When red tape saves time: The Anti-corruption controls for the 2015 Universal Exposition

When a major corruption scandal emerged during the organisation of the 2015 Universal Exposition in Milan, the government set up a brand-new system of preliminary controls for the procurement of all Expo contracts. Controls can certainly be beneficial in many respects, but they inevitably complicate procedures and even produce delays and red tape. Indeed, for a time-pressed schedule as that of the 2015 Expo, preliminary controls were considered a fatal blow. Contrary to expectations, not only bureaucratic delays did not materialise, but controls actually sped up procedures. Therefore, it is worth explaining and learning from this unique outcome. Can it be replicated in other cases? We answer this question by building a model of controls based on programme and non-programme features that support three causal mechanisms: threat attribution, repeated interactions, and actor certification. Such a model is an indispensable tool for designers; it allows to explain how controls work in practice and provide clues on how to adjust the design of the policy to changing contexts. In this respect, the analysis of the Expo controls and their subsequent replications raises several methodological issues relevant to extrapolation-oriented research

Intravenous Fosfomycin for Difficult-to-Treat Infections: A Real-Life Multicentric Study in Italy

Background: Fosfomycin, an old antibiotic attracting renewed interest, offers a broad spectrum of activity and unique synergy with other agents. While widely used in severe infections, real-world data on intravenous fosfomycin remain limited. Objectives: This study aimed to describe the clinical and microbiological characteristics of patients treated with intravenous fosfomycin and to analyze its administration modalities in a real-world setting. Methods: A multicenter retrospective cohort study was conducted across five Italian hospitals. Adult patients receiving intravenous fosfomycin between January 2020 and December 2023 were included. Results: We enrolled 393 patients. The median age was 69 years, with most patients (45%) admitted to Critical Care Units. Pneumonia (34%), bloodstream infections (22%), and urinary tract infections (21%) were the most common indications. Gram-negative bacteria, particularly E. coli and P. aeruginosa, were the predominant pathogens. Fosfomycin was used as empirical therapy in 55% of cases and was combined with other agents in almost all cases (99%). The most frequent partners were piperacillin/tazobactam (21%) and new beta-lactam/beta-lactamase inhibitor combinations (18%). The median treatment duration was seven days, with most subjects (65%) receiving a fosfomycin dosage regimen of 16 g/day. Minimum inhibitory concentrations (MICs) values for fosfomycin were available for 61 isolates (15%), with 78.7% (48/61) showing MIC ≤ 32 mg/L. C. difficile infection occurred in only 2% of patients. Mortality rates at 30, 60, and 90 days were 21.6%, 26.7%, and 29.3%, respectively. Conclusions: This study provides valuable insights into the real-world use of intravenous fosfomycin