Redefining the technical and organizationalcompetences of children vaccination clinics in order to improve performance. A practical experience at the ULSS 12 Venetian Public Health and Hygiene Service

Introduction. Since Regione Veneto suspended compulsory vaccination for children in 2008, and because of an increasing disaffection of parents to the vaccine practice, the vaccination rates have been slowly but steadily decreasing. The aim of this study was to analyze internal and external factors of immuniza- tion reduction and to implement potential solutions of the prob- lem. Methods. Servizio Igiene e Sanita? Pubblica of ULSS 12 Venezi- ana (SISP ? Hygiene and Public Health Service) analyzed and addressed both, the reasons of parents who do not vaccinate their children and the internal problems regarding vaccination clinics management, information to families, procedures and guidelines and, in general, the communication skills of the vaccination staff. Results. A positive trend in vaccination rates was observed, espe- cially in Venice historical centre. Moreover the staff reported a better working atmosphere and benefit from sharing common goals and procedures, even though the workforce was reduced of about 30% in terms of equivalent unit (EU). Discussion. The continuous quality improvement method fol- lowed in this experience led to a steady increase in vaccination coverage in all territorial clinics, to a better adhesion of guide- lines and standard operating procedures and to a general pro- fessional empowerment of SISP staff. The service now offered to the population is better and more efficient, since the workforce has been reduced. Future goals are to improve information about vaccinations among the population

Evaluation of humoral and cellular response to four vaccines against COVID-19 in different age groups: A longitudinal study

To date there has been limited head-to-head evaluation of immune responses to different types of COVID-19 vaccines. A real-world population-based longitudinal study was designed with the aim to define the magnitude and duration of immunity induced by each of four different COVID-19 vaccines available in Italy at the time of this study. Overall, 2497 individuals were enrolled at time of their first vaccination (T0). Vaccine-specific antibody responses induced over time by Comirnaty, Spikevax, Vaxzevria, Janssen Ad26.COV2.S and heterologous vaccination were compared up to six months after immunization. On a subset of Comirnaty vaccinees, serology data were correlated with the ability to neutralize a reference SARS-CoV-2 B strain, as well as Delta AY.4 and Omicron BA.1. The frequency of SARS-CoV-2-specific CD4+ T cells, CD8+ T cells, and memory B cells induced by the four different vaccines was assessed six months after the immunization. We found that mRNA vaccines are stronger inducer of anti-Spike IgG and B-memory cell responses. Humoral immune responses are lower in frail elderly subjects. Neutralization of the Delta AY.4 and Omicron BA.1 variants is severely impaired, especially in older individuals. Most vaccinees display a vaccine-specific T-cell memory six months after the vaccination. By describing the immunological response during the first phase of COVID-19 vaccination campaign in different cohorts and considering several aspects of the immunological response, this study allowed to collect key information that could facilitate the implementation of effective prevention and control measures against SARS-CoV-2

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Integrated Reporting for SMEs: Implementation Guidance

