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Framed into a robust stratigraphic context, multivariate analyses on the Holocene palaeobiological record (pollen, benthic foraminifers, ostracods) of the Po coastal plain (NE Italy) allowed the investigation of microtidal ecosystems variability and driving parameters along a 35-km-long land–sea transect. Millennial-scale ecosystem shifts are documented by coeval changes in the meiofauna, reflecting variations in organic matter–water depth (shallow-marine environments) and degree of confinement-salinity (back-barrier settings). In-phase shifts of vegetation communities track unsteady water-table levels and river dynamics in freshwater palustrine areas. Five environmental–ecological stages followed one another crossing four tipping points that mark changes in relative sea level (RSL), climate and/or fluvial regime. At the culmination of Mediterranean RSL rise, after the 8200 event, remarkable growth of peatlands took place in the Po estuary, while low accumulation rates typified the shelf. At the transgressive–regressive turnaround (~7000 cal a bp), the estuary turned into a delta plain with tidally influenced interdistributary embayments. River flow regime oscillations after the Climate Optimum (post-5000 cal a bp) favoured isolation of the bays and the development of brackish wetlands surrounded by wooded peatlands. The youngest threshold (~800 cal a bp), which led to the establishment of the modern delta, reflects a major avulsion of the Po River.

Background: High-flow nasal oxygen (HFNO) improves exercise capacity, oxygen saturation, and symptoms in patients with chronic obstructive pulmonary disease (COPD). Due to the need of electricity supply, HFNO has not been applied during free ambulation. Objective: We evaluated whether HFNO delivered during walking by a battery-supplied portable device was more effective than usual portable oxygen in improving exercise capacity in patients with COPD and severe exercise limitation. The effects on 6-min walking tests (6MWTs) were the primary outcome. Methods: After a baseline 6MWT, 20 stable patients requiring an oxygen inspiratory fraction (FiO2) 2. Walked distance, perceived dyspnea, pulse oximetry, and inspiratory capacity at end of the tests as well as patients’ comfort were compared between the tests. Results: As compared to baseline, walked distance improved significantly more in HFNO than in the control test (by 61.1 ± 37.8 and 39.7 ± 43.8 m, respectively, p = 0.01). There were no significant differences between the tests in dyspnea, peripheral oxygen saturation, or inspiratory capacity, but HFNO test was appreciated as more comfortable. Conclusion: In patients with COPD and severe exercise limitation, HFNO delivered by a battery-supplied portable device was more effective in improving walking distance than usual oxygen supplementation.

International audience; The fluvial harbour of Aquileia (Italy), one of the most important Roman trading centres in the Mediterranean, was abandoned after the city's destruction in 452 AD. The deserted harbour evolved into a swamp surrounded by a floodplain that has recorded the anthropogenic, environmental and climatic pressures that have occurred during the last 1500 years in the northern Adriatic. Focusing on the period since 500 AD, we here reconstruct the area's long-term ecosystem dynamics. We show that ecosystem dynamics mainly mirror the climate phases of the pre-industrial era. After the Roman era, anthropogenic activities (agriculture, pasture and fire activity) declined in scope and amplitude and are chronologically limited (from the late 7th to the early 13th centuries AD), acting as a background pressure on ecosystems. The main non-human impacts recorded by ecosystems correspond to the Late Antique Little Ice Age, defined by an average temperature anomaly of −2.04 ± 0.17 °C, exceeding the Pre-industrial Little Ice Age by −1.26 ± 0.16 °C in severity. The temperatures reconstructed for the Medieval Climate Anomaly are close to those recorded for the 20th century AD (average anomaly of 0.08 ± 0.15 °C) but they differ from the 21st century AD, according to the CRUTEM4 data. Aquileia shows that ancient harbours are key areas to understand how climate and human societies have shaped northern Adriatic environments since the post-Roman period.

BackgroundRespiratory physiotherapy is reported as safe and feasible in mechanically ventilated patients with severe Coronavirus Disease (COVID-19) admitted to Intensive Care Unit (ICU), but the short-term benefits remain unclear.MethodsWe performed a retrospective observational study in four ICUs in Northern Italy. All patients with COVID-19 admitted to ICU and under invasive mechanical ventilation (MV) between March 1st and May 30th, 2020, were enrolled into the study. Overlap weighting based on the propensity score was used to adjust for confounding in the comparison of patients who had or had not been treated by physiotherapists. The primary outcome was the number of days alive and ventilator-free (VFDs). The secondary outcomes were arterial partial pressure of oxygen (PaO2)/fraction of inspired oxygen (FiO2) ratio (P/F) at ICU discharge, ICU length of stay, ICU and hospital mortality, and survival at 90 days. The trial protocol was registered on clinicaltrials.gov (NCT 05067907).ResultsA total of 317 patients were included in the analysis. The median VFDs was 18 days [interquartile range (IQR) 10; 24] in patients performing physiotherapy and 21 days (IQR 0; 26) in the group without physiotherapy [incidence rate ratio (IRR) 0.86, 95% confidence interval (CI): 0.78; 0.95]. The chance of 0 VFDs was lower for patients treated by physiotherapists compared to those who were not [odds ratio (OR) = 0.36, 95% CI: 0.18–0.71]. Survival at 90 days was 96.0% in the physiotherapy group and 70.6% in patients not performing physiotherapy [hazard ratio (HR) = 0.14, 95% CI: 0.03–0.71]. Number of VFDs was not associated with body mass index (BMI), sex, or P/F at ICU admission for individuals with at least 1 day off the ventilator.ConclusionIn patients with COVID-19 admitted to ICU during the first pandemic wave and treated by physiotherapists, the number of days alive and free from MV was lower compared to patients who did not perform respiratory physiotherapy. Survival at 90 days in the physiotherapy group was greater compared to no physiotherapy. These findings may be the starting point for further investigation in this setting.

