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Background: Preschool children with clinically-diagnosed asthma have a higher rate of emergency department visits and consume more resources for management than older children. However, no clinical trials have yet been performed measuring the impact of a combined diagnostic, therapeutic and educational pathway regimen for evaluation of wheezing control in children aged less than 6 years. The purpose of the present study was to assess the impact of a pediatric program developed in Italy, the Diagnostic Therapeutic Educational Pathway (DTEP), for asthma management in children less than 6 years old attending an asthma referral center. Methods: This is a retrospective population-based cohort study performed in children with asthma aged 0–5 years, attending at "Io e l'Asma center", Brescia, Italy between September 2007 and December 2014. The incidence rates (IRs) of hospitalization, emergency room visits, use of outpatient services and drug usage for dyspnea, wheezing, or respiratory symptoms were evaluated for time periods prior to and after DTEP intervention. Results: A total of 741 patients, aged 0–5 years completed the DTEP, including 391 and 350 children aged 0–2 and 3–5 years, respectively. The percentage of children aged 0–2 and 3–5 years showing improved control of wheezing symptoms during the 1st to 3rd visit interval as a result of the DTEP intervention increased from 39.5 to 60.9% and from 25.5 to 75.5%, respectively. During these periods, the IRs showed a significant decrease for all outcomes, from-8.6% to − 80.4%. Although specific IRs for drug prescriptions declined, particularly for LABA plus corticosteroids, antibiotics, and systemic corticosteroids, they increased for SABA, inhaled corticosteroid and leukotriene receptor antagonist usage. Conclusions: The results suggest that a real-world assessment of the integrated DTEP program for preschool children provides evidence for improved wheezing control and reduction of adverse therapeutic related outcomes. [ABSTRACT FROM AUTHOR]

In the northwestern part of Northern Apennines, between Curone and Staffora Valleys, the tectonic superposition between the External Ligurian Units (i.e. the ophiolitic-bearing chaotic complex of the Groppallo Unit and the non-ophiolitic Cassio Unit), the Middle Eocene – Miocene wedge-top basin Epiligurian Units succession, and the Late Messinian – Pliocene Po Plain succession, records the multistage tectono-stratigraphic evolution from subduction to continental collision. Our geological map, at the 1:20,000 scale, allows us to define 6 main tectonic stages on the basis of (i) the crosscutting relationships between main faults and local to regional stratigraphic unconformities and (ii) the differentiation among different types of chaotic rock unit (olistostromes and broken formations) deposited since Late Cretaceous to late Messinian. This approach provides a new understanding on the tectono-stratigraphic evolution of this sector, and its meaning in the evolution of the northwestern part of Northern Apennines. [ABSTRACT FROM PUBLISHER]

In the Inner Western Alps, three different types of block-in-matrix structures (BIMs) formed sequentially through time at a convergent plate margin. These show the superposition of progressive deformation from (i) subduction to eclogite-facies depths, (ii) collision, accretion, and exhumation of oceanic crust, represented by the Monviso Meta-ophiolite Complex, to (iii) collision, accretion, and exhumation of the continental Dora Maira units. The Type 1 occurs in the metasedimentary cover of the Dora Maira Unit and consists of a map-scale broken formation with boudinaged ‘native’ blocks of marble (Early Jurassic) in a calcschist matrix. It results from the tectonic overprinting of exhumation-related folding (D2-stage) on an earlier subduction-related dismembered succession (D1-stage). Type 1 also includes ‘non-mappable’ BIMs with ‘exotic’ blocks, resulting from the gravitational collapse of the Triassic carbonate platform of European Continental Margin, triggered by the Early Jurassic rifting. In the Monviso Meta-ophiolite Complex, Types 2 and 3 represent tectonically induced broken and dismembered formations, respectively. They differ from each other in the degree of stratal disruption of primary interbedded horizons of mafic metabreccia (Type 3) and mafic metasandstone (Types 2 and 3) sourced by the Late Jurassic–Early Cretaceous denudation of an oceanic core complex. Dismembered interbeds (Type 2) and isolated blocks were mixed together (Type 3) by the overlap of D2 tectonics and late- to post-exhumation extensional shearing (D3-stage). Development of these types of BIMs may be common in many exhumed convergent plate margins, where severe tectonics and metamorphic recrystallization under high-pressure conditions normally prevent the reconstruction of BIMs or mélange-forming processes. Our findings show that documenting the mode and time of the processes forming BIMs is highly relevant in order to reconstruct the oceanic seafloor morphology and composition of associated stratigraphic successions, and their control in the evolution of those convergent plate margins. [ABSTRACT FROM AUTHOR]

