The 2008 Methoni earthquake sequence: the relationship between the earthquake cycle on the subduction interface and coastal uplift in SW Greece

Seismological, GPS and historical data suggest that most of the 40 mm yr$^{-1}$ convergence at the Hellenic Subduction Zone is accommodated through aseismic creep, with earthquakes of $\textit{M}$W ≲ 7 rupturing isolated locked patches of the subduction interface. The size and location of these locked patches are poorly constrained despite their importance for assessment of seismic hazard. We present continuous GPS time-series covering the 2008 MW 6.9 Methoni earthquake, the largest earthquake on the subduction interface since 1960. Post-seismic displacements from this earthquake at onshore GPS sites are comparable in magnitude with the coseismic displacements; elastic-dislocation modelling shows that they are consistent with afterslip on the subduction interface, suggesting that much of this part of the interface is able to slip aseismically and is not locked and accumulating elastic strain. In the Hellenic and other subduction zones, the relationship between earthquakes on the subduction interface and observed long-term coastal uplift is poorly understood. We use cGPS-measured coseismic offsets and seismological body-waveform modelling to constrain centroid locations and depths for the 2008 Methoni $\textit{M}$W 6.9 and 2013 Crete $\textit{M}$W 6.5 earthquakes, showing that the subduction interface reaches the base of the seismogenic layer SW of the coast of Greece. These earthquakes caused subsidence of the coast in regions where the presence of Pliocene–Quaternary marine terraces indicates recent uplift, so we conclude that deformation associated with the earthquake cycle on the subduction interface is not the dominant control on vertical motions of the coastline. It is likely that minor uplift on a short length scale (∼15 km) occurs in the footwalls of normal faults. We suggest, however, that most of the observed Plio-Quaternary coastal uplift in SW Greece is the result of thickening of the overriding crust of the Aegean by reverse faulting or distributed shortening in the accretionary wedge, by underplating of sediment of the Mediterranean seafloor, or a combination of these mechanisms.AH is supported by a Shell Exploration studentship. This study forms part of the NERC- and ESRC-funded project “Earthquakes Without Frontiers” under grant NEJ02001X/1, and was partly funded by the NERC grant “Looking inside the Continents from Space”

Serious adverse events reported in placebo randomised controlled trials of oral naltrexone: a systematic review and meta-analysis

Background Naltrexone is an opioid antagonist used in many different conditions, both licensed and unlicensed. It is used at widely varying doses from 3 - 250 mg. The aim of this review was to evaluate the safety of oral naltrexone by examining the risk of serious adverse events (SAEs) in randomised controlled trials (RCTs) of naltrexone compared to placebo. Methods A systematic search of Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, other databases and clinical trials registries was undertaken up to March 2018. Parallel placebo-controlled RCTs longer than 4 weeks published after 1/1/2001, of oral naltrexone at any dose were selected. Any condition and age group were included, excluding only studies for opioid or ex-opioid users, due to possible opioid/opioid antagonist interactions. The systematic review used the guidance of the Cochrane Handbook throughout. Numerical data was independently extracted by two people and cross-checked. Risk of bias was assessed with the Cochrane Risk of Bias Tool. Meta-analyses were performed using Stata 15 and R, using random and fixed effects models throughout. Results Eighty-nine RCTs with 11194 participants were found, studying alcohol use disorders, various psychiatric disorders, impulse control disorders, other addictions, obesity, Crohn’s disease, fibromyalgia and cancers. Twenty-six studies (4,960 participants) recorded SAEs occurring by arm of study. There was no evidence of increased risk of SAEs for naltrexone compared to placebo, relative risk (RR) 0.84 (95% CI: 0.66 to 1.06). Sensitivity analyses pooling risk differences supported this conclusion (RD = -0.01 (-0.02, 0.00)) and subgroup analyses showed that results were consistent across different doses and disease groups. The quality of evidence for this outcome was judged high using the GRADE criteria. Conclusions Naltrexone does not appear to increase the risk of SAEs over placebo. These findings confirm the safety of naltrexone when used in licensed indications and encourage investments to undertake efficacy studies in unlicensed indications

