Structural and Vibro-Acoustics Optimization of a Car Body Rear Part

The perceived vibro-acoustic comfort, inside the passenger compartment, under driving conditions, is strictly related to the car body torsional behavior. The aim of this work was to identify which parts of a car body most influence the first torsional mode, in order to modify them and acquire an increase in such car body natural frequency. It was also intended to exploit the great potential of 3D printing that allows an increase in the complexity of component shapes, with an acceptable compromise with respect to production costs. A design and material (from steel to aluminum) change of a car body rear part, which was identified as the structural part of the car body with the most relevant impact on the frequency of the first torsional mode, was assessed in terms of structural and vibro-acoustic performances. In particular, with the constraint of increasing the structural and vibroacoustic performances and, at the same time, minimize the weight of the structure itself, geometric, structural (e.g., type of connections), and material changes of the car body rear part were assessed. Working on a car model dating back to 2008, which was already compliant with structural and vibro-acoustic regulatory norms, an increase of 2 Hz on the first torsional mode frequency of the Trimmed Body model was obtained. In parallel, a weight reduction in the optimized components was also gained. It was also requested to lower the cabin sound pressure levels, optimizing the vibro-acoustic transfer functions from the accelerations at engine mounts and suspension attachment points to the cabin inside. It was shown how the combined use of advanced topological and structural optimization tools, with the capabilities of an unconventional manufacturing technology, such as 3D printing in aluminum, could guarantee an increase in the vibro-acoustics and structural car performances, also gaining a weight reduction

Case report: Histological findings of peri-appendicitis in three children with SARS-CoV-2 – related multisystem inflammatory syndrome: A mark for systemic inflammation?

Background: Multisystem inflammatory syndrome in children (MIS-C) is a rare but serious condition that can potentially develop after SARS-CoV-2 infection in children. Gastrointestinal manifestation in MIS-C can mimic acute abdomen, potentially leading to unnecessary surgical treatment. Immune-mediated mechanisms seem to be a determining factor in its pathogenesis, and histological studies can help to shed light on this aspect. We describe three cases of children diagnosed with MIS-C that underwent appendectomy. Methods: We retrospectively collected the clinical features and histological findings of three previously healthy children who underwent appendectomy for clinical suspicion of acute appendicitis but were later diagnosed with MIS-C. Findings: The three children presentedwith prominent abdominalmanifestations andfever leading tothe suspicion of acute abdomen.Histological findings showed transmural and perivascular inflammation. Notably, CD68+ macrophages were predominant in the child with milder abdominal symptoms without cardiac injury, while CD3+ lymphocytes in the patient presented with more severe abdominal pain and cardiovascular involvement at admission. Interpretation: Gastrointestinal symptoms of children with MIS-C improve after proper immunomodulatory therapy, conversely showing inadequate response to surgical appendectomy. Histological findings revealed different inflammatory cell infiltration that primarily involved perivisceral fat and vessels, and subsequently mucosal tissue, in contrast to other forms of acute appendicitis. Our findings suggest that this kind of peri-appendicitis in MIS-C could represent a focal sign of systemic inflammation, with different histological patterns compared to other forms of acute appendicitis

Evaluation of Legionella Air Contamination in Healthcare Facilities by Different Sampling Methods: An Italian Multicenter Study

Healthcare facilities (HF) represent an at-risk environment for legionellosis transmission occurring after inhalation of contaminated aerosols. In general, the control of water is preferred to that of air because, to date, there are no standardized sampling protocols. Legionella air contamination was investigated in the bathrooms of 11 HF by active sampling (Surface Air System and Coriolis®μ) and passive sampling using settling plates. During the 8-hour sampling, hot tap water was sampled three times. All air samples were evaluated using culture-based methods, whereas liquid samples collected using the Coriolis®μ were also analyzed by real-time PCR. Legionella presence in the air and water was then compared by sequence-based typing (SBT) methods. Air contamination was found in four HF (36.4%) by at least one of the culturable methods. The culturable investigation by Coriolis®μ did not yield Legionella in any enrolled HF. However, molecular investigation using Coriolis®μ resulted in eight HF testing positive for Legionella in the air. Comparison of Legionella air and water contamination indicated that Legionella water concentration could be predictive of its presence in the air. Furthermore, a molecular study of 12 L. pneumophila strains confirmed a match between the Legionella strains from air and water samples by SBT for three out of four HF that tested positive for Legionella by at least one of the culturable methods. Overall, our study shows that Legionella air detection cannot replace water sampling because the absence of microorganisms from the air does not necessarily represent their absence from water; nevertheless, air sampling may provide useful information for risk assessment. The liquid impingement technique appears to have the greatest capacity for collecting airborne Legionella if combined with molecular investigation

