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The emissions from transport and residential sectors have significant shares in total emissions of Europe. In this study, we identified key priorities in support to the EU Macro-regional Strategies implementation based on an ex-ante assessment focusing on two EU macro-regions: Adriatic-Ionian (AIR) and Alpine (ALP). Firstly, we analysed how different sectors contribute to air pollution in the ALP and AIR regions and to predict future pollution levels under different emission scenarios such as Current Legislation (CLE), Maximum Technically Feasible Reduction (MTFR), and Climate Mitigation (CLIM) by using the TM5-FASST air quality and impact model. It was found that the residential sector is the main contributor to anthropogenic PM2.5 emissions and it will remain so also beyond 2050 under the CLE scenario while the transport sector remains the major contributor to NOx emissions until 2030, with a significant and growing contribution from shipping in the AIR region. Primary PM2.5 has almost reached its technical reduction limit but secondary PM2.5 still has a large reduction potential. MTFR measures on road transport and shipping emissions can generate an annual health benefit from PM2.5 and ozone of 750 (ALP) + 2950 (AIR) avoided premature mortalities in 2050 of which 64% from shipping emission reductions. The potential health benefits from all sectors under MTFR (ALP + AIR) amounts to 16, 800 avoided premature deaths annually in 2030 (3250 + 13550). The potential health benefits from Climate mitigation (ALP + AIR) amounts to 2200 avoided premature deaths annually in 2050 (620 + 1580), however CLIM policies due to fuel switch to biomass also cause air quality trade-off in the domestic sector leading to an estimated number of 360 extra premature deaths annually in 2050 in AIR. Secondly, the experts in the transport sector from these regions have pointed several areas of improvement. Increased intermodality, combining road, rail and maritime ship transport can have important benefits in both regions. In the ALP, moving from trucks to rail could considerably reduce the environmental impacts of transport by reducing emissions of CO2 and air pollutants and could help to solve traffic congestion problems. In the AIR, many countries use outdated technologies for on-road freight transport, causing large environmental impacts. A modal shift e.g. to electric rail or maritime shipping can thus give particularly large positive environmental benefits for this region. The potential drawbacks of a modal strengthening the role of railway and ship transport are primarily related to the increased complexity, the costs of the necessary infrastructures and the risk of increased air pollution in some port cities due to ship emissions. For traffic on roads, infrastructure development is a key element to move towards more sustainable transport. Electrification of road transport generates emissions reductions when the electricity generation is also clean and attention should be given to the charging infrastructure development. Fleet renewal of trucks and ships and use of cleaner fuels will contribute to clean growth in transport. However, fleet renewal is a costly measure and difficult to implement in poor countries ; consequently, the measures that proved to be effective in other countries may not be beneficial or even applicable in these countries. One important obstacle in implementing the provisions of EU macro-regional strategies is the disparity between countries within the macro-regions. Further, some countries in ALP and AIR are not part of EU and may present limitations in international trade and security agreements. Finally, the experts in the field highlighted the fact that bioenergy is an important opportunity for ALP and AIR regions. Because of potential environmental threats, its clean deployment is an issue to be carefully addressed through appropriate policies and regulatory acts. An example is the impact on regional air pollution of small and medium scale traditional appliances and domestic boilers. Improved efficiency and best available technologies need to be strongly supported with both market strategies and effective controls. On the other side of the supply chain, sustainable collection of feedstock has to be assured through the appropriate management of the forest stocks and accounting for the actual climate mitigation benefits, without forgetting the increasing demand of biomass from other industrial sectors in a bio-economy framework.

Hypothesis / aims of study The research aims at developing an original model for the identification, measurement and analysis, in a societal perspective, of the costs that arise from the complex Diagnosis and Treatment Paths (DTPs) of female UI, making distinction between the costs that are borne by the national healthcare system (NHS) and private expenditures. The need for a model derives from three main motivations: i) UI is a very diverse disease: its various types largely differ for their aetiology and subsequent treatments; ii) in many countries (Italy included), it is not possible to obtain complete and detailed information on actual costs, given the absence of precise treatment protocols, a significant diversity among the different regions of the country and the lack of specifically designed cost accounting systems; iii) through a model, it is possible to assess also the costs privately borne by individuals (and their families, employers, etc.). Study design, materials and methods The research has been carried on by an interdisciplinary team, with specialists in the study and treatment of UI and – with a particular focus on the identification, measurement and assessment of the economic dimensions of the DTPs - experts in business economics and accounting. The application of the model has been limited to 18-85 years old women, not living in residential care homes and not affected by disabling or extremely severe diseases. The model is based on a two-dimensional classification of UI (i.e. by type and by age: four main types, anatomic SUI and ISD SUI, UUI and - as a combination of the other types - MUI, and four significant ages, 30, 45, 60 and 75 yrs), defining modules that have been studied and analysed through the Event tree analysis (ETA) method. The event trees start with the first visit with the GP and, after a sequence of events linked by conditional probabilities, lead to a list of possible outcomes, characterised by different probabilities and costs. The combination of events and probabilities of each module depends mainly on the capability of the healthcare system to effectively attract patients and address them towards proper treatments (supply side) and on the awareness and determination of incontinent women, together with their overall trust in the healthcare system (demand side). The direct costs of DTPs have been classified into six broad categories: GP visits, specialist visits, surgical treatments, pharmacological therapy, physical therapy, absorbent and skin protection products. For the definition of the structure of the trees, the probabilities of the events, the identification and estimates of the cost components and their attribution to either NHS or private expenditure, the study has formulated hypotheses in coherence with the existing research (on Italy and other comparable contexts). When it was not possible to rely unambiguously on adequate publications and secondary data, the overall plausibility of the hypotheses has been validated with a wider panel of selected experts.

