Catastrophic volcanism

Since primitive times, catastrophes due to volcanic activity have been vivid in the mind of man, who knew that his activities in many parts of the world were threatened by lava flows, mudflows, and ash falls. Within the present century, increasingly complex interactions between volcanism and the environment, on scales not previously experienced historically, have been detected or suspected from geologic observations. These include enormous hot pyroclastic flows associated with collapse at source calderas and fed by eruption columns that reached the stratosphere, relations between huge flood basalt eruptions at hotspots and the rifting of continents, devastating laterally-directed volcanic blasts and pyroclastic surges, great volcanic-generated tsunamis, climate modification from volcanic release of ash and sulfur aerosols into the upper atmosphere, modification of ocean circulation by volcanic constructs and attendent climatic implications, global pulsations in intensity of volcanic activity, and perhaps triggering of some intense terrestrial volcanism by planetary impacts. Complex feedback between volcanic activity and additional seemingly unrelated terrestrial processes likely remains unrecognized. Only recently has it become possible to begin to evaluate the degree to which such large-scale volcanic processes may have been important in triggering or modulating the tempo of faunal extinctions and other evolutionary events. In this overview, such processes are examined from the viewpoint of a field volcanologist, rather than as a previous participant in controversies concerning the interrelations between extinctions, impacts, and volcanism

Contemporaneous Trachyandesitic and Calc-alkaline Volcanism of the Huerto Andesite, San Juan Volcanic Field, Colorado, USA

Locally, voluminous andesitic volcanism both preceded and followed large eruptions of silicic ash-flow tuff from many calderas in the San Juan volcanic field. The most voluminous post-collapse lava suite of the central San Juan caldera cluster is the 28 Ma Huerto Andesite, a diverse assemblage erupted from at least 5-6 volcanic centres that were active around the southern margins of the La Garita caldera shortly after eruption of the Fish Canyon Tuff. These andesitic centres are inferred, in part, to represent eruptions of magma that ponded and differentiated within the crust below the La Garita caldera, thereby providing the thermal energy necessary for rejuvenation and remobilization of the Fish Canyon magma body. The multiple Huerto eruptive centres produced two magmatic series that differ in phenocryst mineralogy (hydrous vs anhydrous assemblages), whole-rock major and trace element chemistry and isotopic compositions. Hornblende-bearing lavas from three volcanic centres located close to the southeastern margin of the La Garita caldera (Eagle Mountain-Fourmile Creek, West Fork of the San Juan River, Table Mountain) define a high-K calc-alkaline series (57-65 wt % SiO2) that is oxidized, hydrous and sulphur rich. Trachyandesitic lavas from widely separated centres at Baldy Mountain-Red Lake (western margin), Sugarloaf Mountain (southern margin) and Ribbon Mesa (20 km east of the La Garita caldera) are mutually indistinguishable (55-61 wt % SiO2); they are characterized by higher and more variable concentrations of alkalis and many incompatible trace elements (e.g. Zr, Nb, heavy rare earth elements), and they contain anhydrous phenocryst assemblages (including olivine). These mildly alkaline magmas were less water rich and oxidized than the hornblende-bearing calc-alkaline suite. The same distinctions characterize the voluminous precaldera andesitic lavas of the Conejos Formation, indicating that these contrasting suites are long-term manifestations of San Juan volcanism. The favoured model for their origin involves contrasting ascent paths and differentiation histories through crustal columns with different thermal and density gradients. Magmas ascending into the main focus of the La Garita caldera were impeded, and they evolved at greater depths, retaining more of their primary volatile load. This model is supported by systematic differences in isotopic compositions suggestive of crust-magma interactions with contrasting lithologie

Rapid magma generation or shared magmatic reservoir? Petrology and geochronology of the Rat Creek and Nelson Mountain Tuffs, CO, USA