The aim of this population-based study was to assess the incidence rates of infectious diseases in native- (Italian) and foreign-born (immigrants) populations in a North Italy area, in 2006-2010. Crude, age-specific incidence rates (IRs) and age-standardised rate ratios (SRRs) between foreign- and native-born subjects and their 95 % confidence intervals (95 % CI) were estimated. A total of 32,554 cases of infectious diseases were found (9.9 % in foreign-born subjects). The highest SRRs between foreign- and nativeborn subjects were found for tuberculosis (SRR = 27.1; 95 % CI 21.3-34.3), malaria (SRR = 21.1; 14.6-30.4), scabies (SRR = 8.5; 7.6-9.4), AIDS (SRR = 2.5; 1.8-3.4) and viral hepatitis B (SRR = 3.3; 2.1-5.2). The highest IR was found for AIDS in people from the Americas (IR = 4.57; 95 % CI 2.2-8.4), for malaria and tuberculosis in people from Africa (IR = 13.89; 11.6-16.5 and IR = 11.87; 9.8-14.3 respectively). Therefore immigrants are at a higher risk of acquiring some common infectious diseases compared to the native population in Western European countries. [ABSTRACT FROM AUTHOR]

We investigated the recent evolution of the Po Plain-Alps system by integrating subsurface geophysical data from the Po Plain with new stratigraphic and structural observations from the Southern Alps margin. Inversion of structural data and chronology provided by stratigraphic constraints led to the definition of three tectonic events since the Pliocene, namely, the intra-Zanclean, the Gelasian, and the Middle Pleistocene, driven by an axis of maximum compression formerly oriented NE (intra-Zanclean) and then to the NNW (Gelasian and Middle Pleistocene). The associated deformation has been accommodated by two sets of faults consisting of NNE-trending thrust faults, mostly represented in the western sector of Lake Garda, and NW-trending strike-slip faults, observed in the southern and eastern sectors. The interplay between these two sets of faults is interpreted to produce short (<10 km length) thrust ramps activated in left transpression, bounded by longer (30-60 km) transfer faults activated in a right-lateral strike-slip motion. Based on this structural model, we infer moderate seismicity (Mw < 6) associated with the NNE-directed thrusts and stronger earthquakes (also Mw > 6.5) along the NW-trending strike-slip faults. In this framework, the newly defined Nogara fault and the Sant'Ambrogio fault, all pertaining to the NW-trending system, are regarded as potential candidates for the seismogenic source of the January A.D. 1117 event, the most destructive earthquake in the Po Plain. [ABSTRACT FROM AUTHOR]

The Apenninic fold-and-thrust belt in Italy represents one of several interconnected circum-Mediterranean orogens developed after the Late Cretaceous – early Cenozoic closure of Tethys and convergence between the European and African plates. The Geological Map of the Aventino River Valley, at 1:25,000 scale, provides original mapping of the outermost sector of Central Apennines in the Abruzzi region. Focusing on detailed mapping of the crosscutting relationships between the main regional thrust faults and tectonically driven stratigraphic unconformities, the map describes the complex structural and stratigraphic relationships between the Outer Abruzzi units (i.e. Porrara Unit), Apulia – Adriatic deformed units (i.e. Majella and Casoli Units), and the allochthonous Molise and Sicilide units. These tectono-stratigraphic relationships result from four main tectonic stages that occurred sequentially over a short time interval from late Messinian to early Pliocene. [ABSTRACT FROM AUTHOR]