Preface Richard Howitt Chief Executive Officer International Integrated Reporting Council Small and medium-sized companies represent the beating heart of the global economy. When I think of an SME, I think of their entrepreneurship, their talent, their innovation - and their potential. A thriving economy must nurture SMEs and encourage their innate ability to create value. We must also strive to remove barriers so that they can achieve their potential. SMEs are the most trusted type of business, often family-owned and they are close to the communities they serve. SMEs are an integral part of the global value chain and can become trusted partners of larger companies or academic institutions where they offer a route to the commercialization of intellectual capital. For SMEs, high quality relationships with customers, suppliers, employees and the local community underpin their value. So it is no surprise to see such powerful and practical SME case studies in this guidance. Novamont: using integrated reporting to demonstrate its commitment to sustainable development. Showa Denki: illustrating its value creation process in a concise 20-page integrated report, highlighting the cultural openness of the business. Dellas: setting out its corporate reporting evolution roadmap over three or four years. Because we know integrated reporting demonstrates a commitment from the company’s management, but it is also an investment in the future. It is an investment in the quality of engagement with stakeholders, and a strong signal that purpose, governance, business model and strategy matter - whatever the size of the company. And providers of financial capital need the security of knowing that risks and opportunities are being identified and managed, wherever they exist in the business. Integrated reporting is emerging as the global transparency tool for connecting resource management to the business model and strategy, helping businesses of all sizes to explain how they create value and how they are preparing for the future. The evidence shows that companies that break down internal silos, instill a culture of integrated thinking and make linkages between different drivers of value creation are better prepared for the future; they are more resilient in the face of short-term challenges and more flexible because they are managing risks in real time. It transpires that non-financial reporting is no longer peripheral, but instead is a valuable predictor of long-term financial performance. I would like to thank the Network Italiano for Business Reporting (NIBR) for their strong commitment to working with companies, guiding them to adopting integrated reporting by providing practical support, knowledge and best practice. We are also indebted to Stefano Zambon personally, as Secretary General of NIBR and Chair of the World Intellectual Capital Initiative (WICI) Global Network. Stefano’s energy to bring about change, not just to corporate reporting, but by creating the conditions for more sustainable business models is evident throughout this guidance. I commend it without hesitation to SMEs. They have everything to gain from adopting integrated reporting and this guidance shows that its benefits can be released quickly and it can be adopted with ease. Presentation Prof. Stefano Zambon (PhD, London) Secretary General, Italian Network for Business Reporting (NIBR), WICI Chair, and University of Ferrara It is not without a touch of pride that I am presenting to international readers and stakeholders this NIBR-WICI Global Network Implementation Guidance to the Integrated Reporting of SMEs realized in collaboration with the International Integrated Reporting Council (IIRC). Indeed, for many countries, SMEs represent the backbone of the economic system. In 2017, only Europe counted around twentythree million SMEs, around 99% of the overall companies, with a level of employment in the private sector that represented two thirds of jobs and more than 50% of the value added generated in the EU. Compared to them, the share of large companies was and still is marginal. In addition to this large presence, SMEs have inherent characteristics that can allow them to move more easily towards the implementation of integrated reporting. Owing to their very nature, they are rooted in the territory of origin, sharing values and culture with the local communities and stakeholders. They also tend to pay attention to details, thanks to their smaller size, which generally grants a less complex and more agile structure. The frequent presence of the entrepreneur and his/her family in company operations and governance roles may assure a relatively “natural” application of an integrated thinking in the running of the organization. Relational and organizational intangibles as well as human qualities and skills are basic resources for the vitality and longterm survival of SMEs. In terms of benefits that SMEs can reach in implementing integrated reporting, this may represent not only an advanced accountability device, but also a management tool that gives entrepreneurs and managers a more complete view of the company. Thus, it can help demonstrate where and to what extent the company creates value. SMEs interact with various public and private entities, and the adoption of an integrated report can become the main instrument that shows how important these are and how the company communicates with them, possibly achieving a better image and reputation. Banks and more generally all financial institutions are the most traditional stakeholders for SMEs: integrated reporting meets their information needs on the past, but also on the future of the company in a strategic perspective. The holistic view of the organization rendered by an integrated report facilitates the comprehensive recognition and appreciation of company issues, while driving and reinforcing integrated thinking. In view of the above reasons, with this Implementation Guidance the Italian Network for Business Reporting (NIBR) has aimed to read the International Framework from a specific angle designed to ‘translate’ its principles and contents into a language understandable by small businesses. To put it differently, it has reinterpreted the Framework ‘through the eyes’ of SMEs. In this respect, not only the Fundamental Concepts, Guiding Principles and Content Elements have been here illustrated and explained using this particular viewpoint, but also a roadmap for their adoption by an SME has been illustrated by recurring also to five case studies out of those Italian SMEs that are currently going through their ‘integrated reporting journey’. I would like to warmly thank the IIRC in the persons of Richard Howitt, Lisa French and Laura Girella, the Japanese Cabinet Office, and Paul Thompson of the EFAA (European Federation of Accountants and Auditors for SMEs) for the precious support and collaboration, as well as the members of our Working Group at NIBR for the hard, long and patient work

Non-linear generative embeddings for kernels on latent variable models

Generative embeddings use generative probabilisticmodels to project objects into a vectorial space of reduceddimensionality – where the so-called generative kernels canbe defined. Some of these approaches employ generativemodels on latent variables to project objects into a feature space where the dimensions are related to the latentvariables. Here, we propose to enhance the discriminativepower of such spaces by performing a non-linear mappingof space dimensions leading to the formulation of novel generative kernels. In this paper, we investigate one possiblenon-linear mapping, based on a powering operation, ableto equilibrate the contributions of each latent variable ofthe model, thus augmenting the entropy of the latent variables vectors. The validity of the idea has been shown in thecase of two generative kernels, which have been evaluatedwith tests on shape recognition and gesture classification,with really satisfying results that outperform state-of-theart methods

Nonlinear mappings for generative kernels on latent variable models

Abstract\u2014Generative kernels have emerged in the last yearsas an effective method for mixing discriminative and generativeapproaches. In particular, in this paper, we focus on kernelsdefined on generative models with latent variables (e.g. thestates in a Hidden Markov Model). The basic idea underlyingthese kernels is to compare objects, via a inner product,in a feature space where the dimensions are related to thelatent variables of the model. Here we propose to enhancethese kernels via a nonlinear normalization of the space,namely a nonlinear mapping of space dimensions able toexploit their discriminative characteristics. In this paper weinvestigate three possible nonlinear mappings, for two HMMbasedgenerative kernels, testing them in different sequenceclassification problems, with really promising results