Human responses to the 1906 eruption of Vesuvius, southern Italy

Cultural and political contexts are important in determining the ways in which communities respond to volcanic eruptions. Understanding the manner in which communities and the State apparatus have coped with historic eruptions can provide insights into how responses have influenced vulnerability and resilience. The 1906 eruption of Vesuvius is well suited for such a study as it was one of the first major eruptions in which there was a significant element of State control, and this worked alongside more traditional pre-industrial responses. This eruption was extensively reported in the regional, national and international press and in archives which include still photography. One feature is the rich archive of material published in English language newspapers of record which are analysed fully in the paper for the first time. Many of these data sources are now accessible on-line. The eruption started on April 4th with mild explosive activity and the eruption of lava from 5th to 7th April. On the night of the 7th/8th, activity intensified when a vigorous lava fountain inclined obliquely to the north east, deposited a thick layer of tephra on the towns of Ottaviano and San Giuseppe. This led to roof collapse and a large number of fatalities. There was increased lava emission and a flow progressed south through the outskirts of Boscotrecase cutting the Circumvesuviana railway line and almost reaching Torre Annunziata. Following April 8th the eruption declined and ended on April 21st. In the initial responses to the eruption pre-industrial features were prominent, with the local communities showing social cohesion, self-reliance and little panic. A more negative aspect was the traditional religious response that involved the use of liturgies of divine appeasement and which included the use of saintly relics and images. There is interesting evidence, however, that this coping strategy was driven by the populace rather than by the clergy. The inhabitants of San Giuseppe, for instance, insisted in taking refuge in a church and this led to over 100 fatalities when the roof collapsed. Intervention by the State included: the effective deployment of troops to handle evacuation, to re-open lines of communication and to distribute food and other relief. Management of the disaster was enhanced when prefectural commissioners were given executive powers. We argue that increased State intervention appears to have reduced self-reliance. In the short-term recovery was supported by regional/state aid and by charitable donations particularly from other governments and members of Neapolitan diaspora in other parts of Italy and abroad. This enabled land clearance, agriculture was re-established and roads/rail links were restored. Long-term recovery was slow with affected local-authorities (i.e comuni) showing low rates of population growth for more than 15 years

Supporting the Development of Procedures for Communications During Volcanic Emergencies: Lessons Learnt from the Canary Island (Spain) and Etna and Stromboli (Italy)

Volcanic crises are complex and especially challenging to manage. Volcanic unrest is characterised by uncertainty about: whether an eruption will or will not take place; and its possible location, size and evolution. In addition, the hazards presented by an eruption and the variety of disciplines involved in forecasting and responding to volcanic emergencies, makes planning extremely complicated. On frequently active volcanoes crises often run smoothly because of the experience gained through the continual ‘testing’ of systems of communication. Even when plans have not been officially put in place, all the groups involved have an understanding of their roles and responsibilities and those of other parties. On dormant volcanoes where several generations have not experienced eruptions, there is added uncertainty, not only about the volcanic system per se, but also about the lack of experience of scientists, crisis directors, managers and the public. In such situations communication may be characterised by tensions and misunderstandings, and these have the potential to both affect decision making and delay vital operations. In this paper we present different experiences on communicating information during past volcanic crises on volcanoes that are continuosly active (Etna and Stromboli volcanoes in Sicily) and on a dormant volcano (the El Hierro eruption in the Canary Islands), allowing strategies to improve communications during volcanic emergencies to be proposed. Based on the El Hierro experience, we highlight key aspects that a protocol for communications should consider

The 1928 eruption of Mount Etna (Italy): Reconstructing lava flow evolution and the destruction and recovery of the town of Mascali

