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Background: To control the presence of Legionella in an old hospital water system, an integrated strategy of water disinfection-filtration was implemented in the university hospital Umberto I in Rome. Methods: Due to antiquated buildings, hospital water system design and hospital extension (38 buildings), shock hyperchlorination (sodium hypochlorite, 20–50 ppm of free chlorine at distal points for 1–2 h) followed by continuous hyperchlorination (0.5-1.0 mg/L at distal points) were adopted, and microbiological and chemical monitoring of the water supply was carried out in the university hospital (December 2006-December 2011). Results: Overall, 1308 samples of cold <20°C (44.5%), mixed ≥20°C ≤ 45°C (37.7%) and hot >45°C (17.8%) water were collected, determining residual free chlorine (0.43 ± 0.44 mg/L), pH (7.43 ± 0.29) and trihalomethanes (8.97 ± 18.56 μg/L). Legionella was isolated in 102 (9.8%) out of 1.041 water samples without filters (L. pneumophila sg 1 17.6%, L. pneumophila sg 2–14 28.4%, L. non pneumophila 53.9%), and in none of the 267 samples with filters. Legionella was recovered in 23 buildings out of 38 and 29 samples (28.4%) exceeded 103 cfu/L. When considering the disinfection treatment Legionella was isolated: before shock hyperchlorination (21.1%), 15 days after shock hyperchlorination (7.8%), 30 days after shock hyperchlorination (3.5%), during continuous hyperchlorination (5.5%) and without continuous hyperchlorination (27.3%). Continuous hyperchlorination following the shock treatment achieved >70% reduction of positive samples, whereas no continuous hyperchlorination after shock treatment was more frequently associated to Legionella isolation (OR 6.41; 95% CI 3.10–13.26; p <0.001). Independent risk factors for Legionella isolation were: residual free chlorine <0.5 mg/L (OR 13.0; 95% CI 1.37 – 123.2; p <0.03), water T° ≥20°C ≤ 45°C (OR 12.0; 95% CI 1.28 – 111.48; p <0.03) and no continuous hyperchlorination after shock treatment (OR 10.3; 95% CI 1.06 – 100.05; p <0.05). Conclusions: Shock and continuous hyperchlorination achieved significant Legionella reduction, but effective chlorine levels (>0.5 < 1.0 mg/L) deteriorated water quality (organoleptic and chemical). However, shock and continuous hyperchlorination remains a valid-term option in old buildings with no water system rational design, managing problems due to hospital extension and absence of a proper hot water recirculation system. [ABSTRACT FROM AUTHOR]

Adhesive capsulitis is a condition "difficult to define, difficult to treat and difficult to explain from the point of view of pathology". This Codman's assertion is still actual because of a variable nomenclature, an inconsistent reporting of disease staging and many types of treatment. There is no consensus on how the best way best to manage patients with this condition, so we want to provide an evidence-based overview regarding the effectiveness of conservative and surgical interventions to treat adhesive capsulitis. [ABSTRACT FROM AUTHOR]

The Campi Flegrei caldera is a restless structure affected by general subsidence and ongoing resurgence of its central part. The persistent activity of the system and the explosive character of the volcanism lead to a very high volcanic hazard that, combined with intense urbanization, corresponds to a very high volcanic risk. One of the largest sources of uncertainty in volcanic hazard/risk assessment for Campi Flegrei is the spatial location of the future volcanic activity. This paper presents and discusses a long-term probability hazard map for vent opening in case of renewal of volcanism at the Campi Flegrei caldera, which shows the spatial conditional probability for the next vent opening, given that an eruption occurs. The map has been constructed by building a Bayesian inference scheme merging prior information and past data. The method allows both aleatory and epistemic uncertainties to be evaluated. The probability map of vent opening shows that two areas of relatively high probability are present within the active portion of the caldera, with a probability approximately doubled with respect to the rest of the caldera. The map has an immediate use in evaluating the areas of the caldera prone to the highest volcanic hazard. Furthermore, it represents an important ingredient in addressing the more general problem of quantitative volcanic hazards assessment at the Campi Flegrei caldera. [ABSTRACT FROM AUTHOR]

Abstract: The Campi Flegrei caldera is an active and restless volcano in the densely inhabited Neapolitan area of southern Italy. Because of the very high value (lives, properties, infrastructures, etc.) exposed to potential volcanic hazards, it is one of the areas at highest volcanic risk on Earth. In such a situation we have made an attempt to contribute to assessment of its volcanic hazards by providing a quantitative probabilistic long-term forecast of style and size of the next eruption. We have evaluated the most relevant physical parameters of the 22 explosive eruptions of the Campi Flegrei caldera over the past 5ka. This time span has been taken as the reference period for volcanic hazards assessment on the basis of the volcanic and deformation history of the caldera. The evaluated parameters include dispersal, volume and density of the pyroclastic deposits, volume of erupted magma, total erupted mass, and eruption magnitude. The obtained results permit a size classification of the explosive eruptions, which are grouped into three sizes: small, medium, and large. On the basis of the reconstructed eruption dynamics, we have considered a type event(s) representative of each size class and hypothesized the style of the next event. An effusive eruption will likely generate a dome or very small lava flows, while an explosive event of any size very probably will produce particles fallout and flowage of pyroclastic density currents. Using a Bayesian inference procedure, we have assigned a conditional probability of occurrence to each of the eruption size classes. A small-size explosive eruption is the most likely event with a probability of about 60%; a large-size explosive eruption is the least likely event with a probability of about 4%; a medium-size explosive eruption has a probability of occurrence of about 25%; an effusive eruption has about 11% probability of occurrence. [Copyright &y& Elsevier]

Nine patients developed P. aeruginosa bloodstream infection (BSI) in a neurosurgical intensive care unit (NSICU) during a 2-month period. Environmental strains were isolated from a plasma-expander solution and tap water. All clinical and plasma-expander strains displayed the same PFGE pattern, whereas the water strains were unrelated to the outbreak. [ABSTRACT FROM AUTHOR]

