (EOS) are changing the clinical practice for managing neonates at risk of EOS. Strategies avoiding unnecessary antibiotics while promoting mother-infant bonding and breastfeeding deserve to be considered. Main body We compare strategies for managing newborns at risk of EOS recommended by the American Academy of Pediatrics, which are among the most followed recommendations worldwide. Currently three different approaches are suggested in asymptomatic full-term or late preterm neonates: i) the conventional management, based on standard perinatal risk factors for EOS alone, ii) the neonatal sepsis calculator, a multivariate risk assessment based on individualized, quantitative risk estimates (relying on maternal risk factors for EOS) combined with physical examination findings at birth and in the following hours and iii) an approach entirely based on newborn clinical condition (serial clinical observation) during the first 48 h of life. We discuss advantages and limitations of these approaches, by analyzing studies supporting each strategy. Approximately 40% of infants who develop EOS cannot be identified on the basis of maternal RFs or laboratory tests, therefore close monitoring of the asymptomatic but at-risk infant remains crucial. A key question is to know what proportion of babies with mild, unspecific symptoms at birth can be managed safely without giving antibiotics. Conclusions Both neonatal sepsis calculator and serial clinical observation may miss cases of EOS, and clinical vigilance for all neonates is essential There is a need to assess which symptoms at birth are more predictive of EOS, and therefore require immediate interventions, or symptoms that can be carefully reevaluated without necessarily treat immediately the neonate with antibiotics. Studies comparing strategies for managing neonates are recommended.

Purpose: Intrapartum antibiotic prophylaxis (IAP) prevents group B streptococcus (GBS) early-onset disease (EOD). No European study evaluates the relative impact of risk factors (RFs) for EOD after...

Background: Bronchiolitis is a common cause of hospitalisation of infants less than a year old, with most infants recovering without complications. Respiratory syncytial virus (RSV) is a leading cause of bronchiolitis. Antimicrobial stewardship programmes do not recommend antibiotics for viral infections in neonates unless documented evidence of secondary bacterial infection is present. Case report: We present the case of a 7-day-old infant admitted to hospital with chest retractions and fever. The baby was hospitalised, empirical antibiotic therapy was administered, and non-invasive ventilation was started. When the viral aetiology was identified and clinical conditions improved, antibiotics were discontinued. However, after 48 hours, the newborn’s condition worsened because of pneumococcal septic shock. Intravenous fluids, catecholamine support, and wide-spectrum antibiotics were administered. Non-invasive ventilation was re-started and continued until the full recovery. Conclusions: There is increasing evidence that RSV and S. pneumoniae co-infect and interact with each other, thus increasing respiratory diseases’ severity. We provide a brief overview of the main international guidelines for managing bronchiolitis. Guidelines suggest avoidance of antibiotics use when the diagnosis of viral bronchiolitis is confirmed. We discuss the uncertainties regarding antibiotic use, especially in younger infants, who are more exposed to risks of bacterial superinfection. (www.actabiomedica.it)

Introduction: Neonatal sepsis remains a serious and potentially fatal illness. Intrapartum antibiotic prophylaxis (IAP) prevents group B streptococcal (GBS) early-onset sepsis. The optimal duration of IAP (adequate IAP) to reduce vertical transmission of GBS has been debated. Understanding the mechanism of action of IAP may help in minimizing neonatal evaluation and unnecessary antibiotic use.Areas covered: In recent years, several studies on pharmacokinetics and clinical use of IAP have been published. Although penicillin and ampicillin are the most preferred antibiotics, the clinical efficacy of non-beta-lactam antibiotics, including clindamycin and vancomycin, used in cases of penicillin anaphylaxis-associated allergy, remains debatable. This is a narrative review of the literature regarding the impact of 'inadequate' IAP on the clinical management of women and newborns.Expert opinion: Recent evidence suggests that 'inadequate' IAP with beta-lactams is more effective in preventing vertical transmission of GBS than previously thought. Newborns exposed to intrapartum beta-lactams and who are asymptomatic at birth are likely uninfected, irrespective of IAP duration before delivery. Hence, we may abandon the concept of 'inadequate' IAP with beta-lactams in early-onset GBS sepsis, relying primarily on clinical signs observed at birth for managing IAP-exposed neonates.

