Observations and modelling of soil slip-debris flow initiation processes in pyroclastic deposits: the Sarno 1998 event

International audiencePyroclastic soils mantling a wide area of the Campanian Apennines are subjected to recurrent instability phenomena. This study analyses the 5 and 6 May 1998 event which affected the Pizzo d'Alvano (Campania, southern Italy). More than 400 slides affecting shallow pyroclastic deposits were triggered by intense and prolonged but not extreme rainfall. Landslides affected the pyroclastic deposits that cover the steep calcareous ridges and are soil slip-debris flows and rapid mudflows. About 30 main channels were deeply scoured by flows which reached the alluvial fans depositing up to 400 000 m3 of material in the piedmont areas. About 75% of the landslides are associated with morphological discontinuities such as limestone cliffs and roads. The sliding surface is located within the pyroclastic cover, generally at the base of a pumice layer. Geotechnical characterisation of pyroclastic deposits has been accomplished by laboratory and in situ tests. Numerical modelling of seepage processes and stability analyses have been run on four simplified models representing different settings observed at the source areas. Seepage modelling showed the formation of pore pressure pulses in pumice layers and the localised increase of pore pressure in correspondence of stratigraphic discontinuities as response to the rainfall event registered between 28 April and 5 May. Numerical modelling provided pore pressure values for stability analyses and pointed out critical conditions where stratigraphic or morphological discontinuities occur. This study excludes the need of a groundwater flow from the underlying bedrock toward the pyroclastic cover for instabilities to occur

Soil slips and debris flows on terraced slopes

International audienceTerraces cover large areas along the flanks of many alpine and prealpine valleys. Soil slips and soil slips-debris flows are recurrent phenomena along terraced slopes. These landslides cause damages to people, settlements and cultivations. This study investigates the processes related to the triggering of soil slip-debris flows in these settings, analysing those occurred in Valtellina (Central Alps, Italy) on November 2000 after heavy prolonged rainfalls. 260 landslides have been recognised, mostly along the northern valley flank. About 200 soil slips and slumps occurred in terraced areas and a third of them evolved into debris flows. Field work allowed to recognise the settings at soil slip-debris flow source areas. Landslides affected up to 2.5 m of glacial, fluvioglacial and anthropically reworked deposits overlying metamorphic basement. Laboratory and in situ tests allowed to characterise the geotechnical and hydraulic properties of the terrains involved in the initial failure. Several stratigraphic and hydrogeologic factors have been individuated as significant in determining instabilities on terraced slopes. They are the vertical changes of physical soil properties, the presence of buried hollows where groundwater convergence occurs, the rising up of perched groundwater tables, the overflow and lateral infiltration from superficial drainage network, the runoff concentration by means of pathways and the insufficient drainage of retaining walls

Costs of chronic obstructive pulmonary disease (COPD) in Italy: The SIRIO study (Social Impact of Respiratory Integrated Outcomes)

SummaryChronic respiratory diseases affect a large number of subjects in Italy and are characterized by high socio-health costs. The aim of the Social Impact of Respiratory Integrated Outcomes (SIRIO) study was to measure the health resources consumption and costs generated in 1 year by a population of patients with chronic obstructive pulmonary disease (COPD) in a real-life setting. This bottom-up, observational, prospective, multicentric study was based on the collection of demographic, clinical, diagnostic, therapeutic and outcome data from COPD patients who reported spontaneously to pneumological centers participating in the study, the corresponding economic outcomes being assessed at baseline and after a 1-year survey. A total of 748 COPD patients were enrolled, of whom 561 [408m, mean age 70.3 years (SD 9.2)] were defined as eligible by the Steering Committee. At the baseline visit, the severity of COPD (graded according to GOLD 2001 guidelines) was 24.2% mild COPD, 53.7% moderate and 16.8% severe. In the 12 months prior to enrollment, 63.8% visited a general practitioner (GP); 76.8% also consulted a national health service (NHS) specialist; 22.3% utilized Emergency Care and 33% were admitted to hospital, with a total of 5703 work days lost. At the end of the 1-year survey, the severity of COPD changed as follows: 27.5% mild COPD, 47.4% moderate and 19.4% severe. Requirement of health services dropped significantly: 57.4% visited the GP; 58.3% consulted an NHS specialist; 12.5% used Emergency Care and 18.4% were hospitalized. Compared to baseline, the mean total cost per patient decreased by 21.7% (p<0.002). In conclusion, a significant reduction in the use of health resources and thus of COPD-related costs (both direct and indirect costs) was observed during the study, likely due to a more appropriate care and management of COPD patients

The Effect of Maintenance Treatment with Erdosteine on Exacerbation Treatment and Health Status in Patients with COPD: A Post-Hoc Analysis of the RESTORE Dataset.