The Neapolitan Yellow Tuff (NYT) is the product of the largest known trachytic phreatoplinian eruption. It covered an area larger than 1000 km2 with an estimated volume of about 40 km3 of erupted magma. During the course of the eruption a caldera collapsed within the previously formed Campanian Ignimbrite caldera. The resulting nested structure strongly influenced the following volcanic activity in the Campi Flegrei caldera. As previous dating of the NYT does not converge toward a unique result, a new set of 40Ar/39Ar age determinations has been carried out to better constrain the age of the eruption. Two variants of the 40Ar/39Ar dating method were applied to determine the age of the NYT eruption: (1) single-crystal total fusion (SCTF), on an individual phenocryst of feldspar, and (2) laser incremental heating (LIH), on bulk aliquots of feldspar phenocrysts. The results of the SCTF analyses show that the overall sample weighted mean age, derived from the conventional age calculation, is 15.6±0.8 ka. A weighted mean of the isochron age is 15.3±1.2 ka (2σ), and has been assumed as the best indicator of age to be derived from the SCTF analyses. The LIH analyses results show that plateau ages vary from 15.4±0.5 to 14.5±0.5 ka. The overall weighted mean age of the isochron results is 14.9±0.4 ka (2σ). This result has been assumed as the reference age for the NYT eruption, and agrees with the SCTF age. The new age obtained for the NYT deposits is of great relevance for the understanding of the evolution and the present state of the Campi Flegrei caldera and collocates the NYT in a crucial stratigraphical position to date the climatic oscillations that occurred between the Late Glacial and the Holocene. [Copyright &y& Elsevier]

Sleep quality significantly impacts individuals' overall health, especially in older adults. Older adults often face comorbid conditions, polypharmacy (the intake of five or more medications per day), and medication non-adherence, which are common among those with sleep disorders. The purpose of this systematic review is to examine the relationship between sleep quality and medication adherence in older adults and to describe the measuring instruments used. A systematic review was performed following the PRISMA guidelines. The PubMed, Scopus, Cochrane Library, and CINAHL databases were screened from January 2024 to March 2024. Nine articles were included in the final synthesis based on the inclusion and exclusion criteria. The review found that poor sleep quality is significantly associated with reduced medication adherence in older adults. The key sleep determinants linked to medication non-adherence include sleep disorders, sleep efficiency, sleep duration, and daytime dysfunctions. Inappropriate medication prescriptions have been associated with reduced sleep efficiency. The tools for assessing sleep quality and medication adherence are predominantly subjective and varied. To address these challenges, a comprehensive geriatric assessment should include investigations into sleep disorders and comorbidity factors. Additionally, nursing educational interventions could be pivotal in improving medication adherence among older adults. [ABSTRACT FROM AUTHOR]

For active volcanoes, knowledge of the architecture of the plumbing system and the conditions of magma storage prior to an eruption are highly important, given their influence on the eruptive style and, thus, the management of future volcanic crises. Here, chlorine is used as a geobarometer for potassic alkaline magmas at the Campi Flegrei volcanic complex, revealing the shallowest depth of fluid-melt equilibration with respect to Cl. The results for representative fallout deposits of selected explosive eruptions show the existence of a multi-depth equilibration zone through time, including shallow magma storage. We describe evidence for the shallowest zone located at a depth equivalent to 65 MPa for the Agnano Monte Spina eruption (4482–4625 cal. yrs BP), at ~100 MPa for the Pomici Principali (11 915–12 158 cal. yrs BP), and the Astroni 6 (4098–4297 cal. yrs BP) eruptions, and close to 115 MPa for the last explosive eruption of Monte Nuovo (AD 1538). For comparison, the pressure estimated for a possible reservoir feeding the Cretaio eruption of Ischia island (AD 430), the only studied eruption on Ischia, is ~140 MPa. The pressure estimates for the two largest magnitude eruptions, the Campanian Ignimbrite (40 ka) and the Neapolitan Yellow Tuff (14.9 ka), are also discussed with respect to available magma withdrawal models. The pressures estimated using the Cl geobarometer for the magma leading to the fallout phases of these two eruptions provide evidence for a low-volume, shallow domain (~40 MPa) for the Plinian phase of the Campanian Ignimbrite eruption and a main, deeper reservoir (~130–165 MPa) for the Neapolitan Yellow Tuff eruption. The inferred shallowest equilibration pressures are interpreted here as corresponding to transitory, short-lived magma apophyses, whose eruption may have been facilitated by optimum tectonic stresses, rheological behavior of the crust, and efficiency of volatile exsolution. Alternatively, these magma apophyses may represent an evolved, crystal-rich ponded magma into which a volatile-rich magma ascending from depth was injected. The transient nature of such very shallow reservoirs is suggested by the short timescales inferred from diffusion modeling on crystals available in the literature for the studied Campi Flegrei eruptions. The influence of sulfur (S) on Cl solubility is assessed through Cl solubility modeling and applied to different eruptions. In addition, the pressure at which magmatic fluids and melts equilibrated with respect to Cl is shallower for the Campi Flegrei volcanic complex than the Somma-Vesuvio volcanic complex, erupting more homogeneous differentiated magma, of trachytic or phonolitic composition. This approach of using Cl to investigate the architecture of the plumbing system can be extended to all alkali-rich magma systems. [ABSTRACT FROM AUTHOR]

Ischia, a volcanic island located 18 miles SW of Naples (Southern Italy), is a densely populated active caldera that last erupted in ad 1302. Melt inclusions in phenocrysts of the Vateliero and Cava Nocelle shoshonite–latite eruptive products (6th to 4th centuries bc) constrain the structure and nature of the Ischia deep magmatic feeding system. Their geochemical characteristics make Ischia a natural borehole for probing the physico-chemical conditions of magma generation in mantle contaminated by slab-derived fluids or melts, largely dominated by CO2. Volatile concentrations in olivine-hosted melt inclusions require gas–melt equilibria at between 3 and 18 km depth. In agreement with what has already been demonstrated at the other neighboring Neapolitan volcanoes (Procida, Campi Flegrei caldera and Somma–Vesuvius volcanic complex), a major crystallization depth at 8–10 km has been identified. The analyzed melt inclusions provide clear evidence for CO2-dominated gas fluxing and consequent dehydration of magma batches stagnating at crustal discontinuities. Gas fluxing is further supported by selective enrichment in K owing to fluid-transfer during magma differentiation. This takes place under oxidized conditions (Fe3+/ΣFe &geq; 0·3) that can be fixed by an equimolar proportion of divalent and trivalent iron in the melt if post-entrapment crystallization of the host olivine is discarded. The melt inclusion data, together with data from the literature for other Neapolitan volcanoes, show that magmatism and volcanism in the Neapolitan area, despite differences in composition and eruption dynamics, are closely linked to supercritical CO2-rich fluids. These fluids are produced by devolatilization of subducting terrigenous–pelagic metasediments and infiltrate the overlying mantle wedge, generate magmas and control their ascent up to eruption. Geochemical characteristics of Ischia and the other Neapolitan volcanoes reveal that the extent of fluid or melt contamination of the pre-subduction asthenospheric mantle wedge was similar among these volcanoes. However, differences in the isotopic compositions of the erupted magmas (more enriched in radiogenic Sr at Ischia, Campi Flegrei and Somma–Vesuvius with respect to Procida) and the amount of H2O in the plumbing system of these volcanoes (almost double at Ischia, Campi Flegrei and Somma–Vesuvius than at Procida) reflect the different flow-rates of deep slab-derived fluids or melts through the mantle wedge, which, in turn, control the amount of generated magma. The high bulk permeability of the lithosphere below Ischia, Campi Flegrei and Somma–Vesuvius, determined by the occurrence of intersecting NW–SE and NE–SW regional fault systems, favours fluid ascent and accumulation at crustal levels, with consequent larger magma production and storage than at Procida, located along the NE–SW system. [ABSTRACT FROM AUTHOR]