Early physiotherapy could play an important role in the management of severe COVID-19 subjects with consequences of prolonged ICU stay, although its effectiveness is still unclear. Aim of this study is to describe physiotherapy performed in severe COVID-19 patients and to evaluate its safety and feasibility. Consecutive adults with confirmed SARS-CoV-2 infection, admitted to the ICU, needing invasive mechanical ventilation for >24 hours and receiving early physiotherapy, have been enrolled. Adverse events occurred during physiotherapy sessions and timing and type of physiotherapy delivered were analysed, to identify the interventions most frequently performed and to determine the time taken to first mobilize, stand and walk. Functional and clinical assessment of patients was also performed at hospital discharge. Eighty-four severe COVID-19 subjects were enrolled. Few minor adverse events were recorded. Active mobilization was promoted over passive mobilization and independence in daily life activities was supported. Time interval from patients’ intubation to the first physiotherapy treatment was 13 days and to walking was 27 days. Forty-eight (57.1%) subjects returned at home, whereas 29 (34.5%) were discharged to in-patient rehabilitation. Patients with tracheostomy experienced a delay in time from ICU admission until sit out of bed and ambulation, if compared with subjects without tracheostomy, although no differences were found in 6MWT and 1m-STST performances. This study reporting early physiotherapy during pandemic suggests that this intervention is feasible and safe for severe COVID-19 subjects, as well as healthcare workers, although delayed compared to other critically ill patients.

This study describes the case of an 18-years-old male affected by severe COVID-19, who was receiving bilateral lung transplantation (LT), after 71 days of mechanical ventilation and 55 days of veno-venous extracorporeal membrane oxygenation. From post-operative day 2, early mobilization and physiotherapy treatments were performed. Weaning from mechanical ventilation, the use of non-invasive ventilation and tracheostomy management were included in the treatment. Forty-five days after LT the patient was discharged at home, showing improvements in terms of functional and respiratory parameters, quality of life and mood. While evidences about physiotherapy treatments in lung transplantation post severe COVID-19 remain limited, early approach and a multidisciplinary team may be considered key elements for functional recovery of these subjects.

Objective To evaluate the muscle strength and functional level of patients discharged from intensive care unit (ICU) in relation to the swimmer position as a nurse intervention during pronation. Methods Prospective study conducted in the hub COVID-19 center in Milan (Italy), between March and June 2020. All patients with COVID-19 discharged alive from ICU who received invasive mechanical ventilation were included. Forward continuation ratio model was fitted to explore the statistical association between muscle strength grades and body positioning during ICU stay. Results Over the 128 patients admitted to ICU, 87 patients were discharged alive from ICU, with available follow-up measures at hospital discharge. Thirty-four patients (39.1%) were treated with prone positioning as rescue therapy, for a total of 106 pronation cycles with a median duration of 72 hours (IQR 60–83). Prone positioning did not influence the odds of showing particular level of muscle strength, in any of the evaluated districts, namely shoulder (OR 1.34, 95%CI:0.61–2.97), elbow (OR 1.10, 95%CI:0.45–2.68) and wrist (OR 0.97, 95%CI:0.58–1.63). Only in the shoulder district, age showed evidence of association with strength (OR 1.06, 95%CI:1.02–1.10), affecting people as they get older. No significant sequalae related to swimmer position were reported by physiotherapists or nurses. Conclusion Swimmer position adopted during prone ventilation is not associated with worse upper limb strength or poor mobility level in COVID-19 survivors after hospital discharge.

Understanding Quaternary dynamics of delta-coastal plains across multiple glacial-interglacial cycles in the Milankovitch band (~100 kyrs) is crucial to achieve a robust evaluation of possible environmental response to future climate-change scenarios. In this work, we document the long-term bio-sedimentary record of core 204 S16 (~205 m long), which covers a wide portion of the post-MPR (Mid-Pleistocene Revolution) interval, taking advantage of the highly subsiding context of the SE Po Plain (NE Italy). Detailed facies characterization through an integrated sedimentological and meiofauna (benthic foraminifers and ostracods) approach allowed for the identification of a repetitive pattern of alluvial deposits alternating with four fossiliferous, paralic to shallow-marine units (Units 1–4). The transgressive surfaces identified at the base of these units mark major flooding events, forced by Holocene (Unit 4), Late Pleistocene (Unit 3) and Middle Pleistocene (Units 1, 2) interglacials. Distinct stratigraphic patterns typify the Middle Pleistocene interval, which includes coastal-marine (tidal inlet and bay) deposits. In contrast, lagoonal sediments record the maximum marine influence in the Late Pleistocene-Holocene succession. As a whole, the meiofauna tracks a regressive trend, with the deepest conditions recorded by the oldest Unit 1 (MIS 9/11 age?).