EuReCa ONE—27 Nations, ONE Europe, ONE Registry A prospective one month analysis of out-of-hospital cardiac arrest outcomes in 27 countries in Europe

AbstractIntroductionThe aim of the EuReCa ONE study was to determine the incidence, process, and outcome for out of hospital cardiac arrest (OHCA) throughout Europe.MethodsThis was an international, prospective, multi-centre one-month study. Patients who suffered an OHCA during October 2014 who were attended and/or treated by an Emergency Medical Service (EMS) were eligible for inclusion in the study. Data were extracted from national, regional or local registries.ResultsData on 10,682 confirmed OHCAs from 248 regions in 27 countries, covering an estimated population of 174 million. In 7146 (66%) cases, CPR was started by a bystander or by the EMS. The incidence of CPR attempts ranged from 19.0 to 104.0 per 100,000 population per year. 1735 had ROSC on arrival at hospital (25.2%), Overall, 662/6414 (10.3%) in all cases with CPR attempted survived for at least 30 days or to hospital discharge.ConclusionThe results of EuReCa ONE highlight that OHCA is still a major public health problem accounting for a substantial number of deaths in Europe.EuReCa ONE very clearly demonstrates marked differences in the processes for data collection and reported outcomes following OHCA all over Europe. Using these data and analyses, different countries, regions, systems, and concepts can benchmark themselves and may learn from each other to further improve survival following one of our major health care events

Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome : Insights from the LUNG SAFE study

Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Methods: In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 ≥ 0.60 during hyperoxemia). Results: Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 250 (12%) had sustained hyperoxemia. Excess FIO2 use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO2 use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO2. Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO2 use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO2 use, compared to 39% in a propensity-matched sample of normoxemic (PaO2 55-100 mmHg) patients (P = 0.47). Conclusions: Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort. Trial registration: LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073publishersversionPeer reviewe

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Optical Properties of Canadian Biomass Burning Particles Over Europe Observed with Calipso and Ground-Based Lidar Systems

A long-lasting biomass burning event affected Europe from 27 August to 3 September 2018. The biomass burning aerosol layers were observed with ground- and space-based lidars in heights ranged between 2-7 km (a.s.l.). The mean backscatter coefficient for the ground-based stations ranged between 0.29 and 1.51 Mm-1sr-1, while the CALIPSO retrieved values ranged between 0.43 and 1.83 Mm-1sr-1. Moreover, the mean Ångström exponent (AEb) values, relevant to backscatter, ranged from 0.83 to 1.04 for the aforementioned lidar stations. At the same time, the mean AEb values obtained from CALIPSO ranged between 0.17 and 1.89. The mean particle depolarization ratio ranged between 0.037 and 0.080

Optical Properties of Canadian Biomass Burning Particles Over Europe Observed with Calipso and Ground-Based Lidar Systems

A long-lasting biomass burning event affected Europe from 27 August to 3 September 2018. The biomass burning aerosol layers were observed with ground- and space-based lidars in heights ranged between 2-7 km (a.s.l.). The mean backscatter coefficient for the ground-based stations ranged between 0.29 and 1.51 Mm-1sr-1, while the CALIPSO retrieved values ranged between 0.43 and 1.83 Mm-1sr-1. Moreover, the mean Ångström exponent (AEb) values, relevant to backscatter, ranged from 0.83 to 1.04 for the aforementioned lidar stations. At the same time, the mean AEb values obtained from CALIPSO ranged between 0.17 and 1.89. The mean particle depolarization ratio ranged between 0.037 and 0.080

OPTICAL PROPERTIES OF CANADIAN BIOMASS BURNING PARTICLES OVER EUROPE OBSERVED WITH CALIPSO AND GROUND-BASED LIDAR SYSTEMS