Ischia is an active volcanic island in the Gulf of Naples whose history has been dominated by a caldera-forming eruption (ca. 55 ka) and resurgence phenomena that have affected the caldera floor and generated a net uplift of about 900 m since 33 ka. The results of new geomorphological, stratigraphical and textural investigations of the products of gravitational movements triggered by volcano-tectonic events have been combined with the information arising from a reinterpretation of historical chronicles on natural phenomena such as earthquakes, ground deformation, gravitational movements and volcanic eruptions. The combined interpretation of all these data shows that gravitational movements, coeval to volcanic activity and uplift events related to the long-lasting resurgence, have affected the highly fractured marginal portions of the most uplifted Mt. Epomeo blocks. Such movements, mostly occurring since 3 ka, include debris avalanches; large debris flows (lahars); smaller mass movements (rock falls, slumps, debris and rock slides, and small debris flows); and deep-seated gravitational slope deformation. The occurrence of submarine deposits linked with subaerial deposits of the most voluminous mass movements clearly shows that the debris avalanches impacted on the sea. The obtained results corroborate the hypothesis that the behaviour of the Ischia volcano is based on an intimate interplay among magmatism, resurgence dynamics, fault generation, seismicity, slope oversteepening and instability, and eruptions. They also highlight that volcano-tectonically triggered mass movements are a potentially hazardous phenomena that have to be taken into account in any attempt to assess volcanic and related hazards at Ischia. Furthermore, the largest mass movements could also flow into the sea, generating tsunami waves that could impact on the island's coast as well as on the neighbouring and densely inhabited coast of the Neapolitan area. [ABSTRACT FROM AUTHOR]

Abstract: The results of a detailed stratigraphic study, carried out in the areas located to the east and south-west of Mt. Epomeo at Ischia, are presented and compared with those of previous geological, archaeological and historical investigations to show the relationships among caldera resurgence, volcanism and slope instability in the past 5.5 ka. Resurgence at Ischia began at about 30 ka B.P. and occurred through intermittent uplifting and tectonic quietness phases. During the past 5.5 ka reactivation of faults and related volcanic activity was accompanied by emplacement of deposits generated by surface gravitational movements. These deposits were generated in four main phases, dated between 5.5 and 2.9 ka, around 2.9 ka, between 2.6 and 2.3 ka, and between 2.3 and 1.9 ka, respectively. Deposits formed by gravitational movements preceded and followed the emplacement of volcanic rocks, testifying that slope instability was induced by vertical movements, which also activated and/or reactivated faults and fractures that fed volcanism. The results of this study therefore suggest that, although slope failure can occur as a consequence of a variety of factors, resurgence has to be considered a factor inducing a particularly intense slope instability. Resurgence is accompanied by activation of faults and renewal of volcanism, causing oversteepening of the slopes and generating seismicity that could trigger surface gravitational movements. Furthermore, the availability of large amount of loose material, rapidly accumulated along the slopes during eruptions, favors landslide generation. [Copyright &y& Elsevier]

Background: On 9th January 2020, China CDC reported a novel coronavirus (later named SARS-CoV-2) as the causative agent of the coronavirus disease 2019 (COVID-19). Identifying the first appearance of virus is of epidemiological importance to tracking and mapping the spread of SARS-CoV-2 in a country. We therefore conducted a retrospective observational study to detect SARS-CoV-2 in oropharyngeal samples collected from hospitalized patients with a Severe Acute Respiratory Infection (SARI) enrolled in the DRIVE (Development of Robust and Innovative Vaccine Effectiveness) study in five Italian hospitals (CIRI-IT BIVE hospitals network) (1st November 2019 – 29th February 2020). Objectives: To acquire new information on the real trend in SARS-CoV-2 infection during pandemic phase I and to determine the possible early appearance of the virus in Italy. Materials and methods: Samples were tested for influenza [RT-PCR assay (A/H1N1, A/H3N2, B/Yam, B/Vic)] in accordance with the DRIVE study protocol. Subsequently, swabs underwent molecular testing for SARS-COV-2. [one-step real-time multiplex retro-transcription (RT) PCR]. Results: In the 1683 samples collected, no evidence of SARS-CoV-2 was found. Moreover, 28.3% (477/1683) of swabs were positive for influenza viruses, the majority being type A (358 vs 119 type B). A/H3N2 was predominant among influenza A viruses (55%); among influenza B viruses, B/Victoria was prevalent. The highest influenza incidence rate was reported in patients aged 0–17 years (40.3%) followed by those aged 18–64 years (24.4%) and ≥65 years (14.8%). Conclusions: In Italy, some studies have shown the early circulation of SARS-CoV-2 in northern regions, those most severely affected during phase I of the pandemic. In central and southern regions, by contrast no early circulation of the virus was registered. These results are in line with ours. These findings highlight the need to continue to carry out retrospective studies, in order to understand the epidemiology of the novel coronavirus, to better identify the clinical characteristics of COVID-19 in comparison with other acute respiratory illnesses (ARI), and to evaluate the real burden of COVID-19 on the healthcare system. [ABSTRACT FROM AUTHOR]

