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The importance of veteran trees is well recognised nowadays. The sudden breakage of some of these plants in Trentino (Italy), mainly due to Kretzschmaria deusta, prompted a survey of the veteran beeches reported in this area. Visual tree assessment was carried out in 40 sites with either single trees or groups of beeches, for a total of 115 trees evaluated. Most trees showed serious defects or problems in need of management and 19 had a high level of risk of breakage because of the presence of several structural problems. The presence of K. deusta was recorded on 50.4% of the examined trees. The pathogen was also identified in the proximity of investigated trees at 29 sites. Laboratory tests confirmed the identity of K. deusta by microbiological and molecular approaches and also identified Cosmopora berkeleyana as mycoparasite on K. deusta fruiting bodies. Isolates obtained from declining trees and old stumps showed the same pattern of growth at different temperatures. The risk evaluation emphasised how the fungus could affect the survival and safety of these veteran trees; this was confirmed by the collapse of four of the investigated trees in the last years. Therefore, K. deusta, which has been considered as a facultative parasite up to now, could play a more incisive role both in the decline of old beech trees and the natural evolution of aging beech woods.

Giovanni Maconi, Deborah Camatta, Rosanna Cannatelli, Francesca Ferretti, Anna Carvalhas Gabrielli, Sandro Ardizzone Gastroenterology Unit, Department of Biomedical and Clinical Sciences FBF – L.Sacco, University Hospital, Milan, ItalyCorrespondence: Giovanni MaconiGastroenterology Unit, Department of Biomedical and Clinical Sciences, ASST Fatebenefratelli-Sacco University Hospital, University of Milan, ItalyTel +39 02 39043164Fax +39 02 39042232Correspondence Email giovanni.maconi@unimi.itAbstract: Budesonide MMX is a low bioavailability corticosteroid oral once-daily formulation, which has a controlled rate of release throughout the colon, thanks to the multimatrix (MMX) formulation. It has been available for a decade in the USA and Europe for the induction of remission in patients with active, mild to moderate ulcerative colitis, particularly for those not responsive to mesalamine. The efficacy of budesonide MMX in this setting has been assessed by registrative randomized controlled trials showing a higher rate of clinical and endoscopic remission at 8 weeks compared with placebo, mostly in patients with proctosigmoiditis and left-side colitis. Since it is available in our therapeutic armamentarium, a few studies have confirmed the effectiveness of budesonide MMX also in real-life, highlighting the high rate of clinical response and remission and the high safety profile. In the present review, we summarise clinical trials and real-life results of budesonide MMX, assessing its use and predictors of response and non-response in real-life.Keywords: budesonide MMX, ulcerative colitis, efficacy, effectiveness, safety

Andrea Pozza,1 Richard H Osborne,2,3 Gerald R Elsworth,2 Giacomo Gualtieri,4 Fabio Ferretti,1 Anna Coluccia1 1Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy; 2Centre for Global Health and Equity, Swinburne University of Technology, Melbourne, Australia; 3Department of Public Health, University of Copenhagen, Copenhagen, Denmark; 4Legal Medicine Unit, Santa Maria alle Scotte University Hospital, Siena, Siena, ItalyCorrespondence: Fabio FerrettiDepartment of Medical Sciences, Surgery and Neurosciences, University of Siena, Viale Bracci 16, Siena 53100, ItalyTel +39 0577 586409Fax +39 0577 233222Email ferrefa@unisi.itBackground: The Health Education Impact Questionnaire (heiQ) aims to evaluate eight self-management skills in people with chronic conditions. Knowledge about the relations between these self-management skills and different quality of life (QoL) outcomes has received little attention. It is also important to provide further evidence on its properties in non-English healthcare contexts, as the questionnaire is being used in cross-cultural research. Furthermore, in the Italian healthcare context, the relationship between the medical staff and the patients remains asymmetrical, with the latter having the role of passive recipients of medical prescriptions and services. The current study provided further evidence about the psychometric properties of the heiQ among Italian people with chronic conditions, specifically by assessing the factor structure, reliability, convergent/divergent and criterion validity (ie, the specific contribution of each of the self-management skills to QoL outcomes).Methods: Two hundred ninety-nine individuals with a chronic condition (mean age = 61.4 years, 50% females) completed the heiQ and the Medical Outcomes Study-Short Form (MOS SF-36). Confirmatory factor analyses, Composite Reliability Indices (CRI), bivariate correlations and linear regression analyses were computed.Results: A model with 8 correlated factors showed good fit, in a similar way to previous studies. CRI values were acceptable to good for all the subscales. Associations between some of the heiQ subscales and some of the MOS SF-36 subscales supported criterion validity. In particular, it was confirmed by the moderate associations between the constructive attitudes and approaches subscale and the MOS SF-36 vitality and perceived mental health and by the moderate correlations between the health directed activities subscale and the MOS SF-36 Vitality. In linear regressions, higher emotional distress predicted higher physical and mental QoL, while higher mental QoL was also associated with stronger constructive attitudes and approaches.Conclusion: The heiQ has robust properties across translations and it can also be used routinely in Italian healthcare contexts. The evidence that all the other self-management skills did not predict either physical or mental QoL could suggest that the self-management model of chronic diseases is still not sufficiently developed in the Italian context, where patients are passive recipients of medical instructions.Keywords: chronic diseases, self-management, health education, psychometric properties, health status, quality of life, diabetes, cardiovascular diseases