Purpose: To explore the effect of erdosteine on COPD exacerbations, health-related quality of life (HRQoL), and subjectively assessed COPD severity. Patients and methods: This post-hoc analysis of the RESTORE study included participants with COPD and spirometrically moderate (GOLD 2; post-bronchodilator forced expiratory volume in 1 second [FEV1] 50‒79% predicted; n = 254), or severe airflow limitation (GOLD 3; post-bronchodilator FEV1 30‒49% predicted; n = 191) who received erdosteine 300 mg twice daily or placebo added to usual maintenance therapy for 12 months. Antibiotic and oral corticosteroid use was determined together with patientreported HRQoL (St George’s Respiratory Questionnaire, SGRQ). Patient and physician subjective COPD severity scores (scale 0‒4) were rated at baseline, 6 and 12 months. Data were analyzed using descriptive statistics for exacerbation severity, COPD severity, and treatment group. Comparisons between treatment groups used Student’s t-tests or ANCOVA as appropriate. Results: Among GOLD 2 patients, 43 of 126 erdosteine-treated patients exacerbated (7 moderate-to-severe exacerbations), compared to 62 of 128 placebo-treated patients (14 moderate-to-severe exacerbations). Among those with moderate-to-severe exacerbations, erdosteine-treated patients had a shorter mean duration of corticosteroid treatment (11.4 days vs 13.3 days for placebo, P = 0.043), and fewer patients required antibiotic treatment with/without oral corticosteroids (71.4% vs 85.8% for placebo, P &lt; 0.001). Erdosteine-treated GOLD 2 patients who exacerbated showed significant improvements from baseline in SGRQ total scores and subjective disease severity scores (patient- and physician-rated), compared with placebo-treated patients regardless of exacerbation severity. Among GOLD 3 patients, there were no significant differences between treatment groups on any of these measures. Conclusion: Adding erdosteine to the usual maintenance therapy of COPD patients with moderate airflow limitation reduced the number of exacerbations, the duration of treatment with corticosteroids and the episodes requiring treatment with antibiotics. Additionally, treatment with erdosteine improved HRQoL and patient-reported disease severity

Cost analysis of GER-induced asthma: a controlled study vs. atopic asthma of comparable severity.

Abstract Bronchial asthma is a costly disease: while the role of pharmaceutical strategies was greatly emphasised in order to alleviate its economic burden,the aetiological approach to asthma has received much less attention from this point of view. The impact of gastro-oesophageal reflux (GER)-related asthma was assessed in comparison to atopic asthma in 262 matched patients,and the corresponding direct and indirect annual costs calculated. All subjects were screened by means of a 95-item self-questionnaire. The overall resource utilisation was calculated for the last 12 months. Drug-induced annual costs were euro 290.4 (interquartile range-iqr 32.8) in atopic and euro 438.4 (iqr 27.8) in GER-related asthma (p<0.001); expenditure for medical consultations and diagnostics were euro 166.1 (iqr 14.8) vs. euro 71.6 (iqr 11.0) (p<0.001),and euro 338.4 (20.0) vs. 186.9 (iqr 26.5) (p<0.001),respectively. Direct costs due to hospital admissions and indirect costs due to absenteeism were also higher in GER-related asthmatics: 2.201.7+/-90.0 vs. euro 567.1+/-11.0 (p<0.001),and euro 748.7+/-94.7 vs. euro 103.6+/-33.9 (p<0.001),respectively. The total annual cost per patient was euro 1246.7 (iqr 1979.6) in atopic and euro 3967.1 (iqr 3751.5) in GER-related asthma,p<0.001. In conclusion,GER-induced asthma has a more relevant economic impact on healthcare resources than atopic asthma. Although further studies are needed,present data tend to demonstrate that when facing difficult asthma (GER-related asthma in this case),the aetiological assessment of the disease plays a critical role in optimising the approach to patients' needs

PIKO-1, an effective, handy device for the patient's personal PEFR and FEV1 electronic long-term monitoring.

