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This paper presents data on the geometric and kinematic features of brittle faults in the Carrara area (Alpi Apuane, NW Tuscany, Italy), providing the first paleostress determination in a key region of the Northern Apennine. Meso-and microfault analyses point out the presence of brittle structures formed during a polyphase deformation and characterized by an older stage (DS1), with an interfering system of strike slip and normal faulting, followed by the DS2 stage developing normal faults locally showing apenninic trend (NW/SE). As a whole, the brittle structures are related to the late Pliocene–middle Pleistocene evolution of the Thyrrenian side of the Northern Apennine. [ABSTRACT FROM AUTHOR]

Abstract: We studied the geometry, intensity of deformation and fluid–rock interaction of a high angle normal fault within Carrara marble in the Alpi Apuane NW Tuscany, Italy. The fault is comprised of a core bounded by two major, non-parallel slip surfaces. The fault core, marked by crush breccia and cataclasites, asymmetrically grades to the host protolith through a damage zone, which is well developed only in the footwall block. On the contrary, the transition from the fault core to the hangingwall protolith is sharply defined by the upper main slip surface. Faulting was associated with fluid–rock interaction, as evidenced by kinematically related veins observable in the damage zone and fluid channelling within the fault core, where an orange–brownish cataclasite matrix can be observed. A chemical and isotopic study of veins and different structural elements of the fault zone (protolith, damage zone and fault core), including a mathematical model, was performed to document type, role, and activity of fluid–rock interactions during deformation. The results of our studies suggested that deformation pattern was mainly controlled by processes associated with a linking-damage zone at a fault tip, development of a fault core, localization and channelling of fluids within the fault zone. Syn-kinematic microstructural modification of calcite microfabric possibly played a role in confining fluid percolation. [ABSTRACT FROM AUTHOR]

In the last decade, carbapenem-resistant Klebsiella pneumoniae (CR-Kp) has become endemic in several countries, including Italy. In the present study, we assessed the differences in epidemiology, management, and mortality of CR-Kp bloodstream infection (BSI) in the three main adult acute-care hospitals of the metropolitan area of Genoa, Italy. From January 2013 to December 2014, all patients with CR-Kp BSI were identified through the computerized microbiology laboratory databases of the three hospitals. The primary endpoints of the study were incidence and characteristics of CR-Kp BSI in hospitals within the same endemic metropolitan area. Secondary endpoints were characteristics of CR-Kp BSI in hospitals with and without internal infectious diseases consultants (IDCs) and 15-day mortality. During the study period, the incidence of healthcare-associated CR-Kp BSI in the entire study population was 1.35 episodes per 10,000 patient-days, with substantial differences between the three hospitals. Patients admitted to the two hospital with internal IDCs were more likely to receive post-susceptibility test combined therapy including carbapenems (77% vs. 26%, p<0.001), adequate post-susceptibility test therapies (86% vs. 52%, p<0.001), and post-susceptibility therapies prescribed by an infectious diseases specialist (84% vs. 14%, p<0.001). Overall, the crude 15-days mortality was 26%. In the final multivariable model, only septic shock at BSI presentation was unfavorably and independently associated with 15-days mortality (odds ratio [OR] 6.7, 95% confidence intervals [CI] 2.6-17.6, p<0.001), while a protective effect was observed for post-susceptibility test combined therapies including a carbapenem (OR 0.11, 95% CI 0.03-0.43, p=0.002). Mortality of CR-Kp remains high. Differences in the incidence of CR-Kp BSI were detected between acute-care centers within the same endemic metropolitan area. Efforts should be made to improve the collaboration and coordination between centers, to prevent further diffusion of CR-Kp., (Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objective: To describe the occurrence of CRKP infections in a tertiary care hospital and to analyse the allelic profiles of the clinical strains involved and the most frequent carbapenemases., Design: The study analyzed cases of infection due to CRKP in the period 2013-2014; 147 cases were recorded, most of which (82.31%) were in-hospital infections., Setting: A hospital in northern Italy., Methods: We retrospectively collected: data on patient characteristics and the microbiological characteristics of CRKP. Isolates from 72 of the in-hospital cases underwent molecular typing (MLST); in addition, in each isolate, a procedure for the detection of the blaKPC gene was carried out., Results: The in-hospital death rate was 24.0% in 2013 and 37.5% in 2014. However, the difference between these two values did not prove statistically significant (P > .05). Analysis of mortality revealed that bloodstream infections were more frequently associated with death than other infections (χ 2 = 14.57, P < .001). The age-adjusted Cox proportional hazard model revealed that the patients with bacteremia due to CRKP had a 3-fold higher risk of death (HR 3.11; 95% CI 1.66 - 5.84, P< .001) than those with infections of other sites. MLST revealed that the prevalent allelic profile was ST 512 (79.62%); the most frequent carbapenemase was KPC-3 (83.8%)., Conclusions: Our results are in line with those of recent studies, which have shown that the spread of CRKP in Italy is a matter of concern and that further efforts have to be made to prevent the potential dissemination of carbapenemase-producing clones of K. pneumoniae, whenever possible.