Abstract Mount Etna in Sicily (Italy) shows more than 2,500 years of interactions between volcanic eruptions and human activity, and these are well documented in historical sources. During the last 400 years, flank eruptions have had major impacts on the urban fabric of the Etna region, especially in 1651, 1669, 1923 and 1928, and it is the last of these which is the focus of this paper. In this paper a detailed field and historical reconstruction of the 1928 eruption is presented which allows three themes to be discussed: the evolution of the flow field, lava volume and average magma discharge rate trend; the eruption's human impact, particularly the destruction of the town of Mascali; and the recovery of the region with re-construction of Mascali in a new location. Detailed mapping of lava flows allowed the following dimensions to be calculated: total area, 4.38 x 106 m2; maximum length, 9.4 km; volume, 52.91 ± 5.21 × 106m3 and an average effusion rate of 38.5 m3 s-1. Time-averaged discharged rates are calculated allowing the reconstruction of their temporal variations during the course of the eruption evidencing a high maximum effusion rate of 374 m3 s-1. These trends, in particular with regard to the Lower Fissure main phase of the eruption, are in accordance with the ‘idealized discharge model’ of Wadge (1981), proposed for basaltic eruptions driven by de-pressurization of magma sources, mainly through reservoir relaxation (i.e. elastic contraction of a magma body). The eruption took place when Italy was governed by Mussolini and the fascist party. The State response both, during and in the immediate aftermath of the eruption and in the years that followed during which Mascali was reconstructed, was impressive. This masked a less benign legacy, however, that can be traced for several subsequent decades of using responses to natural catastrophes to manufacture State prestige by reacting to, rather than planning for, disasters

Comparison of circulating tumor DNA assays for Molecular Residual Disease detection in early-stage triple negative breast cancer

Purpose: Detection of circulating tumor DNA (ctDNA) in patients who have completed treatment for early-stage breast cancer is associated with a high risk of relapse, yet the optimal assay for ctDNA detection is unknown. Experimental design: The cTRAK-TN clinical trial prospectively used tumor informed digital PCR (dPCR) assays for ctDNA molecular residual disease (MRD) detection in early-stage triple negative breast cancer. We compared tumor informed dPCR assays with tumor informed personalized multi-mutation sequencing assays in 141 patients from cTRAK-TN. Results: MRD was first detected by personalized sequencing in 47.9% of patients, 0% first detected by dPCR, and 52.1% with both assays simultaneously (p<0.001, Fisher’s exact test). The median lead time from ctDNA detection to relapse was 6.1 months with personalized sequencing and 3.9 months with dPCR (p=0.004, mixed effects Cox model). Detection of MRD at the first timepoint was associated with a shorter time to relapse compared with detection at subsequent timepoints (median lead time 4.2 vs 7.1 months, p=0.02). Conclusions: Personalized multi-mutation sequencing assays have potential clinically important improvements in clinical outcome in the early detection of MRD

Results of the c-TRAK TN trial: a clinical trial utilising ctDNA mutation tracking to detect molecular residual disease and trigger intervention in patients with moderate and high-risk early stage triple negative breast cancer

Background: Post-treatment detection of circulating tumour DNA (ctDNA) in early-stage triple negative breast cancer (TNBC) patients predicts high risk of relapse. c-TRAK-TN assessed the utility of prospective ctDNA surveillance in TNBC and the activity of pembrolizumab in patients with ctDNA detected (ctDNA+). Patients and methods: c-TRAK-TN, a multi-centre phase II trial, with integrated prospective ctDNA surveillance by digital PCR, enrolled patients with early-stage TNBC and residual disease following neoadjuvant chemotherapy, or, stage II/III with adjuvant chemotherapy. ctDNA surveillance comprised three monthly blood sampling to 12 months (18 months if samples were missed due to COVID), and ctDNA+ patients were randomised 2:1; intervention:observation. ctDNA results were blinded unless patients were allocated to intervention, when staging scans were done and those free of recurrence were offered pembrolizumab. A protocol amendment (16/09/2020) closed the observation group; all subsequent ctDNA+ patients were allocated to intervention. Co-primary endpoints were i) ctDNA detection rate ii) sustained ctDNA clearance rate on pembrolizumab (NCT03145961). Results: 208 patients registered between 30/01/18 - 06/12/19, 185 had tumour sequenced, 171 (92·4%) had trackable mutations, and 161 entered ctDNA surveillance. Rate of ctDNA detection by 12 months was 27·3% (44/161,95%CI:20·6-34·9). Seven patients relapsed without prior ctDNA detection. 45 patients entered the therapeutic component (intervention n=31; observation n=14; 1 observation patient was re-allocated to intervention following protocol amendment). Of patients allocated intervention, 72% (23/32) had metastases on staging at time of ctDNA+, and 4 patients declined pembrolizumab. Of the five patients who commenced pembrolizumab, none achieved sustained ctDNA clearance. Conclusion: c-TRAK-TN is the first prospective study to assess whether ctDNA assays have clinical utility in guiding therapy in TNBC. Patients had a high rate of metastatic disease on ctDNA detection. Findings have implications for future trial design, emphasising the importance of commencing ctDNA testing early, with more sensitive and/or frequent ctDNA testing regimes

