Modern sedimentary facies in a progradational barrier-spit system, Goro lagoon, Po delta, Italy

Barriers and spits connected to fluvial sedimentary sources represent environments which tend to evolve rapidly and experience sudden transformations, mainly driven by changes in sediment supply and path. As a consequence, the variability of facies is significant even within small sedimentary records. The 7 km long barrier-spit system facing the Goro Lagoon, and fed by the mouth of the Po di Goro, is a typical example of an accretionary coastal morphotype, suitable to describe adjacent nearshore depositional environments and their stratigraphic signatures, variability, and relationships. Thirteen short cores of sediment were sampled in order to represent the variable depositional subenvironments from the shoreface (prodelta-delta front) to the back barrier, crossing the active barrier-spit and the ancient spit arms and relative swales. The description of the modern sedimentary records, improved upon using core X-rays, has been coupled with information on the morphological changes which occurred during the period of maximum spit development (1955\u20132000), based on available aerial photos and a cartographic/topographic dataset. The results obtained allow for the description and interpretation of the depositional environments changing at the human-scale. Sediments of the upper shoreface are quite uniform, composed by evenly laminated sands; the transition between delta front and prodelta at a depth of 6m is marked by the alternation of sand and mud beds. These reflect the periodic changes in sediment supply by the river, as well as storm events. The most recent spit branch and the relative back barrier-swale environment are the results of the rapid progradation of the spit system, which implies phases of rapid longshore growth, hooked spit development, cannibalization, overwash, and breaching. Morphodynamic changes have resulted in an overlap of short sedimentary records where stratigraphic signatures are linked either to phases of sediment transport and selection by waves and tidal currents (cross-bedding, foreset, and planar laminated sands, shell imbrication, massive beds) or to phases of sedimentary stasis when biological activity is predominant (algal mat and bioturbation). Human signature is also well marked inside the stratigraphic record. Clam harvesting is carried out within the lagoon, causing the physical disturbance and winnowing of the superficial sediment, thus inducing the local formation of graded beds and shell rehash

Recent increases in winter snowfall provide resilience to very small glaciers in the Julian Alps, Europe

Very small glaciers (<0.5 km2) account for more than 80% of the total number of glaciers and more than 15% of the total glacier area in the European Alps. This study seeks to better understand the impact of extreme snowfall events on the resilience of very small glaciers and ice patches in the southeastern European Alps, an area with the highest mean annual precipitation in the entire Alpine chain. Mean annual precipitation here is up to 3300 mm water equivalent, and the winter snow accumulation is approximately 6.80 m at 1800 m asl averaged over the period 1979–2018. As a consequence, very small glaciers and ice/firn patches are still present in this area at rather low altitudes (1830–2340 m). We performed repeated geodetic mass balance measurements on 14 ice bodies during the period 2006–2018 and the results show an increase greater than 10% increase in ice volume over this period. This is in accordance with several extreme winter snow accumulations in the 2000s, promoting a positive mass balance in the following years. The long-term evolution of these very small glaciers and ice bodies matches well with changes in mean temperature of the ablation season linked to variability of Atlantic Multidecadal Oscillation. Nevertheless, the recent behaviour of such residual ice masses in this area where orographic precipitation represents an important component of weather amplification is somehow different to most of the Alps. We analysed synoptic meteorological conditions leading to the exceptional snowy winters in the 2000s, which appear to be related to the influence and modification of atmospheric planetary waves and Arctic Amplification, with further positive feedbacks due to change in local sea surface temperature and its interactions with low level flows and the orography. Although further summer warming is expected in the next decades, we conclude that modification of storm tracks and more frequent occurrence of extreme snowfall events during winter are crucial in ensuring the resilience of small glacial remnants in maritime alpine sectors

Combination antifungal therapy and surgery for the treatment of invasive pulmonary aspergillosis after hematopoietic stem cell transplantation

An 8-year old boy, affected by severe aplastic anemia, developed a probable pulmonary invasive aspergillosis (IA) early after a second unrelated allogeneic hematopoietic stem cell transplant (HSCT). He was treated promptly with the combination of liposomal amphotericin B and caspofungin. Despite the initial stabilization, the patient deteriorated and the antifungal therapy was switched to voriconazole and caspofungin. The patient gradually improved and was discharged home on day +29 post-HSCT on oral voriconazole. On day +119, a sudden episode of hemoptysis occurred and a right superior lobectomy was decided to remove the residual aspergilloma. The patient is now alive and well more than 24 months from HSCT. This case demonstrated that antifungal combination therapy and surgery are valid options to cure pulmonary IA even in patients at high-risk and severely immunosuppressed

Tricuspid regurgitant velocity elevation in a three-year old child with sickle cell anemia and recurrent acute chest syndromes reversed not by hydroxyurea but by bone marrow transplantation

Elevated Tricuspid Regurgitant Velocity (TRV) has been related to higher mortality in adults and to hemolysis, lower oxygen saturation during 6-minute walk test and acute chest syndrome (ACS) in children with sickle cell disease (SCD). Hydroxyurea (HU) has reduced TRV value in children and adults. We describe a three year old HbSS child with recurrent ACS, hypoperfusion of the left lung, mild hemolysis and persistent TRV elevation. TRV did not normalize after HU, despite improvement in clinical conditions and in baseline laboratory parameters related to hemolysis and blood viscosity, but normalized after bone marrow transplantation (BMT). Our experience suggests that in young patients, TRV reduction can be a positive concomitant effect of BMT