Major and trace element, Sr–Nd–Pb isotope and mineral chemical data are presented for mafic and felsic volcanic rocks from the island of Pantelleria. The mafic rocks, mostly basalts, range from hy-normative transitional basalts, through alkali basalts, to basanites. Clinopyroxene in the mafic rocks varies in composition from Al, Ti-poor diopside to Al, Ti-rich augite. These two populations can be present simultaneously in the same sample and even in the same crystal, suggesting polybaric fractionation in the pressure range 0–4 kbar, or mixing between basaltic magmas with different degrees of alkalinity. On the basis of their major and trace element and Sr–Nd–Pb isotope composition and age of eruption, two groups of basalts are distinguished: a high TiO2–P2O5 group, erupted before 50 ka BP, and a low TiO2–P2O5 group, erupted after 50 ka BP, separated by a caldera collapse. The felsic volcanic rocks have compositions ranging from comenditic trachyte to comendite and pantelleritic trachyte to pantellerite, with progressively increasing peralkalinity. The Sr–Nd isotope compositions of most of the felsic volcanic rocks are similar to those of the mafic volcanic rocks, except for some very Sr-poor pantellerites, which show post-depositional exchange with seawater strontium. On the basis of their petrographic and geochemical characteristics, Sr–Nd–Pb isotope data, computer modelling and geological observations, it is suggested that the mafic volcanic rocks represent a number of different alkaline parental magmas from which the felsic volcanic rocks were derived via prolonged, closed-system fractional crystallization. The source region for the parental magmas was heterogeneous, and may have involved at least two distinct geochemical components: a mid-ocean ridge basalt (MORB) source, relatively depleted component, and a HIMU-like enriched component. A further enriched component, similar to the Enriched Mantle 1 (EM 1) component, could also have been involved. According to geophysical data, the lithosphere is thinned beneath the island, and the asthenospheric mantle rises to a depth of 60 km. Rare earth element data require residual garnet in the source and constrain the melting process to a depth of 70–80 km. The petrological and geochemical data suggest that the mafic magmas are generated within the asthenospheric mantle, from a deep plume bringing the HIMU–EM 1 isotopic and trace element signatures. Interaction of these OIB-like magmas with the shallower asthenospheric mantle, providing a depleted MORB signature, gives rise to magmas with the observed isotopic and geochemical characteristics. [ABSTRACT FROM AUTHOR]

Abstract The late Pleistocene trachytic Campanian Ignimbrite (>300 km3 DRE, ca. 39 ka) covers the Campanian Plain (Italy) around Naples. It is found behind ridges >1000 m high at 80 km from the source in the Campi Flegrei caldera. This points towards very dilute currents, that together with the huge amount of discharged magmatic material, suggest a magma reservoir highly enriched in volatiles. The huge volume of magma that extruded during the Campanian Ignimbrite eruption differentiated and mixed at shallow depth (6–3 km), as shown by modelling of the petrologic and geochemical features of the erupted products together with melt inclusion-based studies of gas-melt saturation. With respect to compositionally similar but lower magnitude Phlegraean eruptions (e.g., Agnano-Monte Spina, >1 km3 DRE, ca. 4.6 ka), the large amount of volatiles discharged by Campanian Ignimbrite was likely due to fractional crystallization of the lowermost portion of its magmatic reservoir. Because of the long residence time of the Campanian Ignimbrite magmatic system within the crust, an efficient decoupling took place during the upward migration of volatile elements in response to a chromatographic fractionation between H 2 O and CO 2. This caused early pulses of nearly pure CO 2 (CO 2 -fluxing), followed by a long-lasting H 2 O enrichment which yielded dissolved H 2 O contents up to 6–7 wt%. An overpressurized CO 2 -dominated gas cap was consequently produced, uniformly distributed at the top of the magma chamber. The onset of the eruption tapped this cap and generated Plinian columns, causing depressurization and fast volume decrease that facilitated, or even drove, the caldera collapse. H 2 O-rich magma was discharged during the following phase, characterised by pyroclastic density currents. The uniform distribution of the high values of void fraction (>70%) and the high degree of vesicle connectivity throughout the magma body testify to the huge abundance of volatiles. These percolate from the crystallizing basal layers and determine the volatile-melt fining process yielding an efficient separation between H 2 O and CO 2. The gas saturation-based estimates of the tapped foamy magma are compatible with the extent of magma chamber roof collapse, the strong expansion revealed by textural data, and the transport and deposition mechanisms, reflecting depressurization and inflation of the volatile-rich magma within the collapsed and laterally confined caldera. [ABSTRACT FROM AUTHOR]

Health care workers (HCW) are particularly at risk of acquiring tuberculosis (TB), even in countries with low TB incidence. Therefore, TB screening in HCW is a useful prevention strategy in countries with both low and high TB incidence. Tuberculin skin test (TST) is widely used although it suffers of low specificity; on the contrary, the in vitro enzyme immunoassay tests (IGRA) show superior specificity and sensitivity but are more expensive. The present study reports the results of a three-year TB surveillance among HCW in a large teaching hospital in Rome, using TST (by standard Mantoux technique) and IGRA (by QuantiFERON-TB) as first- and second-level screening tests, respectively. Out of 2290 HCW enrolled, 141 (6.1%) had a positive TST; among them, 99 (70.2%) underwent the IGRA and 16 tested positive (16.1%). The frequency of HCW tested positive for TB seems not far from other experiences in low incidence countries. Our results confirm the higher specificity of IGRA, but, due to its higher cost, TST can be considered a good first level screening test, whose positive results should be further confirmed by IGRA before the patients undergo X-ray diagnosis and/or chemotherapy. [ABSTRACT FROM AUTHOR]

Background The aim of this study was to evaluate the association between urbanization of residential area, parent education level, employment status, overweight/obesity, physical activity, and exposure to environmental tobacco smoke ( ETS), in a sample of healthy Italian school-age children (5-11 years). Methods A cross-sectional study was conducted on 432 children resident, respectively, in a highly urban and in a rural area (Latium Region) in 2014. Information on children and families were obtained via questionnaire. Results One-third of children were overweight or obese, 15% did not participate in any sport outside school, and more than one-third were exposed to ETS in the domestic environment. Living in a rural area (adjusted OR, 2.55; 95% CI: 1.18-5.52) and lower maternal education (adjusted OR, 2.32; 95% CI: 1.03-5.27) were significant predictors of overweight/obese status. Moreover, lower maternal education level (adjusted OR, 2.74; 95% CI: 1.40-5.33) and paternal education level (adjusted OR, 3.06; 95% CI: 1.54-6.07) were significant predictors of ETS exposure. Conclusions It is essential to investigate the reasons underlying the higher frequency of overweight/obesity in children living in rural environments compared with those in urban areas; and preventative actions should be designed to be easily understood by those with lower education levels. [ABSTRACT FROM AUTHOR]