Biodistribution, clearance, and long‐term fate of clinically relevant nanomaterials

Realization of the immense potential of nanomaterials for biomedical applications will require a thorough understanding of how they interact with cells, tissues, and organs. There is evidence that, depending on their physicochemical properties and subsequent interactions, nanomaterials are indeed taken up by cells. However, the subsequent release and/or intracellular degradation of the materials, transfer to other cells, and/or translocation across tissue barriers are still poorly understood. The involvement of these cellular clearance mechanisms strongly influences the long-term fate of used nanomaterials, especially if one also considers repeated exposure. Several nanomaterials, such as liposomes and iron oxide, gold, or silica nanoparticles, are already approved by the American Food and Drug Administration for clinical trials; however, there is still a huge gap of knowledge concerning their fate in the body. Herein, clinically relevant nanomaterials, their possible modes of exposure, as well as the biological barriers they must overcome to be effective are reviewed. Furthermore, the biodistribution and kinetics of nanomaterials and their modes of clearance are discussed, knowledge of the long-term fates of a selection of nanomaterials is summarized, and the critical points that must be considered for future research are addressed

Fulvestrant plus anastrozole or placebo versus exemestane alone after progression on non-steroidal aromatase inhibitors in postmenopausal patients with hormone-receptor-positive locally advanced or metastatic breast cancer (SoFEA): a composite, multicentre, phase 3 randomised trial

SummaryBackgroundThe optimum endocrine treatment for postmenopausal women with advanced hormone-receptor-positive breast cancer that has progressed on non-steroidal aromatase inhibitors (NSAIs) is unclear. The aim of the SoFEA trial was to assess a maximum double endocrine targeting approach with the steroidal anti-oestrogen fulvestrant in combination with continued oestrogen deprivation.MethodsIn a composite, multicentre, phase 3 randomised controlled trial done in the UK and South Korea, postmenopausal women with hormone-receptor-positive breast cancer (oestrogen receptor [ER] positive, progesterone receptor [PR] positive, or both) were eligible if they had relapsed or progressed with locally advanced or metastatic disease on an NSAI (given as adjuvant for at least 12 months or as first-line treatment for at least 6 months). Additionally, patients had to have adequate organ function and a WHO performance status of 0–2. Participants were randomly assigned (1:1:1) to receive fulvestrant (500 mg intramuscular injection on day 1, followed by 250 mg doses on days 15 and 29, and then every 28 days) plus daily oral anastrozole (1 mg); fulvestrant plus anastrozole-matched placebo; or daily oral exemestane (25 mg). Randomisation was done with computer-generated permuted blocks, and stratification was by centre and previous use of an NSAI as adjuvant treatment or for locally advanced or metastatic disease. Participants and investigators were aware of assignment to fulvestrant or exemestane, but not of assignment to anastrozole or placebo. The primary endpoint was progression-free survival (PFS). Analyses were by intention to treat. This trial is registered with ClinicalTrials.gov, numbers NCT00253422 (UK) and NCT00944918 (South Korea).FindingsBetween March 26, 2004, and Aug 6, 2010, 723 patients underwent randomisation: 243 were assigned to receive fulvestrant plus anastrozole, 231 to fulvestrant plus placebo, and 249 to exemestane. Median PFS was 4·4 months (95% CI 3·4–5·4) in patients assigned to fulvestrant plus anastrozole, 4·8 months (3·6–5·5) in those assigned to fulvestrant plus placebo, and 3·4 months (3·0–4·6) in those assigned to exemestane. No difference was recorded between the patients assigned to fulvestrant plus anastrozole and fulvestrant plus placebo (hazard ratio 1·00, 95% CI 0·83–1·21; log-rank p=0·98), or between those assigned to fulvestrant plus placebo and exemestane (0·95, 0·79–1·14; log-rank p=0·56). 87 serious adverse events were reported: 36 in patients assigned to fulvestrant plus anastrozole, 22 in those assigned to fulvestrant plus placebo, and 29 in those assigned to exemestane. Grade 3–4 adverse events were rare; the most frequent were arthralgia (three in the group assigned to fulvestrant plus anastrozole; seven in that assigned to fulvestrant plus placebo; eight in that assigned to exemestane), lethargy (three; 11; 11), and nausea or vomiting (five; two; eight).InterpretationAfter loss of response to NSAIs in postmenopausal women with hormone-receptor-positive advanced breast cancer, maximum double endocrine treatment with 250 mg fulvestrant combined with oestrogen deprivation is no better than either fulvestrant alone or exemestane.FundingCancer Research UK and AstraZeneca