Recent changes commonly observed in forests growth could be the result of a combination of different climatic and non-climatic factors, such as rising atmospheric [CO2], temperature changes, atmospheric N deposition and drought stress. These effects are difficult to assess, however, due to the superimposition of age-related changes. After removing age effects through a novel approach, this study quantifies the effects on tree growth of global change, and assesses the relationship with individual environmental drivers and their relative importance. Generalized Additive Mixed Models (GAMMs) were applied to decouple the non-linear effects of age and co-occurring environmental changes on basal area increments (BAI) series, as derived from tree rings in a Pseudotsuga menziesii stand chronosequence of four different age classes (65-, 80-, 100- and 120-year-old). The model could explain about 57% of the overall variation in BAI as a function of age and a selected set of predictors, including water availability in the current summer and at the end of previous growing season; together with age, winter-spring mean temperature was found to be the most important predictor. After accounting for age-related effects, a significant decrease in BAI was observed in Douglas fir over the last decades. No significant impact of atmospheric [CO2] and atmospheric N deposition were detected.

Andrea Pozza,1 Christine Lochner,2 Fabio Ferretti,1 Alessandro Cuomo,3 Anna Coluccia1 1Department of Medical Sciences, Surgery and Neurosciences, Santa Maria alle Scotte University Hospital of Siena, Siena, Italy; 2SU/UCT MRC Unit on Anxiety and Stress Disorders, Department of Psychiatry, Stellenbosch University, Cape Town, South Africa; 3Department of Molecular Medicine, University of Siena School of Medicine and Department of Mental Health, University of Siena Medical Center (AOUS), Siena, Italy Background: Obsessive–compulsive disorder (OCD) is one of the leading causes of disability and reduced quality of life (QOL), with impairment in a number of domains. However, there is a paucity of literature on the association between severity of OCD symptoms and QOL, and the data that do exist are inconsistent. In addition, the role of severity in QOL has not been summarized as yet from a cross-generational perspective (ie, across childhood/adolescence and adulthood). Through meta-regression techniques, the current study summarized evidence about the moderator role of severity of OCD symptoms on differences in global QOL between individuals with OCD and controls. Methods: Online databases were searched, and cross-sectional case–control studies comparing participants of all ages with OCD with controls on self-report QOL measures were included. Random-effect meta-regression techniques were used to comment on the role of illness severity in global QOL in individuals with OCD. Results: Thirteen studies were included. A positive significant association emerged between OCD severity and effect sizes on global QOL: in samples with higher severity, there were narrower differences in QOL between patients with OCD and controls than in samples with lower severity. Such positive association was confirmed by a sensitivity analysis conducted on studies including only adults, where the difference in QOL ratings between patients and controls was significantly narrower when OCD severity was higher. Conversely, a negative association between severity and QOL was found in those studies including only children/adolescents, where the difference in QOL was significantly larger between patients and controls when OCD severity was higher. Conclusion: QOL remains an important issue to address in the management of OCD in all age groups, irrespective of illness severity. Even in those with lower severity ratings, QOL may be considered as an important marker of treatment response. Keywords: obsessive–compulsive disorder, quality of life, systematic review, symptoms severity, well-being, meta-regression