Lifestyle, educational opportunities, career choices and new unions lead to pregnancy in more advanced age, increasing the emerging preventive solution to freeze oocytes at a young age for later use. In this scenario, the oocyte selection has a great importance in order to choose the best ones capable of a good subsequent embryo development and implantation. The aim of this study was to develop a decision support system, able to classify oocytes according to a score based on morphological features and patients' clinical data. The approach would offer a more effective selection method because it is not dependent on the doctor's experience or on an "at-first-sight" impression. As a first step, a prototype system able to support embryologists in oocyte selection was presented and an experimental evaluation on a real set of data provided. The developed pipeline included the identification of main morphological features influencing oocyte quality and the assignment of a weight and of a better way of measuring them. After that, a standard data format collecting in an organized way all morphological features of oocytes, zigote and embryos and patients' clinical data was developed. More than 150 oocytes images, taken in standard and comparable conditions, from 35 women were collected. Morphological features were extracted manually and automatically. A preliminary version of the scoring algorithm was tested on these data.

Primary healthcare workers, especially nurses, are exposed to the vast majority of patients with influenza and play an important role in vaccinating patients. Healthcare workers' misconceptions about influenza and influenza vaccination have been reported as possible factors associated with lack of vaccination. The objective of this study was to compare the characteristics of unvaccinated physicians and unvaccinated nurses in the 2011-2012 influenza season. We performed an anonymous web survey of Spanish primary healthcare workers in 2012. Information was collected on vaccination and knowledge of and attitudes to the influenza vaccine. Multivariate analysis was performed using unconditional logistic regression. We included 461 unvaccinated physicians and 402 unvaccinated nurses. Compared with unvaccinated nurses, unvaccinated physicians had more frequently received seasonal influenza vaccination in the preceding seasons (aOR 1.58; 95% CI 1.11-2.25), and more frequently believed that vaccination of high risk individuals is effective in reducing complications (aOR 2.53; 95% CI 1.30-4.95) and that influenza can be a serious illness (aOR 1.65; 95% CI 1.17-2.32). In contrast, unvaccinated physicians were less concerned about infecting patients (aOR 0.62; 95% CI 0.40-0.96). Unvaccinated nurses had more misconceptions than physicians about influenza and the influenza vaccine and more doubts about the severity of annual influenza epidemics in patients with high risk conditions and the prevention of complications by means of the influenza vaccination. For unvaccinated physicians, strategies to improve vaccination coverage should stress the importance of physicians as a possible source of infection of their patients. The effectiveness of influenza vaccination of high risk persons should be emphasized in nurses.

This paper aims to describe the sample design and the survey plan used in the survey on incoming tourism in Sicily and Sardinia. The specific goals of the survey are related: a) to the measurement and the analysis of un-observed tourism; b) to the evaluation of tourist mobility within the two Islands; c) to the analysis of some key-factors related to the holyday experience of tourists. It is well known that regional tourists are very difficult-to-reach populations and the problems in sampling human mobile populations derive from the absence of a list of units component units (frame). Despite these issues are well-known in literature under the broader categories of hard to reach, or hidden, or mobile populations, etc., the methodological solutions and most of all the empirical applications in tourism studies are almost poor. The sampling strategy undertaken to analyze non resident tourists leaving Sicily and Sardinia at the end of their vacation is a complex, multi-stage, stratified Time-Location Sampling (TLS). Under this perspective, the availability of information on the distribution of tourism flows by time (months) and space (departure places) for the two Islands was a fundamental prerequisite for the implementation of the sample design. Key words: Hard-to-reach populations; mobile populations; time-location sampling; time-space sampling; frontier surveys, border surveys. Parole chiave: Popolazioni mobili; campionamento spazio-temporale; indagini campionarie alle frontiere.

Having more reliable statistics is essential for policy-makers to be able to make effective decisions. Nevertheless, measuring the number of tourists in a given destination is not an easy task. After reviewing the main problems affecting official statistics on tourism, this paper proposes a general framework by formalizing a theoretical model in which tourism nights and trips in a given destination are broken down into observed and unobserved components, according to the European system of tourism statistics. The main approaches related to the measurement of unobserved tourism are discussed, and some empirical findings in Sicily (Italy) are presented in order to highlight the actual magnitude of unobserved tourism.

The NOE Collaboration has proposed a transition radiation detector (TRD) interleaved with marble targets to tag the electron decay channel of tau leptons produced by v(tau), eventually originated by upsilon (mu) oscillations in a long base line experiment. A reduced scale TRD detector prototype has been built and exposed to an electron/pion beam at the CERN PS. Discrimination capabilities between electrons and both charged and neutral pions, representing the main source of background for our measurement, have been determined obtaining rejection factors of the order of the tenth of percent for charged pions, and of a few percent for the neutral pion, matching the experiment requirements. The capabilities of this detector to measure the energy released by particles that start showering inside the targets are shown, A momentum resolution sigma (p)/p less than or equal to 40% is found for muons in the range of 1-7 GeV/c. (C) 2001 Elsevier Science B.V. All rights reserved.

