Tectono-sedimentary evolution of the ’Numidian Formation’ and Lateral Facies (southern branch of the western Tethys): constraints for central-western Mediterranean geodynamics

The origin of the Numidian Formation (latest Oligocene to middle Miocene), characterized by ultra-mature quartzose arenites with abundant well-rounded frosted quartz grains, remains controversial. This formation, sedimented in the external domain of the Maghrebian Flysch Basin, displays three characteristic stratigraphic members with marked longitudinal (proximal–distal) and transverse (along-chain) variations with palaeogeographical importance. The origin of the Numidian supply is related to the outward tectogenetic propagation when a forebulge evolved in the African foreland, leading to the erosion of African cratonic areas rich in quartzose arenites (Nubian Sandstone-like). The ages of the Numidian Formation checked by Betic, Maghrebian and Southern Apennine data suggest a timing for the accretionary orogenic wedge, earlier in the Betic-Rifian Arc (after middle Burdigalian), later in the Algerian-Tunisian Tell (after late Burdigalian) and afterwards in Sicily and the Southern Apennines (after Langhian). A geodynamic evolutionary model for the central-western Mediterranean is proposed.

Catheter-related bloodstream infection: burden of disease in a tertiary hospital

Background: Surveillance programmes have become the most effective tool for controlling catheter-related bloodstream infections (CRBSI). However, few studies have investigated programmes covering all hospital settings. Aim: To describe the results of a control and prevention programme for CRBSI based on compliance with recommendations for insertion and maintenance, using annual burden of disease in a tertiary level hospital. Methods: A CRBSI control and prevention programme involving all hospital settings was implemented. The programme consisted of CRBSI surveillance, direct observation of insertion and maintenance of catheters to determine performance, and education for healthcare workers. Findings: In total, 2043 short-term catheters were inserted in 1546 patients for 18,570 catheter-days, and 279 long-term catheters were inserted in 243 patients for 40,440 catheter-days. The annual incidence density was 5.98 (first semester 6.40, second semester 5.64) CRBSI per 1000 catheter-days for short-term catheters, and 0.57 (first semester 0.66, second semester 0.43) CRBSI per 1000 catheter-days for long-term catheters. One hundred and forty insertion procedures were observed, with an average insertion time of 13 (standard deviation 7) min. Compliance with recommendations was as follows: hand hygiene, 86.8%; use of alcoholic chlorhexidine solution for skin disinfection, 35.5%; use of mask, 93.4%; use of gloves, 98.7%; use of gown, 75.0%; use of sterile cloth, 93.8%; use of cap, 92.2%; bandage application, 62.7%; and use of aseptic technique, 89.5%. Forty-five maintenance procedures were observed, and compliance rates were as follows: hand hygiene, 42.1%; use of gloves, 78.1%; and port disinfection with alcoholic chlorhexidine solution, 32.5%. Conclusion: The CRBSI control and prevention programme implemented at the study hospital has decreased the rate of CRBSI, provided important information about the total burden of disease, and revealed possible ways to improve interventions in the future.

Geodynamic events reconstructed in the Betic, Maghrebian, and Apennine chains (central-western Tethys)

A synthetic study has been made to identify main tectono-sedimentary and geodynamic events in central-western Tethys. For this, an interdisciplinary analysis has been performed on successions belonging to tectonic units derived from Betic-Maghrebian-southern Apennine “Flysch basin” domain. The stratigraphic records of the internal, external, and mixed successions deposited in lateral basins of different chains show very similar characters, especially regarding: (a) lithostratigraphy and ages; (b) kind and provenance of supplies (immature and supermature petrofacies from internal and external margins, respectively); (c) presence of “mixed successions” (composed of alternating internal and external petrofacies) attesting to clear palaeogeographic relationships between opposite depositional systems; and (d) timing of the deformation. In addition, specific lithofacies reveal correspondence with similar sedimentary events, such as: (1) very thick silicoclastic supply concentrated in restricted time ranges indicating the main deformational phases in the margin/basin systems; (2) levels rich in black-shales, glauconian, siliceous-producers, and volcaniclastic intercalations, widespread in the studied successions and linked to particular events at the Tethyan scale (anoxic periods, starvation-upwelling, acid-intermediate penecontemporaneous volcanic activity, respectively). Tectonic influence has also been recorded by means of unconformities and tectofacies (such as turbidites, slumps, or olisthostromes, etc.), being correlated with the main deformational phases. Similar stratigraphic and tectonic events have also been found in the Calvana unit of Val Marecchia nappe (Ligurides, northern Apennine). Correlations of stratigraphic and tectonic events support the proposal of an evolutionary geodynamic model involving the presence of a “Mesomediterranean microplate” in intermediate position during Africa-Europe convergence. The closure of central-western Tethys occasioned the Betic-Maghrebian-southern Apennine oceanic branch deformation and the birth of perimediterranean chains during middle-late Miocene.