Barium diffusion chronometry applied to sanidine phenocrysts from the trachytic Agnano-Monte Spina eruption (∼4.7 ka) constrains the time between reactivation and eruption of magma batches in the Campi Flegrei caldera. Backscattered electron imaging and quantitative electron microprobe measurements on 50 sanidine phenocrysts from representative pumice samples document core-to-rim compositional zoning. We focus on compositional breaks near the crystal rims that record magma mixing processes just prior to eruption. Diffusion times were modeled at a magmatic temperature of 930 °C using profiles based on quantitative BaO point analyses, X-ray scans, and grayscale swath profiles, yielding times ≤60 years between mixing and eruption. Such short timescales are consistent with volcanological and geochronological data that indicate that at least six eruptions occurred in the Agnano-San Vito area during few centuries before the Agnano-Monte Spina eruption. Thus, the short diffusion timescales are similar to time intervals between eruptions. Therefore, the rejuvenation time of magma residing in a shallow reservoir after influx of a new magma batch that triggered the eruption, and thus pre-eruption warning times, may be as short as years to a few decades at Campi Flegrei caldera. [ABSTRACT FROM AUTHOR]

Geochemical and isotopic ( 87 Sr/ 86 Sr and 18 O/ 16 O) data have been acquired on whole rock and separated mineral samples from volcanic products of the 1302 AD Arso eruption, Ischia volcanic island (Gulf of Naples, Southern Italy), to investigate magmatic processes. Our results highlight petrographic and isotopic disequilibria between phenocrysts and their host rocks. Similar disequilibria are observed also for more mafic volcanic rocks from Ischia and in the Phlegraean Volcanic District in general. Moreover, 87 Sr/ 86 Sr and 18 O/ 16 O values suggest mixing between chemically and isotopically distinct batches of magma, and crystals cargo from an earlier magmatic phase. The radiogenic Sr isotope composition suggests that the mantle source was enriched by subduction-derived sediments. Furthermore, magmas extruded during the Arso eruption were affected by crustal contamination as suggested by high oxygen isotope ratios. Assimilation and fractional crystallization modelling of the Sr-O isotope compositions indicates that not more than ~ 7% of granodioritic rocks from the continental crust have been assimilated by a mantle-derived mafic magma. Hence the recent volcanic activity of Ischia has been fed by distinct batches of magma, variably contaminated by continental crust, that mixed during their ascent towards the surface and remobilized phenocrysts left from earlier magmatic phases. [ABSTRACT FROM AUTHOR]

We illustrate a quantitative conductive/convective thermal model incorporating a wide range of geophysical, petrological, geological, geochemical and isotopical observations that constrain the thermal evolution and present state of the Campi Flegrei caldera (CFc) magmatic system. The proposed model has been computed on the basis of the current knowledge of: (1) the volcanic and magmatic history of the volcano over the last 44 ka, (2) its underlying crustal structure, and (3) the physical properties of the erupted magmas. 3D numerical simulations of heat conduction and convection within heterogeneous rock/magma materials with evolving heat sources and boundary conditions that simulate magma rise from a deep (≥ 8 km depth) to shallow (2–6 km) reservoirs, magma chamber formation, magma extrusion, caldera collapse, and intra-caldera hydrothermal convection, have been carried out. The evolution of the CFc magmatic system through time has been simulated through different steps related to its changes in terms of depth, location and size of magma reservoirs and their replenishment. The thermal modeling results show that both heat conduction and convection have played an important role in the CFc thermal evolution, although with different timing. The simulated present heat distribution is in agreement with the measured geothermal profiles (Agip, 1987), reproduces the thermal gradient peaks at the CFc margins in correspondence to the anomalies in surface gradients (Corrado et al., 1998), and suggests temperatures of 700 °C at depth of 4 km in the central portion of the caldera, in agreement with the estimated temperature for the brittle-ductile transition (Hill, 1992 ). [ABSTRACT FROM AUTHOR]

The increasing application of cryptotephra studies is leading the identification of new tephra marker layers the sources of which in many cases may not be known or may be ambiguous. In this contribution, we discuss the controls on tephra geochemistry in the context of establishing the provenance of an unknown tephra layer. We use the RESET database ( https://c14.arch.ox.ac.uk ), which contains major and trace element data for a number of European silicic tephra erupted in the period 100 ka to ca 10 ka, to define new and modify existing tectonic setting discrimination diagrams for use with volcanic glass analyses. Bivariate plots of the elements Rb, Nb, Ta, Y and Th and K 2 O, SiO 2 , FeO and MgO can be used to identify tephra from different tectonic settings. New, detailed glass chemistry shows that tephra from the productive Neapolitan volcanic centres, Somma-Vesuvius (22–4 ka activity), Campi Flegrei (60–15 ka) and Ischia (75–20 ka), can be separated using major elements, CaO–SiO 2 , Na 2 O/K 2 O–CaO and CaO–MgO. In each of these centres, the tephrostratigraphic record is characterized by the repeated occurrence of similar glass compositions, punctuated by significant changes in magma chemistry. The glass compositions of successive eruptions from Campi Flegrei are similar but there is a significant change in the composition following the Campanian Ignimbrite, and there are comparable compositional changes at Ischia following the Monte Epomeo Green Tuff eruption and at Somma-Vesuvius following the Verdoline event. Distinguishing different tephras from a single volcanic centre is more problematic, and in some instances even impossible, without good chronological and stratigraphic control and/or high-resolution trace element glass data. At Somma-Vesuvius certain major elements can be used to separate glasses from the major chronological phases (Group 1 – Pomici di Base and Verdoline; Group 2 – Mercato and Avellino), but separating tephras within a single group on the basis of glass composition can be problematic. [ABSTRACT FROM AUTHOR]