Abstract: The Argille varicolori (Varicolored scaly clays) of the External Ligurian Units of the Northern Apennines have been widely described as a typical unmetamorphosed broken formation (i.e., a chaotic unit without exotic blocks), produced by offscraping and tectonic imbrication during the evolution of the Ligurian accretionary wedge. Geological mapping and integrated structural and stratigraphic observations show that the Argille varicolori consist of diverse types of small-scale mélanges (non-mappable at a 1:25,000 scale) forming a composite chaotic unit, in which the superposition of tectonic, sedimentary and diapiric processes resulted in the occurrence of polygenetic chaotic bodies at different scales. These mélange units record the evolution of the Ligurian accretionary wedge from subduction to collision and intracontinental deformation. Tectonically Disrupted Body 1 (TDB1) comprises boudinage and pinch-and-swell structures formed by layer-parallel extension/contraction at the wedge front of the Ligurian accretionary complex during the late Cretaceous–middle Eocene. It is interleaved with non-mappable Gravity-driven Chaotic Bodies (GCB) developed during alternating episodes of accretion and removal of material at the wedge front. The late Oligocene–early Miocene out-of-sequence thrusting related to the collisional episodes in the Apennines overprinted the previously formed chaotic bodies and formed a polygenetic tectonic mélange (Tectonically Disrupted Body 2, TDB2). This unit is characterized by a structurally ordered block-in-matrix fabric and by the gradual decrease of stratal disruption away from the regional thrust. Overpressurized fluids concentrated along the shear surfaces, and the scaly cleavage planes facilitated the diapiric upward movement of unconsolidated sediments in the early Miocene. This process produced non-mappable shale dike injections (DDB1) and mappable Diapirically Disrupted Bodies (DDB2), which show an internal zonation of deformation. This deformation reworked the previously formed chaotic bodies. Although some of these polygenetic mélanges cannot be mapped at a 1:25,000 scale, their careful documentation provides a better understanding of time-progressive, scale-independent mélange-forming processes. [Copyright &y& Elsevier]

Geologic mapping and integrated stratigraphic and structural observations of a gypsum quarry from northwestern Italy allow evaluation of the relative contributions, the time relationships, and the causative links between tectonic, sedimentary, and diapiric processes in the genesis of chaotic sediments of Messinian age. Three chaotic units are exposed in the quarry: together, they make up a composite chaotic unit that is unconformably overlain by post-chaotic sediments. Unit 1 is composed of blocks of primary evaporites that are juxtaposed to marine marls by subvertical transpressive faults and are parallel to the fault surfaces. Unit 2 unconformably overlies Unit 1, and consists of a lenticular sedimentary body containing both angular and rounded blocks, randomly distributed in a fine-grained matrix. Unit 3 consists of a 10-m-wide body bounded by transpressive faults, and pierces both Units 1 and 2. It is composed of strongly deformed muddy deposits that envelop blocks of gypsum and carbonate rocks. Between the core and the margins, various zones have been defined based on the increasing amount of deformation toward the margins. The post-chaotic sediments unconformably overlie both Units 1 and 2, sealing the main fault systems. The composite chaotic unit is related to thrust propagation during a regional phase of deformation, and is the result of different evolutionary stages, in each of which a single genetic mechanism prevailed. Tectonic faulting prevailed during stage 1 and was responsible for the formation of a tectonically disrupted assemblage (Unit 1). During stage 2, gravity-driven sedimentary phenomena, related to slope oversteepening triggered by ongoing thrust propagation, resulted in the deposition of Unit 2. Gravity sliding was favored by the mechanical weakening of sediments caused by tectonic faulting. Overpressure conditions resulting from the rapid deposition of Unit 2 triggered the rise of a diapir (Unit 3) that pierced Units 1 and 2. The involvement of methane-rich fluids in the formation of the diapir is suggested by the occurrence of blocks of methane-derived carbonates, found not in the quarry, but just outside it. [ABSTRACT FROM AUTHOR]

The strong morphological similitude of the block-in-matrix fabric of chaotic rock units (mélanges and broken formations) makes problematic the recognition of their primary forming-processes. We present results of the comparison between magnetic fabric and mesoscale structural investigations of non-metamorphic tectonic, sedimentary, and polygenetic mélanges in the exhumed Late Cretaceous to early Eocene Ligurian accretionary complex and overlying wedge-top basin succession in the Northern Apennines (northwest Italy). Our findings show that the magnetic fabric reveals diagnostic configurations of principal anisotropy of magnetic susceptibility (AMS) axes orientation that are well comparable with the mesoscale block-in-matrix fabric of mélanges formed by different processes. Broken formations and tectonic mélanges show prolate and neutral-to-oblate ellipsoids, respectively, with magnetic fabric elements being consistent with those of the mesoscale anisotropic "structurally ordered" block-in-matrix fabric. Sedimentary mélanges show an oblate ellipsoid with a clear sedimentary magnetic fabric related to downslope gravitational emplacement. Polygenetic mélanges show the occurrence of a cumulative depositional and tectonic magnetic fabric. The comparison of field and laboratory investigations validate the analysis of magnetic features as a diagnostic tool suitable to analytically distinguish the contribution of different mélange forming-processes and their mutual superposition, and to better understand the geodynamic evolution of subduction-accretion complexes. [ABSTRACT FROM AUTHOR]