BACKGROUND AND AIM: Subjects with airway obstruction are strongly recommended to monitor their lung function, which is particularly variable in asthma. Unlike PEFR, other personal measurements (such as FEV1) are still difficult to perform. PIKO-1 is the first electronic device for both PEFR and FEV1 personal check, but its precision has not yet been assessed. The aim of this study was to compare PEFR and FEV1 values from PIKO-1 and from a conventional spirometer in subjects with airway obstruction. METHODS: In total, 352 subjects (217 men; 47.6 +/- 19.0 years; 72.6 +/- 15.0 kg; 168.1 +/- 11.9 cm) performed sequential measurements using a PIKO-1 device and a spirometer. Wilcoxon signed-rank test and sign test were used as statistical tests. RESULTS: Mean FEV1 values from the spirometer and PIKO-1, respectively, were 2.9 L +/- 1.1 and 3.0 L +/- 1.1, and mean PEFR values were 466.1 L/min +/- 164.5 SD and 426.3 L/min +/- 151.6 SD. PIKO-1 proved to overestimate FEV1 values by 4% (p<0.0001) and to underestimate PEFR values by 8% (p<0.000) systematically. CONCLUSIONS: The precision of both PIKO-1 measurements (such as FEV1 and PEFR) have been assessed. PEFR and FEV1 measures should be reset by two different constants. Nevertheless, PIKO-1 is a suitable and reliable device for the personal monitoring of obstructive patients in real life

PIKO-1, an effective, handy device for the patient’s personal PEFR and FEV1 electronic long-term monitoring

Background and Aim. Subjects with airway obstruction are strongly recommended to monitor their lung function, which is particularly variable in asthma. Unlike PEFR, other personal measurements (such as FEV1) are still difficult to perform. PIKO-1 is the first electronic device for both PEFR and FEV1 personal check, but its precision has not yet been assessed. The aim of this study was to compare PEFR and FEV1 values from PIKO-1 and from a conventional spirometer in subjects with airway obstruction. Methods. In total, 352 subjects (217 men; 47.6 ± 19.0 years; 72.6 ± 15.0 kg; 168.1 ± 11.9 cm) performed sequential measurements using a PIKO-1 device and a spirometer. Wilcoxon signed-rank test and sign test were used as statistical tests. Results. Mean FEV1 values from the spirometer and PIKO-1, respectively, were 2.9 L ± 1.1 and 3.0 L ± 1.1, and mean PEFR values were 466.1 L/min ± 164.5 SD and 426.3 L/min ± 151.6 SD. PIKO-1 proved to overestimate FEV1 values by 4% (p<0.0001) and to underestimate PEFR values by 8% (p<0.000) systematically. Conclusions. The precision of both PIKO-1 measurements (such as FEV1 and PEFR) have been assessed. PEFR and FEV1 measures should be reset by two different constants. Nevertheless, PIKO-1 is a suitable and reliable device for the personal monitoring of obstructive patients in real life

PIKO-1, an effective, handy device for the patient's personal PEFR and FEV1 electronic long-term monitoring

Background and Aim. Subjects with airway obstruction are strongly recommended to monitor their lung function, which is particularly variable in asthma. Unlike PEFR, other personal measurements (such as FEV1) are still difficult to perform. PIKO-1 is the first electronic device for both PEFR and FEV1 personal check, but its precision has not yet been assessed. The aim of this study was to compare PEFR and FEV1 values from PIKO-1 and from a conventional spirometer in subjects with airway obstruction. Methods. In total, 352 subjects (217 men; 47.6 ± 19.0 years; 72.6 ± 15.0 kg; 168.1 ± 11.9 cm) performed sequential measurements using a PIKO-1 device and a spirometer. Wilcoxon signed-rank test and sign test were used as statistical tests. Results. Mean FEV1 values from the spirometer and PIKO-1, respectively, were 2.9 L ± 1.1 and 3.0 L ± 1.1, and mean PEFR values were 466.1 L/min ± 164.5 SD and 426.3 L/min ± 151.6 SD. PIKO-1 proved to overestimate FEV1 values by 4% (p&lt;0.0001) and to underestimate PEFR values by 8% (p&lt;0.000) systematically. Conclusions. The precision of both PIKO-1 measurements (such as FEV1 and PEFR) have been assessed. PEFR and FEV1 measures should be reset by two different constants. Nevertheless, PIKO-1 is a suitable and reliable device for the personal monitoring of obstructive patients in real life