Unraveling the eruptive history of the Island of Ischia (southern Italy) is problematic due to its burial, caldera collapse, resurgent uplift and erosion. Here, we present new major and trace element glass data for 39–75 ka proximal tephra deposits, including those of the caldera-forming Monte Epomeo Green Tuff (MEGT) eruption. Correlations with the distal tephra archive preserved at Lago Grande di Monticchio (LGdM) are used to constrain the timing of as yet undated eruptive events. Out of 13 LGdM tephras analysed from the 39–104 ka time window, glass geochemical data show that all are compositionally consistent with the explosive volcanic eruptions of Ischia, whilst 5 of them can be correlated with specific proximal deposits. Pre-MEGT pyroclastic sequences comprise three compositional groups, these groups occur repeatedly in sucessive eruptions. Proximal-distal correlations indicate that the Porticello eruption occurred at 59 ± 2 ka and the Tisichiello eruption probably occurred at 76 ± 3 ka. The MEGT eruption is correlated with LGdM TM-19, which has been directly dated at 55 ± 2 ka. Post-MEGT tephras form compositional groups that overlap with the pre-MEGT but are displaced to lower FeO and TiO 2 and lower incompatible element contents. Proximal-distal correlations indicate that the Schiappone and Pietre Rosse eruptions occurred at 50.6 ± 2.0 ka and 45 ± 6 ka, respectively. Tephra from the MEGT eruption span a wide compositional range, broadly overlapping the three pre-MEGT compositional groups but are displaced to higher Nd and Y and contain an additional less evolved glass population. Glass geochemistry is used to recognise and confirm distal equivalents of the MEGT at LGdM (TM-19) and in the Ionian (Y-7), Adriatic (PRAD 1870) and Tyrrhenian (C-18, MD 28) seas. Distal occurences of MEGT tephra define a dispersal axis to the south-southeast and are found as far as 540 km from Ischia, making the MEGT one of the most widely dispersed late Quaternary pyroclastic deposit erupted in the Campanian region. We estimate a volume of approximately 40 km 3 for the fallout portion of the MEGT pyroclastic sequence on the basis of proximal and distal deposit thicknesses. [ABSTRACT FROM AUTHOR]

Background: The Italian Study Group on Hospital Hygiene of the Italian Society of Hygiene, Preventive Medicine and Public Health conducted a multicentre survey aiming to evaluate undergraduate health care students’ knowledge of tuberculosis and tuberculosis control measures in Italy. Methods: In October 2012–June 2013, a sample of medical and nursing students from 15 Italian universities were enrolled on a voluntary basis and asked to complete an anonymous questionnaire investigating both general knowledge of tuberculosis (aetiology, clinical presentation, outcome, screening methods) and personal experiences and practices related to tuberculosis prevention. Data were analysed through multivariable regression using Stata software. Results: The sample consisted of 2,220 students in nursing (72.6%) and medicine (27.4%) courses. Our findings clearly showed that medical students had a better knowledge of tuberculosis than did nursing students. Although the vast majority of the sample (up to 95%) answered questions about tuberculosis aetiology correctly, only 60% of the students gave the correct responses regarding clinical aspects and vaccine details. Overall, 66.9% of the students had been screened for tuberculosis, but less than 20% of those with a negative result on the tuberculin skin test were vaccinated. Multivariable regression analysis showed that age and type of study programme (nursing vs. medical course) were determinants of answering the questions correctly. Conclusions: Although our data showed sufficient knowledge on tuberculosis, this survey underlines the considerable need for improvement in knowledge about the disease, especially among nursing students. In light of the scientific recommendations concerning tuberculosis knowledge among students, progress of current health care curricula aimed to develop students’ skills in this field is needed. [ABSTRACT FROM AUTHOR]

Abstract: Persistent degassing of closed-conduit explosive volcanoes may be used to inspect and monitor magmatic processes. After interaction with shallow hydrothermal fluids, volcanic gases collected at surface can differ substantially from those exsolved from magma. We report here on an innovative approach to identify and separate the contribution of variable magmatic components from fumarolic gases, by processing the 30-year-long geochemical dataset from the Campi Flegrei caldera, Southern Italy. The geochemical record shows periodic variations, which are well correlated with geophysical signals. Such variations are interpreted as due to the time-varying interplay of two magma degassing sources, each differing in size, depth, composition, and cooling/crystallization histories. Similar multiple degassing sources are common at explosive volcanoes, with frequent ascent and intrusion of small magma batches. Our innovative method permits the identification of those magma batches, which contributes to the interpretation of unrest signals, forecasting and assessment of volcanic hazards. [Copyright &y& Elsevier]

Abstract: Volcanic activity at Phlegraean Fields, Italy, produced several major marker tephras over a 50ka period. The caldera forming eruptions of the Campanian Ignimbrite (CI) and Neapolitan Yellow Tuff (NYT) are of particular importance for tephrostratigraphy in Europe. Other key eruptions from this source include the Pomici Principali (PP) and the Tufi Biancastri eruptions. We combine analyses of fresh glasses from proximal locations (i.e., juvenile clasts in proximal flow and fall deposits) with data for key tephra layers from Lago Grande di Monticchio, 120km to the east. The micron-beam major (EMPA) and trace (LA-ICP-MS) element glass dataset allows us to: (a) distinguish between tephra units produced from the Phlegraean Fields before and during the CI eruption (CI-series), and before and during the NYT and PP eruptions (NYT-series/PP); (b) discriminate between the CI and the geochemically similar Pre-CI pyroclastic deposits; (c) separate the NYT from Pre-NYT tephra units, although both major and trace elements do show significant overlap. The complex compositional overlap between Pre-NYT tephras may present a problem for tephra correlations in the 14–39ka time window and may have resulted in incorrect proximal–distal and distal–distal correlations. The diagnostic chemical criteria detailed herein permits more accurate matching of distal tephras with their proximal equivalents and hence will improve chronostratigraphy of distal settings and give insight into tephra dispersal. We show that the dispersal of PP tephra was more limited than previously thought. The surge/fall (Lower Member) and subsequent pyroclastic density current (Upper Member) phases of the NYT eruption can be recognised in distal settings. Both the NYT Lower and Upper Members are found in distal localities to the east of the Phlegraean Fields, however the Lower Member is found in the absence of the Upper Member in locations to the far north of Phlegraean Fields. Chemical compositions of the Plinian and ignimbrite phases of the CI eruption overlap extensively, but can be distinguished on a plot of Zr–Th. [Copyright &y& Elsevier]

