Standard interferon treatment is known to increase the risk of infections; this risk also needs to be evaluated in clinical practice for pegylated interferon. To this end, we studied 255 patients treated with standard (103) or pegylated (152) interferon, in combination with ribavirin, for hepatitis C. Overall, 31 anti-hepatitis C virus treatment-related infections were observed. Neutropenia (neutrophil counts below 1x103 cells/ml) was observed in a significantly higher proportion of patients treated with pegylated interferons (48% vs 9%; P=0.0009). Of the 31 infections, eight were respiratory infections and were observed only in patients with neutropenia. None of the non-respiratory infections was observed in patients with neutropenia. Multivariate analysis, using Cox's proportional hazards regression model, found a higher risk of all infections associated with both use of pegylated interferons [hazard ratio (HR) 4.6] and neutropenia (HR 2.46). However, neutropenia was independently associated with acute respiratory infections only and use of pegylated interferons with non-respiratory infections. In summary, use of pegylated interferon appears to increase the risk of non-respiratory infections independently from neutropenia.

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This paper presents an informal process inspired by a public practice of conflict mediation used until a few decades ago in Gallura (NE Sardinia, Italy), named La Rasgioni (The Reason). The aim is twofold: (i) to introduce an innovative method that translates the complexity of water-related conflicts into a "dialogical tool", aimed at enhancing social learning by adopting theatrical techniques; and (ii) to report the outcomes that emerged from the application of this method in Arborea, the main dairy cattle district and the only nitrate-vulnerable zone in Sardinia, to mediate contrasting positions between local entrepreneurs and representatives of the relevant institutions. We discuss our results in the light of four pillars, adopted as research lenses in the International research Project CADWAGO (Climate Change Adaptation and Water Governance), which consider the specific "social-ecological" components of the Arborea system, climate change adaptability in water governance institutions and organizations, systemic governance (relational) practices, and governance learning. The combination of the four CADWAGO pillars and La Rasgioni created an innovative dialogical space that enabled stakeholders and researchers to collectively identify barriers and opportunities for effective governance practices. Potential wider implications and applications of La Rasgioni process are also discussed in the paper.