Point prevalence survey of antibiotic use and healthcare-associated infections in acute care hospitals: a comprehensive report from the Marche Region of Italy

Background: Healthcare Associated Infections (HAIs) and Antimicrobial Resistance (AMR) are serious health challenges. Point prevalence surveys (PPS) are valuable tools for monitoring HAIs and AMR. Aim: To describe results of the ECDC-PPS 2022 dealing with the prevalence of HAIs, antimicrobial consumption, and associated factors, in acute care hospitals. Methods: The present point-prevalence have been carried out survey in November 2022 in fourteen hospitals according to the protocol proposed by the European Centre for Disease Prevention and Control (ECDC). Multilevel logistic regression was performed using geographical area/hospital type as cluster variable to evaluate the factors independently associated with HAIs and antibiotics. Results: The point prevalence of HAIs was 7.43%. Patients hospitalized for longer periods were more likely to have an HAI as well as those aged 15-44, with a rapidly fatal disease, intubated and with 1 or 2 devices. Antibiotics prevalence was 47.30%. Males, unknown McCabe scores, minimally invasive/non-NHSN surgery, patients with HAIs, hospitals with a higher alcohol hand rub consumption, hospitals with a higher amount of IPC personnel, geriatric wards and hospital with 300-600 beds were more likely to be under antimicrobial therapy. Conclusion: This point prevalence survey provided valuable information on the prevalence of HAIs and antimicrobial consumption and variables associated. The high prevalence of HAIs highlights the need for improved infection control measure

Knowledge about tuberculosis among undergraduate health care students in 15 Italian universities: a cross-sectional study

Background: The Italian Study Group on Hospital Hygiene of the Italian Society of Hygiene, Preventive Medicine and Public Health conducted a multicentre survey aiming to evaluate undergraduate health care students' knowledge of tuberculosis and tuberculosis control measures in Italy. Methods. In October 2012-June 2013, a sample of medical and nursing students from 15 Italian universities were enrolled on a voluntary basis and asked to complete an anonymous questionnaire investigating both general knowledge of tuberculosis (aetiology, clinical presentation, outcome, screening methods) and personal experiences and practices related to tuberculosis prevention. Data were analysed through multivariable regression using Stata software. Results: The sample consisted of 2,220 students in nursing (72.6%) and medicine (27.4%) courses. Our findings clearly showed that medical students had a better knowledge of tuberculosis than did nursing students.Although the vast majority of the sample (up to 95%) answered questions about tuberculosis aetiology correctly, only 60% of the students gave the correct responses regarding clinical aspects and vaccine details. Overall, 66.9% of the students had been screened for tuberculosis, but less than 20% of those with a negative result on the tuberculin skin test were vaccinated. Multivariable regression analysis showed that age and type of study programme (nursing vs. medical course) were determinants of answering the questions correctly. Conclusions: Although our data showed sufficient knowledge on tuberculosis, this survey underlines the considerable need for improvement in knowledge about the disease, especially among nursing students. In light of the scientific recommendations concerning tuberculosis knowledge among students, progress of current health care curricula aimed to develop students' skills in this field is needed

HBsAg loss with HBsAg/anti-HBs seroconversion and non-detectable HCV-RNA in a patient with chronic HBV e-minus/HCV hepatitis treated with two cycles of antiviral therapy