The Paleogene "megabeds" of the Julian-Slovenian Basin are regional, basin-wide deposits, produced by catastrophic carbonate platform collapses. They record the emplacement of a bipartite slide mass behaving as a cohesive blocky/debris flow in the lower part, and as a grain to turbulent flow in the upper part. Several types of primary (sedimentary) soft sediment deformation structures testify fluid overpressure conditions during emplacement. Such structures are identified within a brecciated, fine grained matrix that encloses and intrudes slide blocks and clasts, characterized by NE-, NW- and SW-directed paleo-transport directions, indicating a depositional setting close to the basin margins. Here we present an updated review of some representative megabeds, exposed in the open-pit quarry outcrops of Anhovo (SW Slovenia). In particular, we here discuss new interpretations based on X-ray fluorescence spectrometry (XRF), thermo-gravimetry (TG) and electric resistivity tomography (ERT). Our results indicate that basal marly clasts of the megabeds are markedly different from the uppermost draping marls, suggesting two different coeval sources. The relationships with the underlying successions are strongly erosive, with deep localized scouring of the substrate and amalgamations between different megabeds, and the depositional units inside individual megabeds, supporting the geochemical differences. [ABSTRACT FROM AUTHOR]

The risk of cancer is substantially increased in HIV-infected patients. However, little is known about non-AIDS-defining cancers (NADCs) without an infectious etiology. A total of 5,090 HIV-infected patients registered in the Local Health Authority (LHA) of Brescia and receiving primary care at our clinic were included in a retrospective (1999-2009) analysis. The cancer diagnoses were obtained through a record-linkage procedure between our database and the LHA general database and population-based Cancer Registry of LHA. We compared risks of these malignancies with those of the general population living in the same health area by using age-standardized incidence ratios (SIRs). Poisson regression analysis was used to assess factors associated with non-virus-related NADCs. We recorded an increase in the SIR of non-virus-related NADCs over time, with 138 cancers diagnosed in 131 patients. The mean incidence rate was 42.6/10,000 person years and the median age at the diagnosis was 49 (range, 28-78) years old. Stratifying for gender, only HIV-infected males had an increased risk of non-virus-related NADCs [SIR=1.86; 95% confidence interval (CI), 1.55-2.26]. Risk was higher for lung (SIR=3.59; 95% CI, 2.36-5.45) and testis cancer (SIR=3.11; 95% CI, 1.48-6.52). However,, cancers of the prostate and breast in HIV-positive men and women were null (SIR=1.10; 95% CI, 0.53-2.32 and SIR=0.91; 95% CI, 0.47-1.74, respectively). The only predictors of non-virus-related NADCs included older age [incidence rate ratio (IRR)=1.10; 95% CI, 1.08-1.12 per each additional year, p<0.001] and a shorter or no exposition to combined antiretroviral therapy (cART) (IRR=2.31; 95% CI, 1.38-3.89, p=0.002). A CD4⁺ count lower than 50/mm³ was significantly associated with cancers only in the univariate model (IRR=1.40; 95% CI, 0.99-1.98, p=0.057). HIV-infected men showed a 2-fold increased risk of non-virus-related NADCs compared to the general population. However, the use of cART appeared to be beneficial in protecting against the development of these malignancies.

A questionnaire study was performed in 2008 to evaluate consumption and knowledge regarding tobacco smoke amongst secondary school students (9th grade and 13th grade) in Brescia (Italy). Overall, 1,495 students completed the questionnaire (89.5% of the selected sample). The questionnaire was anonymous and self-administered. 29.4% of males and 36.2% of females attending 9th grade reported smoking at least one cigarette per week. In 13th grade, the percentage of males and females who reported smoking at least one cigarette per week were 37.7% and 42.2% respectively. 13.2% and 17.4% respectively of males and females attending 9th grade reported being habitual smokers (i.e smoking every day or almost). In 13th grade , 27.4% and 30.7% of males and females reported being habitual smokers. Most students attending grade 13 tried smoking for the first time between ages 12 and 15 years (mean age 13.6 years). Tobacco smoking was found to be associated with personal alcohol consumption and with smoking habits of family and friends. Results were compared to a previous survey conducted in 1989 with the same methodology. An increase of the proportion of smokers was observed in the present study as compared to the 1989 study. The increase was observed in both grades especially amongst females.