Seismic imaging of Santorini: subsurface constraints on caldera collapse and present-day magma recharge

Volcanic calderas are surface depressions formed by roof collapse following evacuation of magma from an underlying reservoir. The mechanisms of caldera formation are debated and predict differences in the evolution of the caldera floor and distinct styles of magma recharge. Here we use a dense, active source, seismic tomography study to reveal the sub-surface physical properties of the Santorini caldera in order to understand caldera formation. We find a ∼3-km-wide, cylindrical low-velocity anomaly in the upper 3 km beneath the north-central portion of the caldera, that lies directly above the pressure source of the 2011-2012 inflation. We interpret this anomaly as a low-density volume caused by excess porosities of between 4% and 28%, with pore spaces filled with hot seawater. Vents that were formed during the first three phases of the 3.6 ka Late Bronze Age (LBA) eruption are located close to the edge of the imaged structure. The correlation between older volcanic vents and the low-velocity anomaly suggests that this feature may be long-lived. We infer that collapse of a limited area of the caldera floor resulted in a high-porosity, low-density cylindrical volume, which formed by either chaotic collapse along reverse faults, wholesale subsidence and infilling with tuffs and ignimbrites, phreatomagmatic fracturing, or a combination of these processes. Phase 4 eruptive vents are located along the margins of the topographic caldera and the velocity structure indicates that coherent down-drop of the wider topographic caldera followed the more limited collapse in the northern caldera. This progressive collapse sequence is consistent with models for multi-stage formation of nested calderas along conjugate reverse and normal faults. The upper crustal density differences inferred from the seismic velocity model predict differences in subsurface gravitational loading that correlate with the location of 2011-2012 edifice inflation. This result supports the hypothesis that sub-surface density anomalies may influence present-day magma recharge events. We postulate that past collapses and the resulting topographical and density variations at Santorini influence magma focusing between eruptive cycles, a feedback process that may be important in other volcanoes

A novel emergency department based prevention intervention program for people living with HIV: evaluation of early experiences

<p>Abstract</p> <p>Background</p> <p>HIV prevention is increasingly focused on people living with HIV (PLWH) and the role of healthcare settings in prevention. Emergency Departments (EDs) frequently care for PLWH, but do not typically endorse a prevention mission. We conducted a pilot exploratory evaluation of the first reported ED program to address the prevention needs of PLWH.</p> <p>Methods</p> <p>This retrospective observational cohort evaluation reviewed program records to describe the first six months of participants and programmatic operation. Trained counselors provided a risk assessment and counseling intervention combined with three linkage interventions: i) linkage to health care, ii) linkage to case management, and iii) linkage to partner counseling and referral.</p> <p>Results</p> <p>Of 81 self-identified PLWH who were approached, 55 initially agreed to participate. Of those completing risk assessment, 17/53 (32%, 95 CI 20% to 46%) reported unprotected anal/vaginal intercourse or needle sharing in the past six months with a partner presumed to be HIV negative. Counseling was provided to 52/53 (98%). For those requesting services, 11/15 (73%) were linked to healthcare, 4/23 (17%) were coordinated with case management, and 1/4 (25%) completed partner counseling and referral.</p> <p>Conclusion</p> <p>Given base resources of trained counselors, it was feasible to implement a program to address the prevention needs for persons living with HIV in an urban ED. ED patients with HIV often have unmet needs which might be addressed by improved linkage with existing community resources. Healthcare and prevention barriers for PLWH may be attenuated if EDs were to incorporate CDC recommended prevention measures for healthcare providers.</p

Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Background Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis. Methods A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16–45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis). Results Some 5345 patients across 154 UK hospitals were identified, of which two‐thirds (3613 of 5345, 67·6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28·2 per cent) than men (120 of 993, 12·1 per cent) (relative risk 2·33, 95 per cent c.i. 1·92 to 2·84; P < 0·001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut‐off score 8 or less, specificity 63·1 per cent, failure rate 3·7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut‐off score 2 or less, specificity 24·7 per cent, failure rate 2·4 per cent). Conclusion Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision‐making by identifying adults in the UK at low risk of appendicitis were identified