Abstract: The Campi Flegrei caldera collapsed 39ka in the Neapolitan area (southern Italy) after the Campanian Ignimbrite eruption. This eruption, recognized as the largest and the most cataclysmic volcanic event in the Mediterranean area over the past 200ka, extruded not less than 300km3 of trachytic magma. Controversy exists over the timescales required to assemble such large volume of silicic melt and thus whether large magmatic reservoirs can actually persist below active volcanic systems over prolonged periods of time. Uranium-series analyses have been performed on Campanian Ignimbrite whole-rocks, glass matrixes and separated minerals, and the obtained results have been interpreted in combination with data on Sr, Nd, and Pb isotopes from literature. The compositionally most evolved sample which is most radiogenic with respect to Sr isotopes records a reference age of 71ka. By contrast, U–Th internal isochrones of the three compositionally least evolved samples give identical initial Th isotope ratios and yield consistent ages predating the eruption by up to 6.4ka. The highest Pb and Nd isotopic ratios and 230Th/232Th activity ratios together with the oldest reference age of the most evolved samples suggest the existence of a resident magma body possibly related to a magmatic system that is known to have fed earlier magmatic activity in the Campi Flegrei area. Conversely, the younger age of the least evolved and least radiogenic magma dates the crystallization/differentiation event of a chemically and isotopically new magma batch entering the reservoir of the resident magma some few thousand years before the cataclysmic eruption. Therefore, the time preceding this large caldera-forming eruption during which the large volume of Campanian Ignimbrite magma assembled and mixed is 6.4±2.1ka. [Copyright &y& Elsevier]

The Averno 2 eruption (3,700 ± 50 a B.P.) was an explosive low-magnitude event characterized by magmatic and phreatomagmatic explosions, generating mainly fall and surge beds, respectively. It occurred in the Western sector of the Campi Flegrei caldera (Campanian Region, South Italy) at the intersection of two active fault systems, oriented NE and NW. The morphologically complex crater area, largely filled by the Averno lake, resulted from vent activation and migration along the NE-trending fault system. The eruption generated a complex sequence of pyroclastic deposits, including pumice fall deposits in the lower portion, and prevailing surge beds in the intermediate-upper portion. The pyroclastic sequence has been studied through stratigraphical, morphostructural and petrological investigations, and subdivided into three members named A through C. Member A was emplaced during the first phase of the eruption mainly by magmatic explosions which generated columns reaching a maximum height of 10 km. During this phase the eruption reached its climax with a mass discharge rate of 3.2 10 kg/s. Intense fracturing and fault activation favored entry of a significant amount of water into the system, which produced explosions driven by variably efficient water-magma interaction. These explosions generated wet to dry surge deposits that emplaced Member B and C, respectively. Isopachs and isopleths maps, as well as areal distribution of ballistic fragments and facies variation of surge deposits allow definition of four vents that opened along a NE oriented, 2 km long fissure. The total volume of magma extruded during the eruption has been estimated at about 0.07 km (DRE). The erupted products range in composition from initial, weakly peralkaline alkali-trachyte, to last-emplaced alkali-trachyte. Isotopic data and modeling suggest that mixing occurred during the Averno 2 eruption between a more evolved, less radiogenic stored magma, and a less evolved, more radiogenic magma that entered the shallow reservoir to trigger the eruption. The early phases of the eruption, during which the vent migrated from SW to the center of the present lake, were fed by the more evolved, uppermost magma, while the following phases extruded the less evolved, lowermost magma. Integration of the geological and petrological results suggests that the Averno 2 complex eruption was fed from a dyke-shaped shallow reservoir intruded into the NE-SW fault system bordering to the west the La Starza resurgent block, within the caldera floor. [ABSTRACT FROM AUTHOR]

Abstract: The Astroni volcano was built through seven eruptions that generated pyroclastic deposits and lava domes within the Campi Flegrei caldera (southern Italy) 4.1–3.8 ka BP. Whole-rock geochemical and B–Sr–Nd isotopic investigations were carried out on representative samples of all seven eruptions. The products vary from tephriphonolites to phonolites, and from latites to trachytes. They show textural, mineralogical and isotopic evidence of disequilibrium, including distinct clinopyroxene populations, rounded and/or resorbed plagioclase and alkali-feldspar, and reverse-zoned phenocrysts of all these mineral phases. The Sr, Nd and B isotopic composition of whole rocks is variable and correlated with the degree of chemical evolution, suggesting open-system processes in addition to fractional crystallisation. Moreover, significant Sr-isotopic disequilibrium between the phenocrysts and glass has been documented for one sample. The chemostratigraphy of the products indicates that Astroni eruptions 1 through 5 were fed by magmas of trachytic to phonolitic composition that were less enriched in radiogenic Sr and 11B up-section. This variability has been interpreted as the result of mingling between at least two distinct magmatic end-members, one more evolved and the other less evolved. Another heterogeneous batch of magma, resulting from almost complete mixing between the same two end-members, was drained during eruptions 6 and 7. The more evolved end-member, characterised by 87Sr/86Sr≥0.7075, 143Nd/144Nd≤0.51247 and δ 11B≥−8‰, was very similar to the magma that fed the final phases of the Agnano–Monte Spina eruption, which occurred a few centuries earlier in the Astroni vent area. The less evolved end-member had 87Sr/86Sr≤0.70726, 143Nd/144Nd≥0.51251 and δ 11B≤10‰, and was likely derived by fractional crystallisation of a mantle-derived magma. An abrupt decrease in both the Sr isotope ratio and the Th content, detected at the transition between Unit 4 and 5, suggests that another magma with a 87Sr/86Sr ratio intermediate between those of the two identified end-members may have been involved in Astroni activity. The more evolved end-member is interpreted as a residue of the Agnano–Monte Spina eruption that was invaded by either the intermediate or the less evolved magmatic end-member, promoting mingling and triggering Astroni activity. This study of Astroni provides insights for both short- and long-term volcanic hazard assessment, as the Astroni volcano is the best example of a very close sequence of eruptions from the same vent area in the Campi Flegrei caldera. [Copyright &y& Elsevier]

