Surface-wave imaging of the weakly-extended Malawi Rift from ambient-noise and teleseismic Rayleigh waves from onshore and lake-bottom seismometers

Located at the southernmost sector of the Western Branch of the East African Rift System, the Malawi Rift exemplifies an active, magma-poor, weakly extended continental rift. To investigate the controls on rifting, we image crustal and uppermost mantle structure beneath the region using ambient-noise and teleseismic Rayleigh-wave phase velocities between 9 and 100 s period. Our study includes six lake-bottom seismometers located in Lake Malawi (Nyasa), the first time seismometers have been deployed in any of the African rift lakes. Noise-levels in the lake are lower than that of shallow oceanic environments and allow successful application of compliance corrections and instrument orientation determination. Resulting phase-velocity maps reveal slow velocities primarily confined to Lake Malawi at short periods (T 25 s) a prominent low-velocity anomaly exists beneath the Rungwe Volcanic Province at the northern terminus of the rift basin. Estimates of phase-velocity sensitivity indicates these low velocities occur within the lithospheric mantle and potentially uppermost asthenosphere, suggesting that mantle processes may control the association of volcanic centers and the localization of magmatism. Beneath the main portion of the Malawi Rift, a modest reduction in velocity is also observed at periods sensitive to the crust and upper mantle, but these velocities are much higher than those observed beneath Rungwe

A novel formulation of inhaled sodium cromoglicate (PA101) in idiopathic pulmonary fibrosis and chronic cough: a randomised, double-blind, proof-of-concept, phase 2 trial

Background Cough can be a debilitating symptom of idiopathic pulmonary fibrosis (IPF) and is difficult to treat. PA101 is a novel formulation of sodium cromoglicate delivered via a high-efficiency eFlow nebuliser that achieves significantly higher drug deposition in the lung compared with the existing formulations. We aimed to test the efficacy and safety of inhaled PA101 in patients with IPF and chronic cough and, to explore the antitussive mechanism of PA101, patients with chronic idiopathic cough (CIC) were also studied. Methods This pilot, proof-of-concept study consisted of a randomised, double-blind, placebo-controlled trial in patients with IPF and chronic cough and a parallel study of similar design in patients with CIC. Participants with IPF and chronic cough recruited from seven centres in the UK and the Netherlands were randomly assigned (1:1, using a computer-generated randomisation schedule) by site staff to receive PA101 (40 mg) or matching placebo three times a day via oral inhalation for 2 weeks, followed by a 2 week washout, and then crossed over to the other arm. Study participants, investigators, study staff, and the sponsor were masked to group assignment until all participants had completed the study. The primary efficacy endpoint was change from baseline in objective daytime cough frequency (from 24 h acoustic recording, Leicester Cough Monitor). The primary efficacy analysis included all participants who received at least one dose of study drug and had at least one post-baseline efficacy measurement. Safety analysis included all those who took at least one dose of study drug. In the second cohort, participants with CIC were randomly assigned in a study across four centres with similar design and endpoints. The study was registered with ClinicalTrials.gov (NCT02412020) and the EU Clinical Trials Register (EudraCT Number 2014-004025-40) and both cohorts are closed to new participants. Findings Between Feb 13, 2015, and Feb 2, 2016, 24 participants with IPF were randomly assigned to treatment groups. 28 participants with CIC were enrolled during the same period and 27 received study treatment. In patients with IPF, PA101 reduced daytime cough frequency by 31·1% at day 14 compared with placebo; daytime cough frequency decreased from a mean 55 (SD 55) coughs per h at baseline to 39 (29) coughs per h at day 14 following treatment with PA101, versus 51 (37) coughs per h at baseline to 52 (40) cough per h following placebo treatment (ratio of least-squares [LS] means 0·67, 95% CI 0·48–0·94, p=0·0241). By contrast, no treatment benefit for PA101 was observed in the CIC cohort; mean reduction of daytime cough frequency at day 14 for PA101 adjusted for placebo was 6·2% (ratio of LS means 1·27, 0·78–2·06, p=0·31). PA101 was well tolerated in both cohorts. The incidence of adverse events was similar between PA101 and placebo treatments, most adverse events were mild in severity, and no severe adverse events or serious adverse events were reported. Interpretation This study suggests that the mechanism of cough in IPF might be disease specific. Inhaled PA101 could be a treatment option for chronic cough in patients with IPF and warrants further investigation

Physical, cognitive, and mental health impacts of COVID-19 after hospitalisation (PHOSP-COVID): a UK multicentre, prospective cohort study