The definition of reference conditions has a major role for the understanding of the present-day and paleoecological quality status on transitional environments. The estuarine quality paradox and the paucity of unimpacted sites make the definition of reference conditions a challenging task. In this context, the integration of biological indicators with stratigraphic data is essential, as the vertical stacking pattern of facies composing the shallow subsurface of modern coastal plains reflects changes in physical-chemical parameters which, in turn, affect (paleo-)biotic communities.In the Po coastal plain (N Italy), the mid to late Holocene back-barrier succession of the Mezzano Lowland and the adjacent present-day Bellocchio Lagoon offer a unique example of pristine paralic system for comparing reference conditions defined in fossil and modern settings, respectively. Benthic foraminifers and ostracods from the Mezzano succession allowed us to investigate vertical (i.e., temporal) and lateral (i.e., spatial) changes in (paleo-)environmental conditions, in analogy to the lateral variations recorded at the Bellocchio Lagoon.Both sites present subtidal channel sands almost barren in autochthonous meiofauna and fine-grained lagoon sediments with abundant benthic foraminifers and ostracods mostly represented by euryhaline taxa recording the highest diversity. Intertidal muddy deposits are also recorded, including mud flat clays with abundant oligotypic assemblages dominated by highly-confined benthic foraminifers. In the present study, we demonstrate that changes in modern benthic foraminifer assemblages diversity and composition often interpreted as perturbations of ecological conditions in response to anthropogenic pressures also occur under natural state, as confirmed by paleoenvironmental conditions recorded by ostracods. This reflects the effects of authogenic processes at short time and geographic scales.

The Gulf of La Spezia (GLS) in Northwest Italy is a rocky embayment with low fluvial influence facing the Mediterranean Sea. Past landscape dynamics were investigated through a multi-proxy, facies-based analysis down to a core depth of 30 m. The integration of quantitative ostracod, foraminifera, and pollen analyses, supported by radiocarbon ages, proved to be a powerful tool to unravel the late Quaternary palaeoenvironmental evolution and its forcing factors. The complex interplay between relative sea-level (RSL), climatic changes, and geomorphological features of the embayment drove four main evolution phases. A barrier–lagoon system developed in response to the rising RSL of the Late Pleistocene (likely the Last Interglacial). The establishment of glacial conditions then promoted the development of an alluvial environment, with generalised erosion of the underlying succession and subsequent accumulation of fluvial strata. The Holocene transgression (dated ca. 9000 cal year BP) caused GLS inundation and the formation of a low-confined lagoon basin, which rapidly turned into a coastal bay from ca. 8000 cal year BP onwards. This latter environmental change occurred in response to the last Holocene stage of global sea-level acceleration, which submerged a morphological relief currently forming a drowned barrier-island complex in the embayment.

Coastal-transitional areas, including delta plains, strandplains, lagoons, embayments, salt marshes, and mangroves, are some of the most valuable global resources in terms of both socioeconomic interest and cultural–natural heritage [...]

Large volumes of peatland deposits characterise the Holocene stratigraphy of the Po Plain. A combination of sedimentological and pollen-based paleoenvironmental analyses enables recognition and stratigraphic correlation of small-scale (2–5 m thick) packages of peat-bearing strata, stacked rhythmically in a retrogradational to progradational set and bounded by chronostratigraphically significant surfaces. Across these repetitive lithofacies successions, the proportion of facies-controlled palynomorphs is used as a diagnostic signature to characterise marine flooding surface equivalents (helophytes and hydrophytes) and shoaling-upward (terrestrialization) trends (trees and mesophilous herbs) that record systematic variations in groundwater table associated with increasing/decreasing accommodation. Paludification surfaces at the base of peats delineate the updip (freshwater) equivalents of brackish/marine flooding surfaces recognized at seaward locations atop peat layers (give-up transgressive surfaces). Peat beds exhibit maximum thickness in aggradational strata of the lowermost highstand systems tract, above the maximum flooding surface (MFS). An extrinsic control due to eustatic rise can be inferred for peat development in transgressive deposits: peats, in particular, reveal warmer climates at flooding surfaces (specifically around the MFS) that invariably coincide with rapid shifts to deeper depositional environments. Under highstand conditions, autogenic mechanisms affected base-level changes in the paralic swamps. At this stratigraphic level, peat-bearing strata primarily reflect subtle changes in accommodation due to distributary-channel avulsion, subsidence, and peat autocompaction. Detailed patterns of Holocene peat distribution on millennial timescales can help decipher multiple high-resolution accommodation cycles developed in the rock record on sub-seismic scales, resulting in an improved stratigraphic analysis and prediction of chronologically less constrained non-marine successions.

Background The usefulness of digital chest drain is still debated. We are carrying out a study to determine if the use of a digital system compared with a traditional system reduces the duration of chest drainage. To evaluate safety, benefit, or futility of this trial we planned the current interim analysis. Methods An interim analysis on preliminary data from ongoing investigator-initiated, multicenter, interventional, prospective randomized trial. Original protocol number: (NCT03536130). The interim main endpoint was overall complications; secondary endpoints were the concordance between the two primary endpoints of the RCT (chest tube duration and length of hospital stay). We planned the interim analysis when half of the patients have been randomised and completed the study. Data were described using mean and standard deviation or absolute frequencies and percentage. T-test for unpaired samples, Chi-square test, Poisson regression and absolute standardized mean difference (ASMD) were used. P-value Results From April 2017 to November 2018, out of 317 patients enrolled by 3 centers, 231 fulfilled inclusion criteria and were randomized. Twenty-two of them dropped out after randomization. Finally, 209 patients were analyzed: among them 94 used the digital device and 115 the traditional one. The overall postoperative complications were 35 (16.8%) including prolonged air leak (1.9%). Mean chest tube duration was 3.6 days (SD = 1.8), with no differences between two groups (p = 0.203). The overall difference between hospital stay and chest tube duration was 1.4 days (SD = 1.4). Air leak at first postoperative day detected by digital and traditional devices predicted increasing in tube duration of 1.6 day (CI 95% 0.8–2.5, p p Conclusions This interim analysis supported the authors’ will to continue with the enrollment and to analyze data once the estimated sample size will be reached. Trial registration Trial registration number NCT03536130, Registered 24 May 2018 - Retrospectively registered.