The Agnano–Monte Spina Tephra (AMST) is a complex sequence of beds generated by contrasting fragmentation and transportation dynamics. The 4.1 ka eruption was accompanied by a volcano-tectonic collapse, part of which is the present Agnano plain. The pyroclastic sequence is subdivided into members and submembers, each characterized by different lithological and sedimentological features. Plinian/subplinian fallout deposits frequently alternate with base-surge beds of phreatomagmatic origin. Analysis of lateral facies variations and vertical facies associations of correlated layers of submembers B2, D2 and E2 reveals that during some eruption phases the contrasting eruptive dynamics were almost contemporaneous. Base-surge deposits of submember B2 formed during the declining stage of a plinian column. They resulted from highly energetic and steady pyroclastic density currents that traveled long distances from the vent area and surmounted topographic obstacles such as the Posillipo hill (∼150 m) and the northern sector of the Camaldoli hill (∼250 m). Submember D2 pyroclastic density currents formed when contemporaneous fallout from an eruptive column was present. Coarse particles from the column settled throughout the pyroclastic density current, determining a significant increase of the solid load of the base surge. The consequent increase of supply rate from the transportation to the depositional zone of the base surge led to the formation of unsteady flows that could not efficiently transport the solid load and did not have the ability to travel long distances. Base-surge deposits of submember E2 were fed by a pulsating phreatomagmatic activity, which was punctuated by a short-lived fallout phase. Fallout material, which was incorporated as an additional load to the base surges, was partially transported by low-energy, steady pyroclastic density currents that traveled over the Agnano plain but did not surmount either the Camaldoli or the Posillipo hills. Only the very fine material, in continuous suspension in the upper, no-shearing part of the base-surge cloud, was dispersed higher in the atmosphere and quietly settled over a large area outside the caldera rim. The phreatomagmatic origin of base surges, which contrasts with the magmatic origin of fallout activity, suggests that the pyroclastic density currents of the Agnano–Monte Spina eruption did not result from eruption column collapses. They were most likely related to radially spreading clouds which were contemporaneous with fallout activity but issued from distinct zones in the vent area. The turbulent nature and the high expansion of base surges made them capable, under certain conditions, of passing over high topographic obstacles, with hazardous effects in distal areas. [Copyright &y& Elsevier]

The Astroni volcano formed during the third and most recent epoch of activity (4.8–3.8 ka) of the Campi Flegrei caldera (CFc). The activity of the volcano was dominated by explosive, mostly phreatomagmatic eruptions, with only subordinate lava effusions. We have grouped the sequence of deposits into seven distinct units, separated by erosional unconformities or very thin paleosols. The units include mostly surge beds, with subordinate strombolian deposits and lavas, and one plinian fallout layer. The total volume of erupted magma is 0.45 km3 (DRE), while the total mass is 1.12×1012 kg. The magma feeding the first five eruptions was alkali-trachytic and slightly zoned, while the last two eruptions tapped a magma batch resulting from mixing of the previously extruded alkali-trachytic and a less evolved trachytic magma. The volcano grew at the northwestern edge of the polygonal volcano-tectonic collapse, northwest–southeast elongated, which accompanied the Agnano–Monte Spina eruption (4.1 ka), the largest of the third epoch. Available radiometric dates and stratigraphical data constrain the age of the volcano in the final part of the 4.1–3.8 ka time span. This implies that the seven eruptions followed each other at very short time intervals. This conclusion is also supported by constancy in archaeological facies of findings within the paleosols between variable Astroni units, in the plain north of the caldera. The sequence of close eruptions in the same area, although with a slight migration of the vent from northwest to southeast, makes the Astroni volcano peculiar in the recent history of the CFc. Therefore, the definition of its history is very important in order to understand one of the past phenomenologies of the caldera, relevant elements to forecast its behavior. [Copyright &y& Elsevier]

The dating of the Campanian Ignimbrite (CI) eruption to ∼37,000 cal yr B.P. draws attention to the coincidence of this volcanic catastrophe and the suite of coeval, Late Pleistocene biocultural changes that occurred within and outside the Mediterranean region. These included the Middle to Upper Paleolithic cultural transition and the supposed change from Neanderthal to “modern” Homo sapiens anatomy, a subject of sustained debate. No less than 150 km3 of magma were extruded in the CI eruption, the signal of which can be detected in Greenland ice cores. As widespread discontinuities in archaeological sequences are observed at or following the CI event, a significant interference with ongoing human processes in Mediterranean Europe is hypothesized. [Copyright &y& Elsevier]

The coronavirus disease 2019 (COVID-19) pandemic has led to the adoption of restriction measures that have had notable consequences on the health and wellbeing of individuals. This survey was carried out on a sample of 905 Albanian undergraduates to assess their knowledge about COVID-19 and their health-related behaviors and communication changes during lockdown. The students were invited to complete a pre-validated questionnaire during lessons. The results show that the majority of the surveyed students were able to answer correctly about the main epidemiological features of the disease. The level of knowledge was proven to be proportional to the students' education level (enrollment year and age). No considerable relationship emerged with respect to diet or smoking. On the other hand, a relevant portion of the sample (37.6%) declared decreased physical activity (PA). Finally, a notable increase in the intensity and frequency of communication with their peers and with their parents was declared by 34.7% and 50.8% of the sample, respectively. Lifestyle variables were found to be mutually related, as were communication outcomes. The participants showed a satisfactory awareness regarding the COVID-19 epidemic. However, the registered reduction in PA may represent a public health issue and should be addressed with adequate policies. The use of electronic media seems to have increased communication habits in this population group. [ABSTRACT FROM AUTHOR]

Background: The aim of the study was to explore lifestyle of undergraduate students in southern Italy and to investigate their determinants.Methods: An anonymous, web-based questionnaire investigating weight and its perception, smoking and alcohol use, achievement of recommended levels of physical activity and time spent daily in screen-based sedentary behaviors was administered to students attending two universities in southern Italy. Age, gender, city, type of degree course attended, occupational status and residential status were considered as possible demographic determinants.Results: The majority of the participants reported a normal weight (71.2%), were non-smokers (66.6%), occasional alcohol consumers (60.5%) and insufficiently active (62.6%), with a reported mean screen time exceeding 2 h per day. Gender, city, type of degree course and occupational status were found to be associated with lifestyle by regression analysis. Normal weight, overweight and obese students were generally properly aware of their weight condition; however, weight misperceptions were registered among normal and underweight undergraduates.Conclusions: This study highlighted some critical issues regarding lifestyles of university students that suggest the need for health promotion interventions targeted mainly on physical activity. [ABSTRACT FROM AUTHOR]