Anna Coluccia,1 Fabio Ferretti,1 Andrea Fagiolini,2,3 Andrea Pozza1 1Department of Medical Sciences, Surgery and Neurosciences, Santa Maria alle Scotte University Hospital, 2Department of Molecular Medicine, School of Medicine, University of Siena, 3Department of Mental Health, University of Siena Medical Center (AOUS), Siena, Italy Abstract: Obsessive–compulsive disorder (OCD) is a seriously impairing psychiatric condition that affects 1%–3% of youth. Investigating the quality of life (QOL) is an important issue for treatment planning of this disorder, as targeting symptoms without taking it into account may bias assessment and prognosis when the patient presents with reduced symptoms that do not correspond to improved QOL. However, QOL in young individuals with OCD has been under-studied. This meta-analysis summarized current evidence that assessed differences in global, social and school QOL dimensions, between children/adolescents with OCD and screened controls. Age, sex and OCD severity were examined as moderators. Case–control studies were included if children/adolescents with primary OCD were compared with screened controls on validated self-reported QOL outcomes. Online databases (January 1966–January 2016) were searched. Five case–control studies were included (n=543, 17 effect sizes overall). On global QOL, a large effect size emerged (d=-1.16, P

Anna Coluccia, Fabio Ferretti, Andrea PozzaDepartment of Medical Sciences, Surgery and Neurosciences, Santa Maria alle Scotte University Hospital, University of Siena, Siena, ItalyPurpose: The patient-centered approach to health care does not seem to be sufficiently developed in the Italian context, and is still characterized by the biomedical model. In addition, there is a lack of validated outcome measures to assess outpatient experience as an aspect common to a variety of settings. The current study aimed to evaluate the factorial validity, reliability, and invariance across sex of the Health Services OutPatient Experience (HSOPE) questionnaire, a short ten-item measure of patient-centeredness for Italian adult outpatients. The rationale for unidimensionality of the measure was that it could cover global patient experience as a process common to patients with a variety of diseases and irrespective of the phase of treatment course.Patients and methods: The HSOPE was compiled by 1,532 adult outpatients (51% females, mean age 59.22 years, standard deviation 16.26) receiving care in ten facilities at the Santa Maria alle Scotte University Hospital of Siena, Italy. The sample represented all the age cohorts. Twelve percent were young adults, 57% were adults, and 32% were older adults. Exploratory and confirmatory factor analyses were conducted to evaluate factor structure. Reliability was evaluated as internal consistency using Cronbach’s α. Factor invariance was assessed through multigroup analyses.Results: Both exploratory and confirmatory analyses suggested a clearly defined unidimensional structure of the measure, with all the ten items having salient loadings on a single factor. Internal consistency was excellent (α=0.95). Indices of model fit supported a single-factor structure for both male and female outpatient groups. Young adult outpatients had significantly lower scores on perceived patient-centeredness relative to older adults. No significant difference emerged on patient-centeredness between male and female outpatients.Conclusion: The HSOPE questionnaire seemed to be a tool with high acceptability and excellent psychometric properties to measure patient-centeredness as a unidimensional construct. Limitations and implications for future research are discussed.Keywords: patient-centered care, health care services, psychometric properties, patient-reported outcomes

Perceptive analysis of the Sustainable Forest Management (SFM) through the cognitive maps. SFM is the current paradigm in forest management. This paradigm has mixed the principles of multifunctionality with the concept of sustainable development. Despite the association between SFM and public participation, the sustainable management of forest resource can be achieved from the technical point of view both with a top-down approach, where a low number of social actors are involved in the decision making process, and a bottom-up approach, where the number of social actors and interests is broad. Following this second approach, a preliminary stage is the construction of the scenario perceived (mapping of stakeholders and analysis of the hierarchy of preferences and interests). This analysis, achieved through the construction of individual and collective cognitive maps, improves the cognitive framework and supports the facilitator in the decision making process. The cognitive maps of the stakeholders are the starting point of the participatory forest management. The paper focuses on the implementation of a method, based on the cognitive maps, aimed to identify and analyse the perception and the hierarchy of interests of the stakeholders with respect to the SFM. The method was tested in a case study characterized by rural vocation where the primary sector has a key role from both social and economic point of views (Alto Matese, Molise Region).

Forest landscape planning analyses all forest aspects (economic, ecological and social) and defines long-term forest management guidelines. Various actors are involved in landscape planning; therefore the analysis needs to take into account goals and targets of the different stakeholders. The participatory process can strongly support the development of a bottom-up forest plan definition when stakeholders are involved throughout the decision-making process. In this way, management guidelines are defined by decision makers and local communities through a shared process. With this approach, Public Participation GIS (PPGIS) is a useful tool to support the decision-making process in forest planning. The aim of the paper is to present a method that matches these requirements by exploiting the potential of GIS. The application of Public Participation GIS (PPGIS) is a useful support to integrate stakeholders’ priorities and expectations into forest planning strategies. Furthermore, it represents the starting point to draw up management scenarios by integrating and comparing both technical and social priorities. This paper presents an application of PPGIS in a forest landscape plan in southern Italy (Alto Agri district, Basilicata region).

