Effects of Surface Geology on Seismic Ground Motion Deduced from Ambient-Noise Measurements in the Town of Avellino, Irpinia Region (Italy)

The effects of surface geology on ground motion provide an important tool in seismic hazard studies. It is well known that the presence of soft sediments can cause amplification of the ground motion at the surface, particularly when there is a sharp impedance contrast at shallow depth. The town of Avellino is located in an area characterised by high seismicity in Italy, about 30 km from the epicentre of the 23 November 1980, Irpinia earthquake (M = 6.9). No earthquake recordings are available in the area. The local geology is characterised by strong heterogeneity, with impedance contrasts at depth. We present the results from seismic noise measurements carried out in the urban area of Avellino to evaluate the effects of local geology on the seismic ground motion. We computed the horizontal-to-vertical (H/V) noise spectral ratios at 16 selected sites in this urban area for which drilling data are available within the first 40 m of depth. A Rayleigh wave inversion technique using the peak frequencies of the noise H/V spectral ratios is then presented for estimating Vs models, assuming that the thicknesses of the shallow soil layers are known. The results show a good correspondence between experimental and theoretical peak frequencies, which are interpreted in terms of sediment resonance. For one site, which is characterised by a broad peak in the horizontal-to-vertical spectral-ratio curve, simple one-dimensional modelling is not representative of the resonance effects. Consistent variations in peak amplitudes are seen among the sites. A site classification based on shear-wave velocity characteristics, in terms of Vs30, cannot explain these data. The differences observed are better correlated to the impedance contrast between the sediments and basement. A more detailed investigation of the physical parameters of the subsoil structure, together with earthquake data, are desirable for future research, to confirm these data in terms of site response

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570