Objectives: To establish the possible sources and routes of transmission of a multidrug-resistant Acinetobacter baumannii outbreak involving 22 patients., Study Design: Descriptive, retrospective study., Methods: An environmental investigation was undertaken, monitoring surfaces, air and water. Reconstruction of the spread of the infection took several factors into account such as intrahospital movements of patients and healthcare personnel, hospitalization of patients in the same ward and in chronologically compatible periods, and length of stay. A. baumannii clinical samples were typed using the Multilocus Sequence Typing scheme., Results: The outbreak originated from a patient admitted to the sub-intensive care unit, and the infection subsequently spread to other wards. The allelic profile proved to be the same for all the clinical isolates. Environmental monitoring yielded negative results for A. baumannii., Conclusions: The results suggest that this epidemic spread through cross-transmission involving healthcare workers., (Copyright © 2013 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

Background: Multidrug-resistant Acinetobacter baumannii (MDRAB) is an important cause of hospital acquired infection. We describe a 7-month outbreak of a MDRAB infection involving various wards of an Italian hospital and an investigation of the possible source of the infection was conducted., Methods: A baumannii was isolated from various biological samples from 22 colonized or infected patients, and was identified and characterized for its antibiotic sensitivity. Typing of A baumannii was performed by multilocus sequence typing (MLST). Investigation of the outbreak involved extensive microbiological sampling of the environment., Results: In 50% of cases the infection occurred in the ICU. Invasive procedures were performed in 63.6% of patients. The strain isolated proved to be resistant to all the antibiotics tested, including carbapenems, and displayed the same allelic profile in all patients. None of the 141 samples taken during environmental monitoring showed positivity for A baumannii., Conclusion: The results of the present study reveal the importance of strict adherence to control measures by all health care personnel and highlight the fact that regular staff training and frequent revision of control measures are essential to the successful management of an outbreak., (Copyright © 2011 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.)

Introduction: In dentistry, as in surgery, there is a risk of cross-infection for both patients and staff The aim of this research was to evaluate procedures and behaviors enacted by dental staff which might engender a risk for themselves and their patients., Methods: A questionnaire was administered to 106 dental workers in Genoa (Italy), both public and private. Whenever personal interviews were conducted, the facilities involved were also inspected and the activities of the dental staff were observed directly., Results: This research highlighted some critical points in both structural and organizational features and in the management of infective hazards in the sample considered. In some cases, inadequacies were noted with regard to the prevention of cross-infections, such as the lack of disinfection of work surfaces and the handles of chair-set accessories., Discussion and Conclusions: The particular nature of dental work, in which aerosols of blood and saliva may be produced by rotating instruments, engenders a risk of infection. Application of the various preventive measures available can significantly reduce microbial contamination and the risk of occupational infection and cross-infections. Furthermore, improvement in the structural and organizational features of dental surgeries and the continuing education of health-care workers is indispensable to the control and prevention of infectious diseases.

Background: Many dental procedures produce extensive aerosols and splatters that are routinely contaminated with microorganisms., Methods: Air containing blood-bearing aerosols and surfaces contaminated by sedimenting blood particulate was sampled in 5 different dental cubicles. To assess contamination by blood particulate, the concentration of hemoglobin (Hb) in the air and on the sedimentation surfaces was determined., Results: The mean concentration of Hb in the air aspirated in the 5 cubicles was 0.14 +/- 0.23 microg/m(3), corresponding to a blood volume of 8.7 x 10(-4) microL/m(3). Similarly, the mean concentration of blood particulate sedimented on surfaces was calculated and found to be 1.56 microL/m(2). In 80% of the cubicles monitored, 100% positivity to the Hb determination test was recorded in all of the surface samples., Conclusions: The results obtained revealed contamination of both air and surfaces by blood particulate. Moreover, with the exception of those obtained in 1 cubicle, all of the samples of sedimenting particulate analyzed were positive for the presence of Hb.