To investigate the association between time to active sitting position and clinical features in people with COVID-19 admitted to intensive care unit (ICU) and referred to physiotherapists.Prospective study conducted in the largest temporary ICU in Lombardy (Italy) between April 2020 and June 2021. All individuals with COVID-19 who received physiotherapy were included. Multivariable Cox proportional hazard model was fitted to explore the statistical association between active sitting position and characteristics of patients referred to physiotherapists, also accounting for the different multidisciplinary teams responsible for patients.284 individuals over 478 (59.4%) had access to physiotherapy, which was performed for a median of 8 days, without difference between multidisciplinary teams (P = 0.446). The active sitting position was reached after a median of 18 (IQR: 10.0-32.0) days. Sex was the only characteristic associated with the time to active sitting position, with males showing a reduced hazard by a factor of 0.65 (95% CI: 0.48-0.87; P = 0.0042) compared to females. At ICU discharge, nearly 50% individuals increased Manchester Mobility Score by 3 points. During physiotherapy no major adverse event was recorded.Individuals with COVID-19 take long time to reach active sitting position in ICU, with males requiring longer rehabilitation than females.

Introduction: Smell and taste loss are characteristic symptoms of SARS-CoV-2 infection. The aim of this study is to investigate the prevalence and risk factors associated with olfactory and gustatory dysfunctions in coronavirus disease (COVID-19) patients. Methods: We conducted an observational, retrospective study on 376 patients with documented SARS-CoV-2 infection admitted to the San Gerardo Hospital in Monza, Italy, from March to July 2020. All patients answered a phone questionnaire providing information on age, sex, smoking status, and clinical characteristics. Adjusted odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were estimated through logistic regression models including relevant covariates. Results: The prevalence of olfactory and gustatory dysfunctions in COVID-19 patients was 33.5 and 35.6%, respectively. Olfactory dysfunctions were significantly directly associated with current smoking and history of allergy, the multivariable ORs being 6.53 (95% CI 1.16–36.86) for current smokers versus never smokers, and 1.89 (95% CI 1.05–3.39) for those with an allergy compared to those without any allergy. Respiratory allergy in particular was significantly associated with olfactory dysfunctions (multivariable OR 2.30, 95% CI 1.02–5.17). Significant inverse associations were observed for patients aged 60 years or more (multivariable OR 0.33, 95% CI 0.19–0.57) and hospitalization (multivariable OR 0.22, 95% CI 0.06–0.89). Considering gustatory dysfunctions, after allowance of other variables a significant direct association was found for respiratory allergies (OR 2.24, 95% CI 1.03–4.86), and an inverse association was found only for hospitalization (OR 0.21, 95% CI 0.06–0.76). Conclusion: Our study indicates that current smoking and history of allergy (particularly respiratory) significantly increase the risk for smell loss in COVID-19 patients; the latter is also significantly associated to taste loss. Hospitalization has an inverse association with the risk of olfactory and gustatory dysfunctions, suggesting that these may be symptoms characteristics of less severe SARS-CoV-2 infection.

We produced a new suite of sea-level data which allowed assessing the Holocene evolution of the Bonifacio Strait, a key coastal sector of the Mediterranean Sea which experienced significant morphological changes since the Last Glacial Maximum. Squeezed between Corsica and Sardinia islands, this strait connects the two major basins of the western Mediterranean. Due to its peculiar geographic and morphological setting, the Bonifacio Strait is affected by extreme meteomarine conditions characterized by severe winds, waves, and currents. The millennial sea-level changes were reconstructed through multiproxy investigations made of sediment coring and underwater beachrock sampling carried out on both sides of the strait. These data provided fresh insights into the timing of the progressive opening of the Bonifacio Strait which followed the Last Glacial Maximum when Corsica and Sardinia were connected forming the largest Mediterranean island. Major palaeogeographic changes occurred before ~7 ka BP. Since that period, the significant decrease of the northern ice-sheet melting triggered a significant sea-level stabilization which induced only minor modifications in the palaeogeography of the strait. In the late Holocene, the isostatic-related subsidence became the dominant factor controlling the sea-level changes which rose with rates ≤0.35 mm a−1 in the last four millennia. Our data have also an important archaeological implication because they indicate that the Bonifacio Strait has not represented a significant geographical barrier along the early Neolithic migration path which connected mainland Italy to northern Corsica and finally to Sardinia. This further confirms the ability of early Neolithic communities to navigate not also across large sea stretches but also maritime areas characterized by extremely complex meteomarine conditions.

