Coastal Erosion and Flooding Threaten Low-Lying Coastal Tracts at Lipari (Aeolian Islands, Italy)

Lipari is the largest and most populated island in the Aeolian Archipelago, a UNESCO site, and a highly frequented touristic destination. As in many other insular settings, the low-lying coastal stretches in the E and NE sectors of Lipari are locally exposed to coastal erosion and flooding, enhanced by subsidence effects leading to local sea level rise. Most of these coastal sectors appear critical, being narrow and increasingly threatened by the risk of permanent inundation and beach disappearance. In this study, this setting is placed in the wider context of the decadal evolution of the main beaches, analysed through a multidisciplinary approach, which includes remote sensing techniques (aero-photogrammetry, unmanned aerial vehicle survey, and satellite data), offshore geophysical surveys (high-resolution multibeam bathymetry), and field observations. The results show a variable interaction in space and time between natural and anthropogenic factors in the long- and mid-term evolution of the studied coastal areas. Considering that part of the local economy at Lipari depends on beach tourism, proper future management is required in the view of natural risk reduction and in the light of future climate changes and related impacts

Coastal Erosion and Flooding Threaten Low-Lying Coastal Tracts at Lipari (Aeolian Islands, Italy)

Lipari is the largest and most populated island in the Aeolian Archipelago, a UNESCO site, and a highly frequented touristic destination. As in many other insular settings, the low-lying coastal stretches in the E and NE sectors of Lipari are locally exposed to coastal erosion and flooding, enhanced by subsidence effects leading to local sea level rise. Most of these coastal sectors appear critical, being narrow and increasingly threatened by the risk of permanent inundation and beach disappearance. In this study, this setting is placed in the wider context of the decadal evolution of the main beaches, analysed through a multidisciplinary approach, which includes remote sensing techniques (aero-photogrammetry, unmanned aerial vehicle survey, and satellite data), offshore geophysical surveys (high-resolution multibeam bathymetry), and field observations. The results show a variable interaction in space and time between natural and anthropogenic factors in the long- and mid-term evolution of the studied coastal areas. Considering that part of the local economy at Lipari depends on beach tourism, proper future management is required in the view of natural risk reduction and in the light of future climate changes and related impacts

Recalibrating survival prediction among patients receiving trans\u2010arterial chemoembolization for hepatocellular carcinoma

Background & Aims The Pre-TACE-Predict model was devised to assess prognosis of patients treated with trans-arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC). However, before entering clinical practice, a model should demonstrate that it performs a useful role. Methods We performed an independent external validation of the Pre-TACE model in a cohort that differs in setting and time period from the one that generated the original model. Data from 826 patients treated with TACE for naïve HCC (2008-2018) were used to assess calibration and discrimination of the Pre-TACE-Predict model. Results The four risk-categories identified by the Pre-TACE-Predict model had gradient monotonicity, with median survivals of 52.0, 36.2, 29.9, and 14.1 months respectively. However, predicted survivals systematically underestimated observed survivals (R2: 0.667). A recalibration was adopted maintaining fixed the prognostic index and modifying the baseline survival function. This resulted in an almost perfect calibration (R2: 0.995) in all the four risk categories. Cox regressions showed that aetiology and macrovascular invasion, included in the Pre-TACE-Predict model, had no prognostic impact in the present study population, and that coefficients for tumour size and multiplicity were overestimated. The c-index was similar to that of the m-HAP-III, but higher than those of HAP, m-HAP-II and the six-and-twelve models. Conclusions The recalibration of Pre-TACE-Predict model improved the estimation of survival probabilities of HCC patients treated with TACE. The highest discriminatory ability of the Pre-TACE-model in comparison to other available models, together with risk stratification and recalibration, makes it the best prognostic tool currently available for these patients

Material deprivation affects the management and clinical outcome of hepatocellular carcinoma in a high-resource environment

Aim: This study investigated how material deprivation in Italy influences the stage of hepatocellular carcinoma (HCC) at diagnosis and the chance of cure. Methods: 4114 patients from the Italian Liver Cancer database consecutively diagnosed with HCC between January 2008 and December 2018 were analysed about severe material depriva- tion (SMD) rate tertiles of the region of birth and region of managing hospitals, according to the European Statistics on Income and Living Conditions. The main outcomes were HCC diagnosis modalities (during or outside surveillance), treatment adoption and overall survival. Results: In more deprived regions, HCC was more frequently diagnosed during surveillance, while the incidental diagnosis was prevalent in the least deprived. Tumour characteristics did not differ among regions. The proportion of patients undergoing potentially curative treat- ments progressively decreased as the SMD worsened. Consequently, overall survival was bet- ter in less deprived regions. Patients who moved from most deprived to less deprived regions increased their probability of receiving potentially curative treatments by 1.11 times (95% CI 1.03 to 1.19), decreasing their mortality likelihood (hazard ratio 0.78 95% CI 0.67 to 0.90). Conclusions: Socioeconomic status measured through SMD does not seem to influence HCC features at diagnosis but brings a negative effect on the chance of receiving potentially curative treatments. Patient mobility from the most deprived to the less deprived regions increased the access to curative therapies, with the ultimate result of improving survival

Material deprivation affects the management and clinical outcome of hepatocellular carcinoma in a high-resource environment

Aim: This study investigated how material deprivation in Italy influences the stage of hepatocellular carcinoma (HCC) at diagnosis and the chance of cure. Methods: 4114 patients from the Italian Liver Cancer database consecutively diagnosed with HCC between January 2008 and December 2018 were analysed about severe material depriva- tion (SMD) rate tertiles of the region of birth and region of managing hospitals, according to the European Statistics on Income and Living Conditions. The main outcomes were HCC diagnosis modalities (during or outside surveillance), treatment adoption and overall survival. Results: In more deprived regions, HCC was more frequently diagnosed during surveillance, while the incidental diagnosis was prevalent in the least deprived. Tumour characteristics did not differ among regions. The proportion of patients undergoing potentially curative treat- ments progressively decreased as the SMD worsened. Consequently, overall survival was bet- ter in less deprived regions. Patients who moved from most deprived to less deprived regions increased their probability of receiving potentially curative treatments by 1.11 times (95% CI 1.03 to 1.19), decreasing their mortality likelihood (hazard ratio 0.78 95% CI 0.67 to 0.90). Conclusions: Socioeconomic status measured through SMD does not seem to influence HCC features at diagnosis but brings a negative effect on the chance of receiving potentially curative treatments. Patient mobility from the most deprived to the less deprived regions increased the access to curative therapies, with the ultimate result of improving survival