The research analyses the efficiency of the representative democracy model in the land policies definition. The representative model is based on the assumption that people (public) are not able to manage their interests, but need the presence of representatives in order to assure the common interest. The paper focuses on the comparison between social preferences and institutional preferences. The hypothesis is that in the case there is a wide divergence of preferences between institutional and social preferences, it means that institutional actors have a different perception of priority in comparison to the society. To analyse the divergences concerning land policies authors have used a questionnaire designed in order to consider the main management strategies on rural development. The questionnaire - subdivided into thematic sections (forest functions, strategies of territorial development, renewable energies and forest fire control strategies) - has been submitted face-to-face to the representatives of local institutions and to the non-institutional actors. The results of the interviews have been compared statistically considering the two groups of actors, with the purpose of emphasizing the convergence and divergence on land policies. The study area is the forest district of Arci-Grighine in the Oristano department (Sardinia).

This paper presents the results of a forest cover analysis over a time span of 150 years in a protected area of Eastern Trentino (Northern Italy), Paneveggio Pale di S. Martino Nature Park. With the aid of Grass GIS two historical maps (1859 and 1936) and a set of aerial photographs taken from 1945 to 2006 have been analysed, orthorectified and classified with a supervised method, in order to derive a series of forest cover maps. Techniques applied and problems encountered in using heterogeneous material are discussed. The research shows that from 1859 to the present the increase of forest cover is about 25%, due to the reduced impact of forestry and farming. Timberline dynamics have also been considered; an average growth of about 1 m/year has been estimated for the last 150 years and the data have been compared with the timberline cartography and to field surveys. Timberline estimation for recent years appears to be affected mainly by lower human pressure while the relationship with climate changes is difficult to evaluate. Landscape metrics were used to quantify the changes in forest fragmentation and to identify three core areas that have remained unchanged over time. This case study fills a gap of knowledge about the history of forest cover in the area, shows how multi temporal analysis can support protected area management. This study has been requested by the Park managers, a sign t that landscape planners are becoming aware of past landscape importance.

This paper describes goals and methodologies of the Land Plan for Forest and Natural Environment Management Guidance (PFTI) stemming from the Ri.Selv.Italia national project (within the “Forest Land Planning” 4.2 subproject). The PFTI geographic range of application is at an intermediate level between single forest-management-unit-level plan and regional forest plans, and deals with forest and pastures resources management. PFTI’s main purposes concern forest resource and forest economy analysis and assessment of the benefits that can be provided to local population through a rational forest management, taking into account also the social structure and potential local conflicts. PFTI’s final task is then to weigh up all these issues in order to give specific participated forest management guidelines at a territorial scale. Unlike the forest-management-unit-level plan, whose specific duties are predetermined and fixed, the PFTI is not necessarily a mandatory plan. On the opposite, PFTI should suggest several specific silviculture guidelines and alternative management scenarios.

This paper reports the first results of an investigation carried out within the research project "Study and improvement of woods and shrubbery derived from abandoned agricultural areas" (RiSelvItalia Project). Changes occurred in the past 50 years in the pastoral area of S. Paolo in Alpe (Appennino Romagnolo, Northern Apennines, Italy) were described on the grounds of photo-interpretation of three sets of aerial photos (1955, 1976, 1997). A high reduction of the surface of sowable lands and pastures (from 80% to 33%) was pointed out, together with an increase of shrubbery (from 5% to 18%) and woods (from 0 to 42%). The characterization of woods, shrubbery and pastures was performed through structural transects and phyto-sociological investigations. Thus it was possible to reconstruct the dynamic series of vegetation, from grasslands belonging to the association Centaureo bracteatae-Brometum erecti (Festuco-Brometea) to woods referable to the association Aceri obtusati-quercetum cerridis (Querco-Fagetea). Investigations on meadows revealed also a good quality of pastures, not only in open grasslands (mean pastoral value - VP - of 30), but even in partially shrubby areas (VP 21). Some guidelines for a multi-purpose exploitation of the site are suggested, taking into account not only economic aspects, but also the conservation of environment and landscape.