Background The usefulness of digital chest drain is still discussed. We are carrying out a study to determine if the use of a digital system compared with a traditional system reduces the duration of chest drainage. To evaluate safety, benefit, or futility of this trial we planned the current interim analysis. Methods An interim analysis on preliminary data from ongoing investigator-initiated, multicenter, interventional, prospective randomized trial. Original protocol number: (NCT03536130). The interim main endpoint was overall complications; secondary endpoints were the concordance between the two primary endpoints of the RCT (chest tube duration and length of hospital stay). We planned the interim analysis when half of the patients have been randomised and completed the study. Data were described using mean and standard deviation or absolute frequencies and percentage. T-test for unpaired samples, Chi-square test, Poisson regression and absolute standardized mean difference (ASMD) were used. P-value

Direct observations from the geologic record are commonly used in conjunction with indirect seismo-stratigraphic inferences to detail environmental settings and stratal architecture of sedimentary successions. However, examples of integration between seismic facies and macrobenthic insights are scarce and limited to the use of such a group as auxiliary to other proxies. This case study investigated mollusc and ostracod dynamics along an onshore-offshore profile that intersects the C2 clinothem (15.6 – 14.4 ky BP) of the Po River Lowstand Wedge (PRLW) and the overlying transgressive deposits formed in the central Adriatic Sea. Multivariate analyses were applied to benthic data to assess to what extent mollusc and ostracod assemblages can improve the resolution of seismic-derived depositional environments and stratigraphic architecture of cored succession. Along the profile of the C2 clinothem, seismic reflection facies correspond with three sedimentary environments. Specifically, i) High Amplitude Continuous reflections (HAC) are interpreted as delta plain/subaqueous shelf; ii) High Amplitude Continuous Wavy Dipping reflections (HACWDip) characterize prodelta deposits, and iii) Low Amplitude Continuous reflections (LAC) are associated with distal basin settings. The integration of quantitative palaeoecologic trends with the seismic-derived depositional environments allowed the subdivision of the HAC facies into a proximal (core LSD-26) and a distal (cores LSD-27 and -28) area. In particular, the proximal area with HAC seismic facies encompasses semi-barred lower delta plain with vegetated substrates that evolves to more open, nearshore settings. Conversely, the distal area with HAC seismic facies is distinguished by clusters reminiscent of ecological mixing due to strong bioturbation and gravity flows in offshore transition/inner shelf settings. The paucity of benthic fauna for the units with HACWDip (core LSD-05) and LAC (core LSD-04) seismic facies, hampered a complete reconstruction of the palaeoenvironmental dynamics. However, both benthic groups investigated support the seismic-derived interpretation of shelf and basinal settings respectively, both subjected to high sedimentation rates. Moreover, the integration of mollusc and ostracod multivariate-derived trends with grain-size data across the study profile reveals distinctive stratal stacking patterns useful in constraining the position of key stratigraphic surfaces such as the Maximum Regressive Surface that marks the initial phase of the abandonment of the PRLW.

The Lake Moo plain has a surface area about 0.15Km2. It is located near the boundary between Emilia-Romagna and Liguria regions, at an altitude of 1130m a.s.l. (northern Apennines, Italy). This site is strategic to the dominant atmospheric currents, very prone to high intensity precipitation events (HIP) and related high-density flood. Indeed, Lake Moo area has been partially covered by a flood deposit released by a record-breaking rainfall intensity in September 2015. The intensity and wide spatial scale of those phenomena has leads us to investigate their frequency in the past, beyond the instrumental time. The lacustrine succession (ca. 13 m-thick) was studied through the extraction of one core and framed within sedimentary facies analysis approach. The paleoenvironmental interpretation of the succession was achieved combining sedimentological, pollen and pedological data and radiocarbon dating. Thirteen different facies types have been identified and the core succession is was subdivided into five informal units. The different coarse-grained layers interbedded with organic-rich silty clays and peaty layers have been interpreted as the extreme flood deposits triggered by high-intensity convective rainfall events in the catchment area that flow into the Lake Moo plain.These coarse-grained deposits were grouped according to the genetic approach and therefore based on facies tract concept. The goal of this study is how the facies tract approach may represent a novel method that can be used to improve our understanding of flood reconstruction dynamics and may be applied to other similar deposits. We interpret the local lacustrine succession is like to the infill of a structural depression produced by gravitational block sliding that was induced by post-glacial fluvial incision.Finally, the observed depositional cycles were put in relation with other specific paleoclimatic proxies available in literature for the area.

Respiratory physiotherapy in patients with COVID-19 infection in acute setting: a Position Paper of the Italian Association of Respiratory Physiotherapists (ARIR) On February 2020, Italy, especially the northern regions, was hit by an epidemic of the new SARS-Cov-2 coronavirus that spread from China between December 2019 and January 2020. The entire healthcare system had to respond promptly in a very short time to an exponential growth of the number of subjects affected by COVID-19 (Coronavirus disease 2019) with the need of semi-intensive and intensive care units.

Despite the growing employment of Remote Sensing (RS) techniques in paleoenvironmental studies, the stratigraphic interpretation of RS-derived paleodrainage traces is still an open issue, as their relation to subsurface is largely unexplored. Here we applied a multi-data analysis approach, including publicly available optical images from different satellites (Landsat, ASTER, Sentinel, Hyperion), LiDAR-derived Digital Terrain Model (DTM), soil reflectance spectra and facies core data, which succeeded in revealing a paleodrainage system buried beneath a 200-sq km wide wetland (the Mezzano Lowland-ML) of the Po coastal plain (northern Adriatic Sea, Italy). Data integration in a GIS environment allowed the 3D mapping of numerous and temporally persistent meandering traces. From distal to proximal locations, the RS-derived traces show a hierarchical organization, in terms of sinuosity and width, and form a dense and dendritic pattern typical of a tidally-influenced system. Surface and subsurface cross-investigation of two meandering traces through soil reflectance spectra and core stratigraphy reveal that these landforms represent the surface expression of buried channels that eroded the underlying lagoonal succession, with lateral transition to intertidal deposits. LiDAR-detected micro-morphologies related to paleomeanders evolution strongly influenced the spatial distribution of mid-late Holocene peat-bearing lithofacies (i.e., salt marsh and swamp), and hence soil moisture distribution, inducing the sharp radiance contrasts (traces) detected by satellite sensors on the surface. On-trace areas invariably lack peat deposits and record the top of 3–4 m-thick channel-fill sands, some 2–4 m below the ground level. In contrast, out-of-trace areas are characterized by organic-rich soils that cap a 2.5–3.5 m-thick succession of intertidal-supratidal peat deposits, accumulated in depressed areas lateral to the channel-levee complex. We conclude that in the early stage of Po Delta construction, between ca. 6000–2500 cal yr BP, two distinct tidal-influenced drainage networks fed the Mezzano Lowland lagoon under a predominantly autogenic control. These findings indicate the suitability of a low-cost RS-stratigraphic approach to improve the reconstruction of past paleogeographic scenarios buried beneath deltaic lowlands, shedding new light on the evolution trends of coastal landforms, environments and sedimentary patterns under highstand conditions.

