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Background: Traditionally, pneumonia has been classified as either community- or hospital-acquired. Although only limited data are available, health care–associated pneumonia has been recently proposed as a new category of respiratory infection. “Health care–associated pneumonia” refers to pneumonia in patients who have recently been hospitalized, had hemodialysis, or received intravenous chemotherapy or reside in a nursing home or long-term care facility. Objective: To ascertain the epidemiology and outcome of community-acquired, health care–associated, and hospital-acquired pneumonia in adults hospitalized in internal medicine wards. Design: Multicenter, prospective observational study. Setting: 55 hospitals in Italy comprising 1941 beds. Patients: 362 patients hospitalized with pneumonia during two 1-week surveillance periods. Measurements: Cases of radiologically and clinically assessed pneumonia were classified as community-acquired, health care–associated, or hospital-acquired and rates were compared. Results: Of the 362 patients, 61.6% had community-acquired pneumonia, 24.9% had health care–associated pneumonia, and 13.5% had hospital-acquired pneumonia. Patients with health care–associated pneumonia had higher mean Sequential Organ Failure Assessment scores than did those with community-acquired pneumonia (3.0 vs. 2.0), were more frequently malnourished (11.1% vs. 4.5%, and had more frequent bilateral (34.4% vs. 19.7%) and multilobar (27.8% vs. 21.5%) involvement on a chest radiograph. Patients with health care–associated pneumonia also had higher fatality rates (17.8% [CI, 10.6% to 24.9%] vs. 6.7% [CI, 2.9% to 10.5%]) and longer mean hospital stay (18.7 days [CI, 15.9 to 21.5 days] vs. 14.7 days [CI, 13.4 to 15.9 days]). Logistic regression analysis revealed that depression of consciousness (odds ratio [OR], 3.2 [CI, 1.06 to 9.8]), leukopenia (OR, 6.2 [CI, 1.01 to 37.6]), and receipt of empirical antibiotic therapy not recommended by international guidelines (OR, 6.4 [CI, 2.3 to 17.6]) were independently associated with increased intrahospital mortality. Limitations: The number of patients with health care–associated pneumonia was relatively small. Microbiological investigations were not always homogeneous. The study included only patients with pneumonia that required hospitalization; results may not apply to patients treated as outpatients. Conclusion: Health care–associated pneumonia should be considered a distinct subset of pneumonia associated with more severe disease, longer hospital stay, and higher mortality rates. Physicians should differentiate between patients with health care–associated pneumonia and those with community-acquired pneumonia and provide more appropriate initial antibiotic therapy.

Paroxysmal activity of Stromboli volcano (Aeolian Islands, South Italy) is characterized by unusually large vulcanian explosions. The 2003, April 5th event has been the most energetic blast ever occurred at Stromboli volcano since 1930. Its high explosive nature is testified by the 1 km-high eruptive column, and the 4 km-high convective plume. Ballistic ejecta reached distances larger than 2 km. We analyze available seismic and geochemical data available for this event and interpret them in terms of release and ascent of a gas slug of deep crustal origin. In particular, important variations in seismic tremor features and anomalous ultra-long period signals provide constraints on pre-explosive timing, while geochemistry of erupted products yields pressure-volume relations and the budget of discharged volatiles. The bulk of these information is then processed within the classical Jaupart and Vergniolle model of foam layer collapse providing a fully consistent framework for the strombolian paroxysm

A fundamental goal of volcano seismology is to understand the dynamics of active magmatic systems in order to assess eruptive behavior and the associated hazard. Imaging of magma conduits, quantification of magma transport, and investigation of long-period seismic sources, together with their temporal variations, are crucial for the comprehension of eruption-triggering mechanisms. At Mt. Etna volcano, several intense episodes of tremor activity were recorded during 2007, in association with strombolian activity and/or intense fire fountaining episodes occurring from the South East Crater (SEC). The locations of the tremor sources and of the long-period seismic events are used here to constrain both the area and the depth range of magma degassing, highlighting the geometry of the shallow conduits feeding SEC. The imaged conduits consist of two connected resonating dike-like bodies, NNW-SSE and NW–SE oriented, extending from sea level to the surface. In addition, we show how tremor, long-period (LP), and very-longperiod (VLP) event locations and signatures reflect pressure fluctuations in the plumbing system associated with the ascent/discharge of gas-rich magma linked to the lava fountains. The evidence here reported, also corroborated by ground deformation variations, can help develop a better prediction and early warning system for those eruptions (effusive or explosive) that apparently manifest no clear precursors.

Gastroesophageal reflux disease (GERD) can be described as a clinical picture resulting from the reflux of stomach contents into the esophagus. The actual prevalence of GERD remains unestablished, although this disorder is generally common in old patients, male sex and in subsets of patients with pulmonary manifestations such as asthma. From a pathophysiological stand-point, GERD is thought to have a multifactorial etiology which involves genetics, anatomical, functional, environmental, hormonal and pharmacological factors. GERD has different clinical presentations which may be divided in three main classes: typical symptoms (heartburn and regurgitation); atypical or extraesophageal symptoms (angina-like chest pain, asthma, chronic cough and laryngitis); and complications (ulcers, strictures and Barrett's esophagus). In GERD diagnosis a key role is played by: accurate symptom evaluation, response to proton pump inhibitors and, finally, at least one in a life-time endoscopy. Moreover, barium swallow X-ray, 24-h esophageal pH monitoring and gastro-esophageal manometry can be useful to support diagnosis in some unusual cases or in cases partially or unresponsive to standard pharmacologic treatment.

Gastroesophageal reflux disease (GERD) can be defined as a condition resulting from the reflux of stomach contents into the esophagus. Its pharmacological treatment is aimed at symptom relief, healing of erosions and ulcerations and prevention of relapses. Based on the pathophysiology, the ideal treatment is directed to enhance basal sphincter pressure or decrease the frequency of TLESR, restore esophageal "clearance", accelerate gastric emptying and highten mucosal resistance as well as reduce or inhibit gastric acid secretion. Most of these targets are currently achievable because the availability of different types of drugs, however the "ideal" pharmacologic treatment of GERD does not exist. Current remedies for GERD include life style changes along with a wide array of antisecretory drugs, such as antacids, H2-antagonists and proton pump inhibitors (PPI). Surgery, based on anti-reflux procedures, and endoscopic approaches may have a role in the management of patients with GERD.