Nowadays lots of answers are required concerning forest management planning. For this reason adopting standard procedures in the planning process is becoming a necessity in the forest sector. The aim of this paper is to identify standard procedures aimed at the division of forest into compartments, in the context of forest management plans. First of all we analyse the bases on which different systems of division into compartments are founded. The approach of subdivision from bottom upwards (or by aggregation) is the most suitable within the present context of sustainable management. The study points out both the potential and the requirements of such an approach. In this way we have identified the characteristics which define and guide the process and which should be gathered in a new key concept: the cultural identity. These characteristics are: forest cover, composition, applicable silviculture, assignable function. The cultural identity - which includes physical, cultural and functional variables - offers a working system and a reasoning method that can be repeated and applied to any situation..

CNS infection is a nearly constant facet of systemic CNS infection and is generally well controlled by suppressive systemic antiretroviral therapy (ART). However, there are instances when HIV can be detected in the cerebrospinal fluid (CSF) despite suppression of plasma viruses below the clinical limits of measurement. We review three types of CSF viral escape: asymptomatic, neuro-symptomatic, and secondary. The first, asymptomatic CSF escape, is seemingly benign and characterized by lack of discernable neurological deterioration or subsequent CNS disease progression. Neuro-symptomatic CSF escape is an uncommon, but important, entity characterized by new or progressive CNS disease that is critical to recognize clinically because of its management implications. Finally, secondary CSF escape, which may be even more uncommon, is defined by an increase of CSF HIV replication in association with a concomitant non-HIV infection, as a consequence of the local inflammatory response. Understanding these CSF escape settings not only is important for clinical diagnosis and management but also may provide insight into the CNS HIV reservoir.

The Influenza A H1N1 subtype can present with a wide spectrum of severity, from mild symptoms of influenza to severe respiratory distress. The morbidity and mortality connected to influenza are mostly associated with secondary bacterial infections. The influenza syndrome alone can cause a massive release of cytokines with dysregulation of the immune system, and it can act in synergy with other bacteria which can enhance cytokines secretion. This article deals with a case of severe pneumonia of H1N1 in a 17-year-old woman with bacterial superinfection with Staphylococcus aureus characterized by a high level of interleukine-6 (105900 pg/mL) and the appearance of severe leukopenia with immuno-suppression, such that HIV infection and hematological diseases were included in the initial differential diagnosis. After death, the autopsy confirmed the presence of severe pneumonia, in addition to an hepatic steatosis in absence of other risk factors. This case reports the rapid and lethal course of influenza A / H1N1 in a young and healthy subject without co-morbidities, in an age group in which mortality is about 0.3 deaths per 100,000. The case underlines the importance of quickly diagnosis of viral infections and the differential diagnoses with other immunosuppressive diseases, which can be fatal even in adolescent and healthy subjects. [ABSTRACT FROM AUTHOR]

This brief report is a partial replication of the study by Jackson and Atance ("J Dev Disabil" 14:40-45, 2008) assessing nonverbal Self-based and Mechanical-based future thinking (FT) in children with Autism Spectrum Disorder (ASD). In a first step, these tasks were administered to 30 children with ASD. The two Self-based tasks were then modified as a verbal component could not be completely ruled out. Consequently, 77 children with ASD and 77 children with typical development received the modified Self-based FT tasks and the Mechanical-based FT tasks. We partially replicated the previous findings. Participants with ASD had impaired FT in both kinds of tasks and both groups performed better on tasks assessing Mechanical-based FT than Self-based FT. These results suggest that impairments of FT in ASD are not limited to Self-Projection.

This brief report is a partial replication of the study by Jackson and Atance (J Dev Disabil 14:40-45, 2008 (See CR12)) assessing nonverbal Self-based and Mechanical-based future thinking (FT) in children with Autism Spectrum Disorder (ASD). In a first step, these tasks were administered to 30 children with ASD. The two Self-based tasks were then modified as a verbal component could not be completely ruled out. Consequently, 77 children with ASD and 77 children with typical development received the modified Self-based FT tasks and the Mechanical-based FT tasks. We partially replicated the previous findings. Participants with ASD had impaired FT in both kinds of tasks and both groups performed better on tasks assessing Mechanical-based FT than Self-based FT. These results suggest that impairments of FT in ASD are not limited to Self-Projection., Author(s): A. Marini[sup.1] [sup.2] , F. Ferretti[sup.3] , A. Chiera[sup.3] , R. Magni[sup.4] , I. Adornetti[sup.3] , S. Nicchiarelli[sup.3] , S. Vicari[sup.4] , G. Valeri[sup.4] Author Affiliations: (1) Department of [...]