Development of micro-fibrous solid dispersions of poorly water-soluble drugs in sucrose using temperature-controlled centrifugal spinning

Solid dispersion technology represents a successful approach to addressing the bioavailability issues caused by the low aqueous solubility of many Biopharmaceutics Classification System (BCS) Class II drugs. In this study, the use of high-yield manufacture of fiber-based dispersion is explored as an alternative approach to monolith production methods. A temperature-controlled solvent-free centrifugal spinning process was used to produce sucrose-based microfibers containing the poorly water-soluble drugs olanzapine and piroxicam (both BCS Class II); these were successfully incorporated into the microfibers and the basic characteristics of fiber diameter, glassy behavior, drug loading capacity and drug-sucrose interaction assessment were measured. Scanning electron microscopy revealed that bead-free drug-loaded microfibers with homogenous morphology and diameter in the range of a few micrometers were prepared using our process. Differential scanning calorimetric and X-ray diffraction analyses showed that both drug and carrier were present in the amorphous state in the microfibers, although in the case of piroxicam-loaded microfibers, the presence of small amounts of crystalline drug was observed under polarized light microscopy and in Fourier transform infrared spectra. Drug dissolution performance was evaluated under both sink and non-sink conditions and was found to be significantly enhanced compared to the corresponding crystalline physical mixtures and pure drugs, with evidence of supersaturation behavior noted under non-sink conditions. This study has demonstrated that microfiber-based dispersions may be manufactured by the centrifugal spinning process and may possess characteristics that are favorable for the enhanced dissolution and oral absorption of drugs. © 2016 The Authors

HER2-enriched subtype and novel molecular subgroups drive aromatase inhibitor resistance and an increased risk of relapse in early ER+/HER2+ breast cancer

BACKGROUND: Oestrogen receptor positive/ human epidermal growth factor receptor positive (ER+/HER2+) breast cancers (BCs) are less responsive to endocrine therapy than ER+/HER2- tumours. Mechanisms underpinning the differential behaviour of ER+HER2+ tumours are poorly characterised. Our aim was to identify biomarkers of response to 2 weeks’ presurgical AI treatment in ER+/HER2+ BCs. METHODS: All available ER+/HER2+ BC baseline tumours (n=342) in the POETIC trial were gene expression profiled using BC360™ (NanoString) covering intrinsic subtypes and 46 key biological signatures. Early response to AI was assessed by changes in Ki67 expression and residual Ki67 at 2 weeks (Ki672wk). Time-To-Recurrence (TTR) was estimated using Kaplan-Meier methods and Cox models adjusted for standard clinicopathological variables. New molecular subgroups (MS) were identified using consensus clustering. FINDINGS: HER2-enriched (HER2-E) subtype BCs (44.7% of the total) showed poorer Ki67 response and higher Ki672wk (p<0.0001) than non-HER2-E BCs. High expression of ERBB2 expression, homologous recombination deficiency (HRD) and TP53 mutational score were associated with poor response and immune-related signatures with High Ki672wk. Five new MS that were associated with differential response to AI were identified. HER2-E had significantly poorer TTR compared to Luminal BCs (HR 2.55, 95% CI 1.14–5.69; p=0.0222). The new MS were independent predictors of TTR, adding significant value beyond intrinsic subtypes. INTERPRETATION: Our results show HER2-E as a standardised biomarker associated with poor response to AI and worse outcome in ER+/HER2+. HRD, TP53 mutational score and immune-tumour tolerance are predictive biomarkers for poor response to AI. Lastly, novel MS identify additional non-HER2-E tumours not responding to AI with an increased risk of relapse