Background The impact of COVID-19 on physical and mental health and employment after hospitalisation with acute disease is not well understood. The aim of this study was to determine the effects of COVID-19-related hospitalisation on health and employment, to identify factors associated with recovery, and to describe recovery phenotypes. Methods The Post-hospitalisation COVID-19 study (PHOSP-COVID) is a multicentre, long-term follow-up study of adults (aged ≥18 years) discharged from hospital in the UK with a clinical diagnosis of COVID-19, involving an assessment between 2 and 7 months after discharge, including detailed recording of symptoms, and physiological and biochemical testing. Multivariable logistic regression was done for the primary outcome of patient-perceived recovery, with age, sex, ethnicity, body-mass index, comorbidities, and severity of acute illness as covariates. A post-hoc cluster analysis of outcomes for breathlessness, fatigue, mental health, cognitive impairment, and physical performance was done using the clustering large applications k-medoids approach. The study is registered on the ISRCTN Registry (ISRCTN10980107). Findings We report findings for 1077 patients discharged from hospital between March 5 and Nov 30, 2020, who underwent assessment at a median of 5·9 months (IQR 4·9–6·5) after discharge. Participants had a mean age of 58 years (SD 13); 384 (36%) were female, 710 (69%) were of white ethnicity, 288 (27%) had received mechanical ventilation, and 540 (50%) had at least two comorbidities. At follow-up, only 239 (29%) of 830 participants felt fully recovered, 158 (20%) of 806 had a new disability (assessed by the Washington Group Short Set on Functioning), and 124 (19%) of 641 experienced a health-related change in occupation. Factors associated with not recovering were female sex, middle age (40–59 years), two or more comorbidities, and more severe acute illness. The magnitude of the persistent health burden was substantial but only weakly associated with the severity of acute illness. Four clusters were identified with different severities of mental and physical health impairment (n=767): very severe (131 patients, 17%), severe (159, 21%), moderate along with cognitive impairment (127, 17%), and mild (350, 46%). Of the outcomes used in the cluster analysis, all were closely related except for cognitive impairment. Three (3%) of 113 patients in the very severe cluster, nine (7%) of 129 in the severe cluster, 36 (36%) of 99 in the moderate cluster, and 114 (43%) of 267 in the mild cluster reported feeling fully recovered. Persistently elevated serum C-reactive protein was positively associated with cluster severity. Interpretation We identified factors related to not recovering after hospital admission with COVID-19 at 6 months after discharge (eg, female sex, middle age, two or more comorbidities, and more acute severe illness), and four different recovery phenotypes. The severity of physical and mental health impairments were closely related, whereas cognitive health impairments were independent. In clinical care, a proactive approach is needed across the acute severity spectrum, with interdisciplinary working, wide access to COVID-19 holistic clinical services, and the potential to stratify care. Funding UK Research and Innovation and National Institute for Health Research

Seismic anisotropy of the upper mantle below Western rift, East Africa

Although the East African rift system formed in cratonic lithosphere above a large‐scale mantle upwelling, some sectors have voluminous magmatism, while others have isolated, small‐volume eruptive centers. We conduct teleseismic shear wave splitting analyses on data from 5 lake‐bottom seismometers and 67 land stations in the Tanganyika‐Rukwa‐Malawi rift zone, including the Rungwe Volcanic Province (RVP), and from 5 seismometers in the Kivu rift and Virunga Volcanic Province, to evaluate rift‐perpendicular strain, rift‐parallel melt intrusion, and regional flow models for seismic anisotropy patterns beneath the largely amagmatic Western rift. Observations from 684 SKS and 305 SKKS phases reveal consistent patterns. Within the Malawi rift south of the RVP, fast splitting directions are oriented northeast with average delays of ~1 s. Directions rotate to N‐S and NNW north of the volcanic province within the reactivated Mesozoic Rukwa and southern Tanganyika rifts. Delay times are largest (~1.25 s) within the Virunga Volcanic Province. Our work combined with earlier studies shows that SKS‐splitting is rift parallel within Western rift magmatic provinces, with a larger percentage of null measurements than in amagmatic areas. The spatial variations in direction and amount of splitting from our results and those of earlier Western rift studies suggest that mantle flow is deflected by the deeply rooted cratons. The resulting flow complexity, and likely stagnation beneath the Rungwe province, may explain the ca. 17 Myr of localized magmatism in the weakly stretched RVP, and it argues against interpretations of a uniform anisotropic layer caused by large‐scale asthenospheric flow or passive rifting