HIV-1 drug resistance represents a major obstacle to infection and disease control. This retrospective study analyzes trends and determinants of resistance in antiretroviral treatment (ART)-exposed individuals across 7 countries in Europe. Of 20 323 cases, 80% carried at least one resistance mutation: these declined from 81% in 1997 to 71% in 2008. Predicted extensive 3-class resistance was rare (3.2% considering the cumulative genotype) and peaked at 4.5% in 2005, decreasing thereafter. The proportion of cases exhausting available drug options dropped from 32% in 2000 to 1% in 2008. Reduced risk of resistance over calendar years was confirmed by multivariable analysis. © 2013 The Author.

The extent to which HIV-1 proviral DNA mutations cause clinically relevant antiretroviral resistance is still controversial. Paired plasma HIV-1 RNA and whole blood DNA were compared in patients failing HAART to investigate if the additional knowledge of archived mutations could improve the selection of potentially active drugs. Seventy-three HIV-1-infected patients with first/second HAART failure were studied before starting a new regimen based on RNA genotyping. Follow-up data after a 12-week therapy were available. DNA genotyping was retrospectively performed on stored whole blood samples and mutational profiles were compared to those from RNA. The mean number of IAS pol mutations was significantly higher in RNA (4.45 ± 2.76) than in DNA (2.88 ± 2.47) (P < 0.001). DNA genotyping provided a 6% increase in detection of resistance-associated mutations. Among 64/73 patients showing discordant DNA/RNA profiles, 54 (84%) also differed for predicted active drugs. 16/73 (22%) patients had ≥1 mutation revealed by DNA genotyping alone, probably affecting therapy success in 2/16. However, neither RNA/DNA discordance nor detection of isolated DNA mutations were statistically associated with outcome. In conclusion, plasma RNA remains the elective choice for HIV genotyping in patients with therapy failure, even if the detection of proviral resistance-associated mutations, not simultaneously found in RNA, is a frequent event. Therefore, in some cases DNA plus RNA genotyping might assist in choosing more accurately subsequent antiretroviral regimens. © 2008 Wiley-Liss, Inc.

Nuova Serie

Introduction: This study aimed at defining protease (PR) resistance mutations associated with darunavir (DRV) failure and PR resistance evolution at DRV failure in a large database of treatment-experienced human immunodeficiency virus (HIV) patients. Results: Overall, 1,104 patients were included: 118 (10.7%) failed at a median observation time of 16 months. The mean number of PR mutations at baseline was 2.7, but it was higher in patients who subsequently failed DRV. In addition, the number of PR mutations increased at failure. The increase in the mean number of mutations was completely related to mutations considered to be associated with DRV resistance following the indications of the main DRV clinical trials. Discussion The higher statistical difference at baseline between failing versus non-failing patients was observed for the V32I and I84V mutations. At DRV failure, the major increase was still observed for V32I; I54L, V11I, T74P and I50V also increased. Despite the increment in the mean number of mutations per patient between baseline and failure, in 21 patients (17.8%) at baseline and 36 (30.5%) at failure, no PR mutation was detected. Conclusion: The HIV-DB interpretation algorithm identified few patients with full DRV resistance at baseline and few patients developed full resistance at DRV failure, indicating that complete resistance to DRV is uncommon. © Springer-Verlag 2011.

This study deals with the characterization of ancient seawater concretes from the Roman harbour of Soli-Pompeiopolis, 1 st century B.C., at Mersin in Turkey, drilled by the ROMACONS (Roman Maritime Concrete Study) team in 2009. This research activity was performed in collaboration with the Laboratories Department of CTG Italcementi Group and the Earth Sciences Department of the University "Federico II" of Naples. Results confirmed that the Roman engineers extensively used coarse tuff aggregate, lime hydrated in seawater, and pozzolanic volcanic fine sand, the so-called pulvis puteolanus of Vitruvius's treatise De Architectura (1 st century B.C.). The typical mineralogical association of phillipsite > chabazite > analcime, in particular points out the provenance for the tuff aggregate from the Yellow Neapolitan Tuff (NYT) formation, which is connected to the Campi Flegrei volcanic activity, dated back to 15.000 years ago. As far as the fine pozzolanic sand, of which just some scoria relics have been observed, can be ascribed to the same formation, or, probably, to the pozzolan stricto sensu pyroclastic flow from the Campi Flegrei area, as well. EDS microanalyses of different phillipsite crystals showed that the content of major alkaline and alkaline-earth metals was very close to those of phillipsite crystals from NYT, with K higher than Na and Ca, as previously reported in the literature. This fact clearly attests that zeolites were not involved in cation exchange processes within the seawater, despite of their long time curing - approximately two thousand years - in the marine environment.