Self-rated health and hospital services use in the Spanish National Health System: a longitudinal study

Background: Self-rated health is a subjective measure that has been related to indicators such as mortality, morbidity, functional capacity, and the use of health services. In Spain, there are few longitudinal studies associating self-rated health with hospital services use. The purpose of this study is to analyze the association between self-rated health and socioeconomic, demographic, and health variables, and the use of hospital services among the general population in the Region of Valencia, Spain. Methods: Longitudinal study of 5,275 adults who were included in the 2005 Region of Valencia Health Survey and linked to the Minimum Hospital Data Set between 2006 and 2009. Logistic regression models were used to calculate the odds ratios between use of hospital services and self-rated health, sex, age, educational level, employment status, income, country of birth, chronic conditions, disability and previous use of hospital services. Results: By the end of a 4-year follow-up period, 1,184 participants (22.4 %) had used hospital services. Use of hospital services was associated with poor self-rated health among both men and women. In men, it was also associated with unemployment, low income, and the presence of a chronic disease. In women, it was associated with low educational level, the presence of a disability, previous hospital services use, and the presence of chronic disease. Interactions were detected between self-rated health and chronic disease in men and between self-rated health and educational level in women. Conclusions: Self-rated health acts as a predictor of hospital services use. Various health and socioeconomic variables provide additional predictive capacity. Interactions were detected between self-rated health and other variables that may reflect different complex predictive models, by gender.

The Early Miocene “Bisciaro volcaniclastic event” (northern Apennines, Italy): a key study for the geodynamic evolution of the central-western Mediterranean

The Early Miocene Bisciaro Fm., a marly limestone succession cropping out widely in the Umbria–Romagna–Marche Apennines, is characterized by a high amount of volcaniclastic content, characterizing this unit as a peculiar event of the Adria Plate margin. Because of this volcaniclastic event, also recognizable in different sectors of the central-western Mediterranean chains, this formation is proposed as a “marker” for the geodynamic evolution of the area. In the Bisciaro Fm., the volcaniclastic supply starts with the “Raffaello” bed (Earliest Aquitanian) that marks the base of the formation and ends in the lower portion of the Schlier Fm. (Late Burdigalian–Langhian p.p.). Forty-one studied successions allowed the recognition of three main petrofacies: (1) Pyroclastic Deposits (volcanic materials more than 90 %) including the sub-petrofacies 1A, Vitroclastic/crystallo-vitroclastic tuffs; 1B, Bentonitic deposits; and 1C, Ocraceous and blackish layers; (2) Resedimented Syn-Eruptive Volcanogenic Deposits (volcanic material 30–90 %) including the sub-petrofacies 2A, High-density volcanogenic turbidites; 2B, Low-density volcanogenic turbidites; 2C, Crystal-rich volcanogenic deposits; and 2D, Glauconitic-rich volcaniclastites; (3) Mixing of Volcaniclastic Sediments with Marine Deposits (volcanic material 5–30 %, mixed with marine sediments: marls, calcareous marls, and marly limestones). Coeval volcaniclastic deposits recognizable in different tectonic units of the Apennines, Maghrebian, and Betic Chains show petrofacies and chemical–geochemical features related to a similar calc-alkaline magmatism. The characterization of this event led to the hypothesis of a co-genetic relationship between volcanic activity centres (primary volcanic systems) and depositional basins (depositional processes) in the Early Miocene palaeogeographic and palaeotectonic evolution of the central-western Mediterranean region. The results support the proposal of a geodynamic model of this area that considers previously proposed interpretations.