In this paper it is discussed a typical tourism statistical problem: the substitution of an elementary unit of observation (the tourist) with an indicator, making use of an empirical research. Therefore the necessity to consider the quality of some aggregates in addition to the quality of individual measurements, is stressed.

Si affronta il tema della qualità delle statistiche sul turismo, mettendo in evidenza la mancata corrispondenza tra arrivi e turisti, e proponendo alcune soluzioni per la stima del numero dei turisti attraverso l'ausilio di informazioni ausiliarie.

AIM To investigate whether serial physical examinations (SPEs) are a safe tool for managing neonates at risk for early-onset sepsis (EOS). METHODS This is a retrospective cohort study of neonates (≥ 34 wks’ gestation) delivered in three high-volume level IIIbirthing centres in Emilia-Romagna (Italy) during a 4-mo period (from September 1 to December 31, 2015). Neonates at risk for EOS were managed according to the SPEs strategy, these were carried out in turn by bedside nursing staff and physicians. A standardized form detailing general wellbeing, skin colour and vital signs was filled in and signed at standard intervals (at age 3, 6, 12, 18, 36 and 48 h) in neonates at risk for EOS. Three independent reviewers reviewed all charts of neonates and abstracted data (gestational age, mode of delivery, group B streptococcus status, risk factors for EOS, duration of intrapartum antibiotic prophylaxis, postpartum evaluations, therapies and outcome). Rates of sepsis workups, empirical antibiotics and outcome of neonates at-risk (or not) for EOS were evaluated. RESULTS There were 2092 live births and 1 culture-proven EOS (Haemophilus i) (incidence rates of 0.48/1000 live births). Most newborns with signs of illness (51 out of 101, that is 50.5%), and most of those who received postpartum antibiotics (17 out of 29, that is 58.6%) were not at risk for EOS. Compared to neonates at risk, neonates not at risk for EOS were less likely to have signs of illness (51 out of 1442 vs 40 out of 650, P = 0.009) or have a sepsis workup (25 out of 1442 vs 28 out of 650, P < 0.001). However, they were not less likely to receive empirical antibiotics (17 out of 1442 vs 12 out of 650, P = 0.3). Thirty-two neonates were exposed to intrapartum fever or chorioamnionitis: 62.5% (n = 20) had a sepsis workup and 21.9% (n = 7) were given empirical antibiotics. Among 216 neonates managed through the SPEs strategy, only 5.6% (n = 12) had subsequently a sepsis workup and only 1.9% (n = 4) were given empirical antibiotics. All neonates managed through SPEs had a normal outcome. Among 2092 neonates, only 1.6% (n = 34) received antibiotics; 1.4% (n = 29) were ill and 0.2% (n = 5) were asymptomatic (they were treated because of risk factors for EOS). CONCLUSION The SPEs strategy reduces unnecessary laboratory evaluations and antibiotics, and apparently does not worsen the outcome of neonates at-risk or neonates with mild, equivocal, transient symptoms.

The use of "mashups" is expanding considerably in the business environment. Business mashups are usually adopted within integrating business and data-service frameworks to provide the ability to develop new integrated services quickly. Typically, mashups provide organisations with a pronounced and flexible commodity to combine internal with external services in order to create new services, usually accessed through user-friendly Web-browser interfaces. In this study, a Web 2.0 technology was adopted to promote a key field of bioinformatics research through the management and automation of bioinformatics workflows. Consumables (widgets and services) have been developed using the Lotus Widget Factory, an Eclipse plug-in providing an easy-to-use development environment enabling developers of all skill levels to create dynamic widgets rapidly. A workflow built from widgets works as follows: the core widget receives data from one or more widgets, invokes a generic Web service, performing iteration and/or recursion, and sends the results to all other connected widgets. The number of iterations and recursions depends on the input data-set dimension and user-defined parameter values related to each specific application. Some prototype workflows have been assembled and tested with a number of widgets created with algorithms from the European Molecular Biology Open Software Suite (EMBOSS), exposed as Web services. The adoption of recent Web 2.0 technologies, such as mashup platforms, has enabled rapid generation, sharing and discovery of reusable application building-blocks (widgets, feeds, mashups), and has shown to be a plausible alternative environment for supporting bioinformatics workflow design, management and execution.