To better explore the potential of Holocene subaqueous deltas as sedimentary archives, we quantitatively examined the benthic foraminiferal content of the muddy wedges belonging to three major Western Mediterranean deltas: Po Delta (N Adriatic Sea), Arno Delta (Ligurian Sea) and Rhone Delta (Gulf of Lions). The application of multivariate analyses (R-mode cluster, nMDS) on a regional dataset allowed defining six Mediterranean assemblages of taxa whose distribution, through time and space, is guided by the distance from the feeding mouths and by the balance of power between river and sea processes at the sea floor. At each site, the stratigraphic distribution of multivariate faunal data efficiently tracks the main changes in riverine fluxes and hydrodynamic levels, leading to a robust evaluation of (dis-)similarities in delta growth patterns. The dominant role of fluvial processes invariably emerges from the Po record, pointing to a river-dominated regime; whereas the foraminiferal fauna in the Arno and Rhone deltas indicates a wave-dominated regime with an intense redistribution of the river load by wind-driven currents throughout the Holocene. The distribution patterns of benthic foraminiferal assemblages in the multivariate space allow the identification of six biofacies, reflecting specific subaqueous environments that typify the Mediterranean shelves under different delta regimes: i) inner shelf; ii) deep-water mud belt; iii) shallow-water mud belt; iv) distal, river-dominated prodelta; v) distal, wave-dominated prodelta and vi) proximal prodelta. These biofacies can be a useful palaeoenvironmental tool for the interpretation of ancient, shallow-marine muddy successions belonging to the western Mediterranean stratigraphic record. The stratigraphic-based multivariate approach applied in this work can strongly support the analysis of subaqueous delta successions, developed even under different delta regimes and difficult to unravel from sedimentological features alone.

The mid-late Holocene subsurface succession of the Po River plain records complex delta outbuilding under a predominantly autogenic control during the sea-level high stand phase. Chronologically constrained phases of the Po Delta evolution represent a solid base to test the response of microfossils to short time-scale delta dynamics. Benthic foraminifers and ostracods from the 21m-thick shallow-marine succession of core EM13 were quantitatively analysed and statistically compared to modern North Adriatic meiofaunal assemblages, in order to assess the main palaeoecological factors that controlled the composition of assemblages, and compare the palaeoenvironmental resolution provided by these two benthic groups. Benthic foraminifers from the lowermost shallow-marine succession indicate the transition from inner shelf to coastal conditions, marked by the gradual increase in Ammonia tepida and Ammonia parkinsoniana. Ostracods from the same stratigraphic interval are comparable to those nowadays recorded in shallow-marine settings affected by relatively low river flows. Chronologically in accordance with the development of cuspate deltas during the Roman Age, benthic foraminifers record the approach to coastal environments, subject to low fluvial inputs as evidenced by ostracods. The overlying deposits with high frequencies (ca. 50%) of A. tepida and A. parkinsoniana suggest the transition to a proximal prodelta, as confirmed by the similarity with modern assemblages at shallow depths, few km far from the river mouths. Upwards, the overwhelming dominance of the same taxa is indicative of extreme vicinity to river mouths. Within the same stratigraphic portion, ostracods indicate conditions similar to those nowadays present along the mid-Adriatic Italian coast, where the dominant action of longshore current distributes river-supplied material enriched in organic matter. Following one of the main avulsion events in the Po Delta history (XII century), the transition from wave- to fluvially dominated deltaic systems is marked by a great change in ostracod assemblages. Therefore, distinct palaeoecological information are provided by each fossil group: benthic foraminifers give indications about the distance from river mouths, whereas the dominant depositional regime is suggested by ostracods. Benthic foraminifers and ostracods are excellent palaeoenvironmental indicators in river-influenced shelves, but refined sub-environmental characterization can be achieved with their combined application only.