Inventory and conservation assessment for the management of coastal dunes, Veneto coasts, Italy

Management of coastal dunes on developed coasts could effectively take advantage of comprehensive and multi temporal georeferenced data collection, which offers the possibility to relate dune data with the natural and cultural characteristics of the beach and hinterland. The recent implementation of a coastal management geodatabase for the Veneto region provides the opportunity for improving knowledge on coastal dunes on developed littoral as well as a basis for appropriate future coastal planning in the study area. The geodatabase gathers data concerning different physical, evolutionary and human aspects of the coastal zone, with a special focus on coastal dunes. Established foredunes, human-altered dunes and relict dunes are irregularly distributed along 59 km, 38% of the entire coastal length. Their distribution and characteristics are the result of favourable natural conditions as well as long-lasting tourism exploitation (evaluated through an index of Land Use Pressure) and fragmentary and diversified uses of beaches (evaluated through an index of Tourism Pressure on the beach). At the same time, beach/dune nourishment intervention allowed the presence of artificial or sand fenced dunes along 17 km of coast. High dune elevation up to 8\u201310 m is promoted by the onshore exposition of the beach to dominant wind (from ENE), by stable-to-slowly negative sedimentary budget or by the re-activation of high relict foredunes in the case of shoreline retreat associated with strong negative budget. Present sedimentary budget (evaluated through the code ASPE \u2013 Accretion, Stable, Precarious, Erosive) is the tool used for dividing coasts in sedimentary compartments or cells. Past and present sedimentary budget and different human responses to erosive cases (hard and soft interventions) give the foredunes different means to form, grow, survive and evolve over time. The assessment of human impact and active management practices on the dunes allows a first evaluation of the management effectiveness, which shows strong shortcomings for 81% of the dunes. The great variability of beach usage, human impact and management practises on the different dune stretches highlight the lack of effective and systematic management actions being correctly scheduled and performed

Inventory and conservation assessment for the management of coastal dunes, Veneto coasts, Italy

4noreservedmixedBezzi, A.; Pillon, S.; Martinucci, D.; Fontolan, G.Bezzi, Annelore; Pillon, Simone; Martinucci, Davide; Fontolan, Giorgi

Geomorphological Changes of a Migrating Sandbank: Multidecadal Analysis as a Tool for Managing Conflicts in Coastal Use

While beach erosion and sand loss are typically of great concern to the tourism industry, managing rapid morphological changes linked to large amounts of moving sediments is the challenge facing Grado, an important seaside resort in the northern Adriatic, Italy. The cause of the unusual management conflict is the presence of the Mula di Muggia Bank, a nearshore depositional system made up of relict and active migrating sandbanks extending up to 2 km seawards from the touristic beachfront. A reconstruction of the morpho-sedimentary evolution of the coastal system over a 200-year period was done using a large dataset which includes historical cartography, topographic maps, aerial photos and topo-bathymetric surveys. The results show the growth of a significant urban development aimed at creating a tourist destination by occupying the waterfront along fetch-limited coastal tracts with very shallow water and scarce hydrodynamics. Furthermore, a number of sandy dynamic landforms (longshore migrating bars, a bypass corridor, an ebb-tidal delta) and accumulation zones attest to a sediment excess which can be mostly attributed to the eastern river supplies. The progressive constant migration rate of 12.6 my-1 allowed the bank to induce the expansion of the low-energy silty backbarrier environment, characterised by abundant seagrass meadows a short distance directly in front of the tourist beaches of Grado. As a result of historical analysis and more current observations, areas with diverse morphosedimentary features and with varying tourist/recreational, ecological, and conservation values have been identified. These can be considered as basic units for future accurate planning and re-evaluation of coastal management choices to balance environmental protection and tourist use. A soft coastal defence approach is proposed which includes either the preservation of specific environments or the proper use of excess sand for beach nourishment via periodic dredging or sediment bypassing

Patient Satisfaction in Italian Childhood Cancer Survivors: Human Aspects of Treatment as a Key Factor in Patients' Quality of Life

The purpose of this study was to illustrate childhood cancer survivors\u2019 perceptions about their experience with the health services and their perceived quality of life. Participants were 213 Northeast Italian childhood cancer survivors with a mean age of 19.4 years (SD = 2.95). Survivors were mostly affected by hematologic disorders (n = 114); 99 had different types of solid tumors. A 30-item questionnaire assessing patient satisfaction was given to the survivors, who had finished treatment on average 9.8 years previously (SD = 4.13). Socioeconomic, medical, and health-related quality of life (HRQOL) data were also collected. The authors ran a varimax rotated factor analysis on patient satisfaction questions and identified four psychometrically robust dimensions (58.15 percent of variance): medical communication and technical quality of care, accessibility and physical environment satisfaction, interpersonal manner, and empathy. Childhood cancer survivors over 18 years old mostly declared that they had a worse HRQOL compared with controls. Patients with the greatest number of years since treatment and who declared that they had more energy at present were also more satisfied with the health care they received. The questionnaire is a promising research tool to give direct voice to childhood cancer survivors