In recent years, hospitals have increasingly been faced with a growing proportion of their inpatient work coming from the fluctuating and unpredictable demand of emergency admissions. The opportunity to move emergency patients who have been selected for admission out of the emergency department (ED) is linked to the ability of the hospital network to actually admit them. The latter is, in turn, correlated to the availability of inpatient beds in the hospital wards, which are shared resources between elective and emergency patients. Due to the overcrowding of EDs and the growing concern regarding reducing the number of inpatient ward beds, it is thus becoming crucial to improve the bed capacity planning and the management of emergency and elective patient admissions. In this direction, greater coordination and communication among the different healthcare providers involved in the pathway flows is required, and the so-called "bed management" function plays a key role. This study starts with collaboration with the local health government (LHG) of the Liguria region aimed at studying the hospital bed management function. A large quantity of data records have been collected during one year of activity to obtain information related to the flow of emergency and elective patient pathways. A medium-sized hospital located in the city of Genova has been chosen as a case study, and a discrete event simulation model has been developed to reproduce the multiple patient flows involved in the system. Multiobjective optimization analysis has been performed to choose the best bed allocations considering both operational and tactical decisions characterized by various trade-offs among alternative conflicting objectives. The model can be used to help decision makers find a representative set of Paretooptimal solutions and quantify trade-offs when satisfying different objectives.

Abstract.Background. In developed countries invasive listeriosis is an infection of great concern to public health to due its clinical severity and high fatality rate, despite its low incidence. In Europe, statistically significant increasing trends in listeriosis notification rates from 2005 to 2009 were noted in Austria, Denmark, Hungary, Italy, Spain and Sweden. Materials and methods. The standardized techniques based on phenotype to typing Listeria monocytogenes is the serotyping. In Europe, as elsewhere in the world, about 95% of L. monocytogenes strains isolated from clinical and food samples belongs to serovars 1/2a, 1/2b, 1/2c and 4b. Results. The target of this work is to draw attention to this important and atypical foodborne disease, reporting epidemiological data and serotypes distribution of 251 human L. monocytogenes isolates reported during 2000-2010 to Veterinary Public Health and Food Safety Department of Istituto Superiore di Sanità, focusing on epidemiological trend of invasive listeriosis in Lombardia, a North Italian Region. The serotypes most frequently identified are 1/2a, 4b, 1/2b (in total 92%), but the detection of uncommon serotypes is not missing (1/2c, 3a, 3b, 4d). Conclusions. In Italy the surveillance laboratory network, as well as the foodborne disease network (ENTER-NET), has revealed in the last 11 years an increase trend of listeriosis cases reported likewise with results of Notificable National Infectious Disease surveillance System. This is probably due to a real increase of listeriosis, even if there is a greater sensitivity of the network in some regions.Key words: Listeria monocytogenes, serotypes, surveillance. (2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010). Introduzione. Nei Paesi industrializzati, nonostante la sua bassa incidenza la listeriosi invasiva è un'infezione alimentare di grande impatto per la salute pubblica, a causa della gravità delle sue manifestazioni cliniche e dell'alto tasso di letalità. In Europa, fra il 2005 e il 2009, sono stati notati incrementi, statisticamente significativi, delle notifiche di listeriosi in Austria, Danimarca, Ungheria, Italia, Spagna e Svezia. Materiali e metodi. Dal punto di vista fenotipico la tipizzazione sierologica rappresenta la tecnica più tradizionale per classificare gli stipiti di Listeria monocytogenes. In Europa come nel resto del mondo, il 95% circa dei ceppi di L. monocytogenes isolati da campioni clinici e alimentari appartengono ai sierotipi 1/2a, 1/2b, 1/2c e 4b. Risultati. L'obiettivo di questo studio è quello di attirare l'attenzione su questa grave e atipica malattia alimentare, riportando i dati epidemiologici e la distribuzione dei sierotipi, relativamente a 251 stipiti raccolti nel periodo 2000-2010, dal Dipartimento di Sanità Pubblica Veterinaria e Sicurezza Alimentare dell'Istituto Superiore di Sanità, focalizzando l'attenzione sui dati provenienti dalla Regione Lombardia. I sierotipi più frequentemente identificati sono 1/2a, 4b, 1/2b (per un complessivo 92%) ma non è mancato il risc...

In 2012 a US multistate outbreak of listeriosis was linked to ricotta salata imported from Italy, made from pasteurized sheep's milk. Sampling activities were conducted in Italy to trace the source of Listeria monocytogenes contamination. The cheese that caused the outbreak was produced in a plant in Apulia that processed semi-finished cheeses supplied by five plants in Sardinia. During an 'emergency sampling', 179 (23·6%) out of 758 end-products tested positive for L. monocytogenes, with concentrations from <10 c.f.u./g to 1·1 × 106 c.f.u./g. Positive processing environment samples were found in two out of four processing plants. A 'follow-up sampling' was conducted 8 months later, when environmental samples from three out of six plants tested positive for L. monocytogenes and for Listeria spp. PFGE subtyping showed 100% similarity between US clinical strains and isolates from ricotta salata, confirming the origin of the outbreak. The persistence of strains in environmental niches of processing plants was demonstrated, and is probably the cause of product contamination. Two PFGE profiles from clinical cases of listeriosis in Italy in 2011, stored in the MSS-TESSy database, were found to have 100% similarity to one PFGE profile from a US clinical case associated with the consumption of ricotta salata, according to the US epidemiological investigation (sample C, pulsotype 17). However, they had 87% similarity to the only PFGE profile found both in the US clinical case and in 14 ricotta cheese samples collected during the emergency sampling (sample B, pulsotype 1). Sharing of molecular data and availability of common characterization protocols were key elements that connected the detection of the US outbreak to the investigation of the food source in Italy. Simultaneous surveillance systems at both food and human levels are a necessity for the efficient rapid discovery of the source of an outbreak of L. monocytogenes.

Marine sponges commonly host a repertoire of bacterial-associated organisms, which significantly contribute to their health and survival by producing several anti-predatory molecules. Many of these compounds are produced by sponge-associated bacteria and represent an incredible source of novel bioactive metabolites with biotechnological relevance. Although most investigations are focused on tropical and temperate species, to date, few studies have described the composition of microbiota hosted by Antarctic sponges and the secondary metabolites that they produce. The investigation was conducted on four sponges collected from two different sites in the framework of the XXXIV Italian National Antarctic Research Program (PNRA) in November–December 2018. Collected species were characterized as Mycale (Oxymycale) acerata, Haliclona (Rhizoniera) dancoi, Hemigellius pilosus and Microxina sarai by morphological analysis of spicules and amplification of four molecular markers. Metataxonomic analysis of these four Antarctic sponges revealed a considerable abundance of Amplicon Sequence Variants (ASVs) belonging to the phyla Proteobacteria, Bacteroidetes, Actinobacteria and Verrucomicrobia. In particular, M. (Oxymycale) acerata, displayed several genera of great interest, such as Endozoicomonas, Rubritalea, Ulvibacter, Fulvivirga and Colwellia. On the other hand, the sponges H. pilosus and H. (Rhizoniera) dancoi hosted bacteria belonging to the genera Pseudhongella, Roseobacter and Bdellovibrio, whereas M. sarai was the sole species showing some strains affiliated to the genus Polaribacter. Considering that most of the bacteria identified in the present study are known to produce valuable secondary metabolites, the four Antarctic sponges could be proposed as potential tools for the discovery of novel pharmacologically active compounds.

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