Un-fragmented stratigraphic records of late Quaternary multiple incised valley systems are rarely preserved in the subsurface of alluvial-delta plains due to older valley reoccupation. The identification of a well-preserved incised valley fill succession beneath the southern interfluve of the Last Glacial Maximum Arno palaeovalley (northern Italy) represents an exceptional opportunity to examine in detail evolutionary trends of a Mediterranean system over multiple glacial–interglacial cycles. Through sedimentological and quantitative meiofauna (benthic foraminifera and ostracods) analyses of two reference cores (80 m and 100 m long) and stratigraphic correlations, a mid-Pleistocene palaeovalley, 5 km wide and 50 m deep, was reconstructed. Whereas valley filling is chronologically constrained to the penultimate interglacial (Marine Isotope Stage 7) by four electron spin resonance ages on bivalve shells (Cerastoderma glaucum), its incision is tentatively correlated with the Marine Isotope Stage 8 sea-level fall. Above basal fluvial-channel gravels, the incised valley fill is formed by a mud-prone succession, up to 44 m thick, formed by a lower floodplain unit and an upper unit with brackish meiofauna that reflects the development of a wave-dominated estuary. Subtle meiofauna changes towards less confined conditions record two marine flooding episodes, chronologically linked to the internal Marine Isotope Stage 7 climate-eustatic variability. After the maximum transgressive phase, recorded by coastal sands, the interfluves were flooded around 200 ka (latest Marine Isotope Stage 7). The subsequent shift in river incision patterns, possibly driven by neotectonic activity, prevented valley reoccupation guiding the northward formation of the Last Glacial Maximum palaeovalley. The applied multivariate approach allowed the sedimentological characterization of the Marine Isotope Stage 7 and Marine Isotope Stage 1 palaeovalley fills, including shape, size and facies architecture, which revealed a consistent river-coastal system response over two non-consecutive glacial–interglacial cycles (Marine Isotope Stages 8 to 7 and Marine Isotope Stages 2 to 1). The recurring stacking pattern of facies documents a predominant control exerted on stratigraphy by Milankovitch and sub-Milankovitch glacio-eustatic oscillations across the late Quaternary period.

To understand the complex stratigraphic response of a coastal depositional system to rapid eustatic rise and sediment inputs, the evolution of the Adriatic coastline and Po River system, during the post-glacial (Holocene) transgression, was investigated. The landward migration and evolution of a wave-dominated estuary was mapped, based on an extensive data set comprising 14 boreholes, 28 core descriptions and 308 piezocone tests, chronologically constrained between 11·5 and 7·0Âkyr bp by 137 radiocarbon dates. Palaeogeographic maps reveal temporal differences in retrogradational geometries and mechanisms that likely underpin shoreline retreat. The Po estuary initially developed within a shallowly incised valley and then spread onto the interfluves. Between 11·5 and 9·2Âkyr bp the Po fluvial system became avulsive/distributive and wetlands developed in topographically depressed areas. The shoreline retreated at a mean rate of ca 10ÂmÂyear−1, between 9·2Âkyr and 7·7Âkyr bp, following a stepped trajectory at the centennial scale. After 7·7Âkyr bp, bayhead deltas started to prograde and partially filled the estuary. The overall stratigraphic architecture is interpreted to reflect the sedimentary response of the coastal depositional system to the main pulses of early Holocene eustatic rise. The influence of antecedent topography, partly due to local subsidence, was dominant at the time of initial transgression. Basin morphology influenced sediment dispersal and partitioning. Sediment supplied by the Po River was trapped within the estuary, whereas coastal sand bodies at the estuary mouth were fed by alongshore currents and by reworking of older barriers. High-resolution age control that ties facies evolution to independently constrained eustasy provides direct data to test models of short-term coastal retreat under conditions of relative sea-level rise, and makes this case study a useful analogue for the interpretation of ancient marginal-marine, retrogradational systems where only stratal geometries are available.

The type, thickness, and volume of anthropogenic deposits buried beneath long-settled cities are good indicators of the human impact on urban environments and topography. Pisa is a multilayered city settled since Etruscan times in the lower Arno Plain. Stratigraphic and geomorphologic data from the urban subsurface show that Pisa today is located on a mound (ca. 4 m high) made up dominantly of anthropogenic deposits. Two types of anthropogenic facies are distinguished: human-modified deposits of Etruscan Age and made-ground deposits dated since the Roman Age onward. Integrating subsurface stratigraphy with ancient ground-level topography, we reconstruct the evolutionary phases of the Pisa urban landscape subject to a dominant human influence. Urbanization processes started in Etruscan times, as testified by the lower boundary of the anthropogenic succession (Pisa archaeosphere). The formation and the highest increase in elevation of the Pisa mound, which is still growing, occurred during the Roman and the Middle Ages. At the same time, the urban fabric moved southward, toward the Arno River, and a thick anthropogenic succession accumulated in the city sector where an ancient ring of walls had been hypothesized. However, the highest acceleration in the urban ground growth rate is recorded since A.D. 1950 onward, corresponding to the Anthropocene “Great Acceleration.”.

Several record-breaking precipitation events have stricken the mountainous area of Emilia-Romagna Region (northern Apennines, Italy) over the last years. As consequence, several geomorphological processes, like widespread debris flows along the slopes and hyperconcentrated flood in the stream channels, shallow landslides and overbank flooding affected the territory, causing serious damages to man-made structures. The intensity and wide spatial scale of these phenomena leads us to investigate their frequency in the past, beyond the instrumental time. A detailed study of these recent deposits compared with fossil peat bog and lake paleodeposits can provide useful insight to support a strong match between precipitation intensity and warm climatic phases in antecedent climatic periods, as expected by the increase air water vapour holding capacity at higher temperatures. Here we present the results of the field campaign performed in summer 2017 at Lake Moo a 0.15 km2 peat bog located at an altitude of 1130 m a.s.l. The chosen area has been affected, during the flooding of the upper Trebbia and Nure valleys 13–14 September 2015, by several high-density flows generated by the stream that flow into the plain. Our main assumption is that, in such a small drainage basin (area 2), with favourable geologic and geomorphic characteristics implying advantageous sediment transfer into lake, high density flood can be triggered only by high intensity precipitation events (HIP) lasting enough time for water to infiltrate and mobilize large quantities of debris. The sedimentary succession (ca. 13 m-thick) was studied through the extraction of two cores and one trench. The facies/paleoenvironmental interpretation of the sedimentary succession, characterized by clusters of coarse-grained alluvial deposits interbedded with organic-rich silty clays and peaty layers, was achieved combining sedimentological and pollen data with pedological data and radiocarbon dating (AMS 14C). Observed depositional cycles were put in relation with other specific paleoclimatic proxies available in literature for the North-Apennine area. This comparison illustrates that the increase of extreme paleoflood (associated with coarse-grained deposits similar to the ones observed recently) correlates well with warm phases with a maximum activity during the Holocene thermal maximum and from the small ice age to the present day.