A long-lasting biomass burning event affected Europe from 27 August to 3 September 2018. The biomass burning aerosol layers were observed with ground- and space -based lidars in heights ranged between 2-7 km (a.s.l.). The mean backscatter coefficient for the ground-based stations ranged between 0.29 and 1.51 Mm(-1)sr(-1), while the CALIPSO retrieved values ranged between 0.43 and 1.83 Mm(-1)sr(-1). Moreover, the mean Angstrom exponent (AE(b)) values, relevant to backscatter, ranged from 0.83 to 1.04 for the aforementioned lidar stations. At the same time, the mean AE(b) values obtained from CALIPSO ranged between 0.17 and 1.89. The mean particle depolarization ratio ranged between 0.037 and 0.080

Saharan Dust Events Over the Northern Mediterranean: 4 Years of Measurements Over 4 Earlinet Stations

Four years (2014-2017) of observations of depolarization Raman Lidar systems of four EARLINET (European Aerosol research Lidar Network) stations [from West to East: Granada (Spain), Potenza (Italy), Athens (Greece) and Limassol (Cyprus)] were collected and used to a statistical analysis of Saharan dust events over Mediterranean basin. In this study, emphasis is given to the consistency of the particle linear depolarization ratio (δp532), the extinction-to-backscatter ratio mentioned as Lidar Ratio (LR532) and the Aerosol Optical Thickness (AOT532) within the observed Saharan dust layers, corresponding to the visible range (532 nm). Geometrical properties and clusters of aerosol mixtures are also presented. Our clustering was based on previous classification by airborne High Spectral Resolution Lidar (HSRL) observations and was further supported by backward trajectory analysis. We found mean δp532 values of 0.24±0.05, 0.26±0.06, 0.28±0.05 and 0.28±0.04, mean LR532 values of 52±8 sr, 51±9 sr, 52±9 sr and 49±6 sr, mean AOT532 values of 0.40±0.31, 0.11±0.07, 0.12±0.10 and 0.32±0.17 and mean layer thicknesses of 3392±1458 m, 2150±1082 m, 1872±816 m and 1716±567 m for Granada, Potenza, Athens and Limassol respectively. This work could assist in bridging the existing gaps related to the extensive and intensive dust aerosol properties over the Mediterranean and enriching the bibliography about mixed aerosol layers from different sources (e.g. dust and biomass burning (BB) aerosols, dust and urban/ industrial aerosols)

Saharan Dust Events Over the Northern Mediterranean: 4 Years of Measurements Over 4 Earlinet Stations

Four years (2014-2017) of observations of depolarization Raman Lidar systems of four EARLINET (European Aerosol research Lidar Network) stations [from West to East: Granada (Spain), Potenza (Italy), Athens (Greece) and Limassol (Cyprus)] were collected and used to a statistical analysis of Saharan dust events over Mediterranean basin. In this study, emphasis is given to the consistency of the particle linear depolarization ratio (δp532), the extinction-to-backscatter ratio mentioned as Lidar Ratio (LR532) and the Aerosol Optical Thickness (AOT532) within the observed Saharan dust layers, corresponding to the visible range (532 nm). Geometrical properties and clusters of aerosol mixtures are also presented. Our clustering was based on previous classification by airborne High Spectral Resolution Lidar (HSRL) observations and was further supported by backward trajectory analysis. We found mean δp532 values of 0.24±0.05, 0.26±0.06, 0.28±0.05 and 0.28±0.04, mean LR532 values of 52±8 sr, 51±9 sr, 52±9 sr and 49±6 sr, mean AOT532 values of 0.40±0.31, 0.11±0.07, 0.12±0.10 and 0.32±0.17 and mean layer thicknesses of 3392±1458 m, 2150±1082 m, 1872±816 m and 1716±567 m for Granada, Potenza, Athens and Limassol respectively. This work could assist in bridging the existing gaps related to the extensive and intensive dust aerosol properties over the Mediterranean and enriching the bibliography about mixed aerosol layers from different sources (e.g. dust and biomass burning (BB) aerosols, dust and urban/ industrial aerosols)