The present study evaluated the percentage of methicillin-resistant Staphylococcus aureus strains with reduced susceptibility to glycopeptides in four intensive care units (ICU) by means of environmental sampling of air and representative surfaces. The total bacterial count was taken and possible S. aureus strains were subsequently isolated. To assess methicillin resistance, an antibiogram was performed on the colonies that were positive to the coagulase test. A standard E-test was then carried out on the colonies that developed, in order to evaluate glycopeptide resistance, and any heterogeneous resistance was confirmed by means of a macromethod E-test. The antibiogram performed on the colonies of S. aureus revealed that 85.7% of all air samples were positive for MRSA, and that 64.3% of all the samples proved to be heterogeneously resistant to glycopeptides. Methicillin resistance was recorded in 41.0% of surface samples, and 32.5% of all samples proved positive for hGISA.

The potential harmful effects of glutaraldehyde on human health are well known, and in recent years various new substitutes for this compound have been proposed for the disinfection and thorough sterilization of medical instruments. Nevertheless, glutaraldehyde is still widely used in hospital environments. In order to evaluate environmental contamination by glutaraldehyde vapours, the rooms of a hospital out-patient department of digestive endoscopy were monitored in 2005; a total of 52 samples were taken. The mean environmental concentration of glutaraldehyde was 3.7+/-7.4 microg/m(3). The number of efficacious air exchanges per hour was 6.3 v/h in all of the environments monitored. The study revealed that, in a hospital setting, adequate structural and functional planning, combined with responsible management on the part of the personnel and constant careful checking of the results obtained can minimize the risk of occupational exposure to glutaraldehyde.

Introduction: As occupational exposure to anaesthetic gases is one of the main risks for operating theatre staff an environmental monitoring campaign was conducted in order to evaluate the degree of pollution by nitrous oxide (N2O) in the operating theatres of some hospital facilities in Liguria., Methods: Any leaks (systemic and/or managerial) of anaesthetic gas and the number of efficacious air exchanges per hour supplied by air-conditioning systems were evaluated by means of an IR spectrometer, which was wired to a computer for data collection and analysis. The concentration of nitrous oxide in the centre of each operating theatre was measured by means of chemo-adsorbent cartridges analysed by gas chromatography., Results: In 76.0% of the operating theatres examined a mean environmental concentration of N2O below the legal limits was recorded. The highest mean concentrations were generally associated with the presence of systemic leaks. Supplying an adequate number of efficacious air exchanges per hour enabled environmental concentrations of anaesthetic gas to be kept within acceptable levels., Discussion and Conclusions: Training personnel in the correct management of the operating theatre and of anaesthesia equipment, and ensuring the availability of an adequate air-conditioning system enable the risk of exposure to nitrous oxide to be minimised. This can be achieved through a concerted effort on the part of all involved, in accordance with the concept of ongoing improvement in healthcare services.

Although formaldehyde has recently been classified by the IARC as "carcinogenic in humans" (class 1), it is still widely used in pathology departments for the fixing and conservation of biological tissues. Its use therefore raises the question of occupational exposure. The present paper reports the results of an environmental monitoring campaign to evaluate pollution by formaldehyde in various areas of three pathology departments. Chemi-adsorbent cartridges able to adsorb airborne formaldehyde were used to detect the substance. Quantitative determination of the formaldehyde was carried out by means of liquid chromatography (HPLC). The concentrations of airborne formaldehyde in the areas monitored were fairly modest, being below the limits of indoor concentration proposed by the OSHA. In one of the three departments, however these limits were exceeded in 40% of the samples taken in the room used for the storage of containers. As yet, in spite of the recent class 1 classification by the IARC, no provisions have been made to ban the use of formaldehyde. It is therefore essential to draw up environmental monitoring programmes in order to evaluate occupational exposure and to assess the efficacy of any preventive measures adopted.

The authors report 2 cases of amebic hepatic abscess, through to their observation with a little interval of time one from another and both coming from the same small town. Transmission modalities, the diagnostic approach and the therapeutic possibilities are discussed on the basis of personal experience.