A multi-proxy investigation of sediment cores has enabled us to reconstruct the coastal environmental evolution of East-Central Corsica (the sites of Saint Florent, Piantarella-Bonifacio and Palo-Solenzara) for the last 8000 years. The analytical methods comprise pollen (five original pollen diagrams), weight loss-on-ignition measurements, laser granulometry, and ostracod identification. In addition, 26 radiocarbon dates are used to provide a robust chronostratigraphy for the sedimentary sequences. The assessment of coastal landscape dynamics enables us to define the major morphological changes and to evaluate the complex interplay between climatic forcing and anthropogenic activity on the vegetation history of Corsica, within an archaeological context, since the early Neolithic period (∼7.4 cal kyr BP). The major findings are that the first farmers reached Corsica by sea, and they encountered a coastal environment mainly composed of freshwater ponds located close to the shoreline. This specific paleoenvironmental feature offered a favourable location for agriculture and for the development of permanent settlements where a subsistence economy was developed. Since the Middle Holocene, postglacial sea-level rise has caused major changes in local coastal environments, often characterized by salt intrusion into freshwater bodies. At the transition between the Mid and Late Holocene (∼4.0 cal kyr BP), an increase in both salinity and aridity caused substantial landscape changes, mainly characterized by a further expansion of saline marshland, mainly occupied by Chenopodiaceae. The results also provide new insights into the role of Erica in the original Holocene vegetation of Corsica. Our data clearly indicate that an Erica arborea - Quercus ilex forest transition occurred before 6.3 cal kyr BP, significantly earlier than previously proposed. Finally, the earliest evidence of cereal cultivation is at ∼7350 cal kyr BP, and in addition we are better able to constrain the role of humans in the landscape dynamics of Corsica since the early Neolithic., JR is member of the research group GAPS (2017 SGR 836) and acknowledges postdoctoral fellowship support from the Spanish “Juan de la Cierva (FJC2017)” program (MICINN, Spain). This article is a contribution of the PCR “Approche géoarchéologique des paysages de Corse à l’Holocène, entre mer et intérieur des terres « Trà Mare è Monti »and “Bouches de Bonifacio” research programmes, funded by the DRAC Corsica and directed by Matthieu Ghilardi and Gaël Brkojewitsch, respectively. It is also part of the MISTRALS-PALEOMEX programme of CNRS (INEE-INSU scientific departments) and was funded by the ARCHEOMED workshop (Dir. Laurent Lespez). MV is funded by the Italian Ministry of Research (MIUR) through the Rita Levi Montalcini grant 2019–2021. AC is funded by the Galician Innovation Agency (GAIN) research grant. This study is a contribution to the MOPP-Medflood (INQUA CMP 1603P).

Although general trends in transgressive to highstand sedimentary evolution of river-mouth coastlines are well-known, the details of the turnaround from retrogradational (typically estuarine) to aggradational–progradational (typically coastal/deltaic) stacking patterns are not fully resolved. This paper examines the middle to late Holocene eustatic highstand succession of the Po Delta: its stratigraphic architecture records a complex pattern of delta outbuilding and coastal progradation that followed eustatic stabilization, since around 7·7calkyrbp. Sedimentological, palaeoecological (benthic foraminifera, ostracods and molluscs) and compositional criteria were used to characterize depositional conditions and sediment-dispersal pathways within a radiocarbon-dated chronological framework. A three-stage progradation history was reconstructed. First, as soon as eustasy stabilized (7·7 to 7·0calkyrbp), rapid bay-head delta progradation (ca 5myear−1), fed mostly by the Po River, took place in a mixed, freshwater and brackish estuarine environment. Second, a dominantly aggradational parasequence set of beach-barrier deposits in the lower highstand systems tract (7·0 to 2·0calkyrbp) records the development of a shallow, wave-dominated coastal system fed alongshore, with elongated, modestly crescent beaches (ca 2·5myear−1). Third, in the last 2000years, the development of faster accreting and more rapidly prograding (up to ca 15myear−1) Po delta lobes occurred into 30m deep waters (upper highstand systems tract). This study documents the close correspondence of sediment character with stratal distribution patterns within the highstand systems tract. Remarkable changes in sediment characteristics, palaeoenvironments and direction of sediment transport occur across a surface named the ‘A–P surface’. This surface demarcates a major shift from dominantly aggradational (lower highstand systems tract) to fully progradational (upper highstand systems tract) parasequence stacking. In the Po system, this surface also reflects evolution from a wave-dominated to river-dominated deltaic system. Identifying the A–P surface through detailed palaeoecological and compositional data can help guide interpretation of highstand systems tracts in the rock record, especially where facies assemblages and their characteristic geometries are difficult to discern from physical sedimentary structures alone.