Introduction: Loss of HBsAg is observed in only 3-4% of patients who receive interferon for chronic HBV+HCV hepatitis, and there are few reports of HBsAg loss induced by treatments other than interferon. We report a case of chronic HBV+HCV hepatitis, in which a positive outcome was achieved with a new therapeutic strategy. Case report: The patient was a 49-year-old Caucasian woman found to be HBsAg+ in 1978 and HCVAb+ in 1997. During 2000-2003, the patient had markedly increased AST/ALT, histology grade 5, stage 1 (Ishak) disease with HBsAg positivity, HBV-DNA 1,450 cp/mL, HCV-RNA 7.57x105 IU/mL (genotype 1b). In May 2003 she began a 48-week course of PEG-IFNa2b (80 mg/week) without ribavirin. The latter drug was not used because it had recently been observed that in some HBV/HCV-coinfected patients treated with the two drugs, the hepatic flares preceding the seroconversion to HBsAb caused fulminant liver failure. Neither the HBV and HCV infections responded to this treatment, but during follow-up the HBV-DNA dropped to 40 cp/mL and the patient presented persistently normal transaminase values (6th month) followed by loss of HBsAg (24th month) and the appearance of anti-HBs (36th month). By December 2008, the HBV negativity and HBsAg/anti-HBs seroconversion were well-established, but HCV replication persisted. The decision was therefore made to administer PEG-IFNa2a (180 mg/week) and ribavirin (1,000 mg/day). There was no evidence of an RVR or EVR, so therapy was continued for 48 weeks. At the scheduled 12-month treatment, the patientwas found to be HCV-RNA negative by TaqMan PCR. Conclusions: In our opinion this case is of great interest because: 1) it is the first report of a virological response in a HBV/HCV-coinfected CH patient treated with PEG-IFN; 2) control of the two viral infections was achieved with a new therapeutic strategy that included two phases: a) HBV-DNA loss at 6 months and HBsAg/anti-HBs seroconversion between months 24 and 36, after PEG-IFNa2b mono-therapy, which was administered when the HCV replication seemed to prevail over that of HBV; b) ETR for HCV after 72 weeks of PEG-IFNa2a+ribavirin, which was continued in spite of the lack of an EVR, as this does not preclude the possibility of a SVR

Body protection for healthcare professionals: the correct choice based on the risk assessment

The ongoing SARS-CoV-2 pandemic has drawn attention to Personal Protective Equipment (PPE) for healthcare workers, including gowns and coveralls for body protection. However, PPEs are essential also in non-emergency situations, in order to protect both personnel and patients from infective agent transmission during normal healthcare activity. This paper reviews protective clothing available for healthcare on the market, providing criteria for selecting the proper device based on the risk assessment of the specific patient-care activity. Main aspects related to comfort and fit of protective clothing are then analyzed. Finally, differences between disposable and reusable devices are discussed, comparing advantages and disadvantages of both solutions. While these considerations are applicable to general healthcare activities, the survey provides specific references to the COVID-19 emergency, when the necessity of providing adequate protection to healthcare workers may be influenced by the shortage of PPE supplies

Gender awareness among Italian medical students

Gender differences may affect the health status and presentation of diseases, sometimes determining a different approach by doctors and potentially resulting in a different use of prevention and care services. The aim of this cross-sectional survey was to compare the attitudes towards gender and gender stereotyping among male and female students in an Italian university. Data has been collected through a questionnaire administered to all medical students admitted to the School of Medicine and Surgery, resulting in a total sample of 153 subjects. The questionnaire investigated the following topics: Gender sensitivity (GS), Gender role ideology toward patients (GRIP), and Gender role ideology toward doctors (GRID). The results showed significant differences between genders in the GRIP and GRID areas. Males showed a more stereotyped gender atti-tude toward doctors and patients, with a higher score than females in the GRID and GRIP sub-scales. Gender differences among medical students need to be considered in medical educatio

Caesarean Delivery in South Italy: Women without Choice. A Cross Sectional Survey

BACKGROUND: In spite of the World Health Organization’s recommendations to maintain caesarean delivery (CD) between 5% and 15% of total births, the rates of CD continue to rise in countries with routine access to medical services. As in Italy CD rate reached 38% in 2008, the highest at EU level, we evaluated socioeconomic and clinical correlates of “elective” and “non programmed” CD in the Country. We performed a stratified analysis in order to verify whether the effect of such correlates differed among women with an “a priori” preference for natural and caesarean delivery respectively. METHODS AND FINDINGS: We analyzed cross-sectional data from the Italian National Statistics Institute (ISTAT) survey on health condition. Socio-demographic variables, information on maternal care services use and health conditions during pregnancy, as well as maternal preferences on delivery, were available for a representative sample of 2,474 primiparous women. After an initial bivariate analysis, we used logistic regressions to evaluate factors associated to the study outcomes. Overall CD accounted for 35.5% of the total births in our sample (CI 33.6–37.4%); moreover, 30.7% (CI 28.6–32.6%) of women preferring natural delivery actually delivered with a CD. Elective CD rate is higher among women over 35 years (22.9%, CI 18.8–27.4%), and those living in the South (26.2%, CI 23.0–29.6%). The multivariate analysis showed that, even adjusting for several confounders, women in the South, receiving care in the private sector had higher chances of CD, also in case of preference for natural delivery. CONCLUSION: Policy interventions are required to reduce the rate of undesired CD, e.g. increasing women knowledge regarding delivery in order to favour aware choices. An effective strategy to reduce CD rate should address the Southern Regions, as women here appear to have a very limited control over the delivery, in spite of a widespread preference for natural delivery