This study was supported by the ETH Research Grant ETH-34 15-2 (JS).Large-volume silicic volcanism poses global hazards in the form of proximal pyroclastic density currents, distal ash fall and short-term climate perturbations, which altogether warrant the study of how silicic magma bodies evolve and assemble. The southern rocky mountain volcanic field (SRMVF) is home to some of the largest super-eruptions in the geological record, and has been studied to help address the debate over how quickly eruptible magma batches can be assembled–whether in decades to centuries, or more slowly over 100’s of kyr. The present study focuses on the San Luis caldera complex within the SRMVF, and discusses the paradigms of rapid magma generation vs. rapid magma assembly. The caldera complex consists of three overlapping calderas that overlie the sources of three large-volume mid-Cenozoic ignimbrites: first, the Rat Creek Tuff (RCT; zoned dacite-rhyolite, 150 km3), followed by the Cebolla Creek Tuff (mafic dacite, 250 km3) and finally, the Nelson Mountain Tuff (NMT; zoned dacite-rhyolite, 500 km3), which are all indistinguishable in age by 40Ar/39Ar dating. We argue for a shared magmatic history for the three units on the basis of (1) similar mineral trace element compositions in the first and last eruptions (plagioclase, sanidine, biotite, pyroxene, amphibole, titanite, and zircon), (2) overlapping zircon U-Pb ages in all three units, and (3) similar thermal rejuvenation signatures visible in biotite (low-Mn, high-Ba) and zircon (low-Hf, low-U) geochemistry within the RCT and NMT. It is postulated that the NMT was sourced from a pre-existing magma reservoir to the northeast, which is corroborated by the formation of the nearby Cochetopa Caldera during the eruption of the NMT. The inferred lateral magma transport has two important implications: (1) it demonstrates long-distance transport of highly viscosity magmas at volumes (100’s of km3) not previously recorded, and (2) the sourcing of magma from a nearby pre-existing magma reservoir greatly reduces the rate of magma generation necessary to explain the close coincidence of three overlapping, large-volume magma systems. Additionally, the concept of magmatic “flux” (km3 kyr−1) is discussed in this context, and it is argued that an area-normalized flux (km3 kyr–1 km−2) provides a more useful number for measuring magma production rates: it is expected that magmatic volumes will scale with footprint of the thermal anomaly, and not taking this into account may lead to errant volumetric flux (km3 kyr−1) estimates. Meanwhile, area-normalized flux estimates in a given area are similar between units, consistent with evolution in a relatively constant thermal regime. Such estimates also demonstrate similar fluxes for ∼cogenetic volcanic and plutonic units.Publisher PDFPeer reviewe

Psychosocial Treatment of Children in Foster Care: A Review

A substantial number of children in foster care exhibit psychiatric difficulties. Recent epidemiologi-cal and historical trends in foster care, clinical findings about the adjustment of children in foster care, and adult outcomes are reviewed, followed by a description of current approaches to treatment and extant empirical support. Available interventions for these children can be categorized as either symptom-focused or systemic, with empirical support for specific methods ranging from scant to substantial. Even with treatment, behavioral and emotional problems often persist into adulthood, resulting in poor functional outcomes. We suggest that self-regulation may be an important mediat-ing factor in the appearance of emotional and behavioral disturbance in these children

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

Development and Validation of a Risk Score for Chronic Kidney Disease in HIV Infection Using Prospective Cohort Data from the D:A:D Study

Ristola M. on työryhmien DAD Study Grp ; Royal Free Hosp Clin Cohort ; INSIGHT Study Grp ; SMART Study Grp ; ESPRIT Study Grp jäsen.Background Chronic kidney disease (CKD) is a major health issue for HIV-positive individuals, associated with increased morbidity and mortality. Development and implementation of a risk score model for CKD would allow comparison of the risks and benefits of adding potentially nephrotoxic antiretrovirals to a treatment regimen and would identify those at greatest risk of CKD. The aims of this study were to develop a simple, externally validated, and widely applicable long-term risk score model for CKD in HIV-positive individuals that can guide decision making in clinical practice. Methods and Findings A total of 17,954 HIV-positive individuals from the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) study with >= 3 estimated glomerular filtration rate (eGFR) values after 1 January 2004 were included. Baseline was defined as the first eGFR > 60 ml/min/1.73 m2 after 1 January 2004; individuals with exposure to tenofovir, atazanavir, atazanavir/ritonavir, lopinavir/ritonavir, other boosted protease inhibitors before baseline were excluded. CKD was defined as confirmed (>3 mo apart) eGFR In the D:A:D study, 641 individuals developed CKD during 103,185 person-years of follow-up (PYFU; incidence 6.2/1,000 PYFU, 95% CI 5.7-6.7; median follow-up 6.1 y, range 0.3-9.1 y). Older age, intravenous drug use, hepatitis C coinfection, lower baseline eGFR, female gender, lower CD4 count nadir, hypertension, diabetes, and cardiovascular disease (CVD) predicted CKD. The adjusted incidence rate ratios of these nine categorical variables were scaled and summed to create the risk score. The median risk score at baseline was -2 (interquartile range -4 to 2). There was a 1: 393 chance of developing CKD in the next 5 y in the low risk group (risk score = 5, 505 events), respectively. Number needed to harm (NNTH) at 5 y when starting unboosted atazanavir or lopinavir/ritonavir among those with a low risk score was 1,702 (95% CI 1,166-3,367); NNTH was 202 (95% CI 159-278) and 21 (95% CI 19-23), respectively, for those with a medium and high risk score. NNTH was 739 (95% CI 506-1462), 88 (95% CI 69-121), and 9 (95% CI 8-10) for those with a low, medium, and high risk score, respectively, starting tenofovir, atazanavir/ritonavir, or another boosted protease inhibitor. The Royal Free Hospital Clinic Cohort included 2,548 individuals, of whom 94 individuals developed CKD (3.7%) during 18,376 PYFU (median follow-up 7.4 y, range 0.3-12.7 y). Of 2,013 individuals included from the SMART/ESPRIT control arms, 32 individuals developed CKD (1.6%) during 8,452 PYFU (median follow-up 4.1 y, range 0.6-8.1 y). External validation showed that the risk score predicted well in these cohorts. Limitations of this study included limited data on race and no information on proteinuria. Conclusions Both traditional and HIV-related risk factors were predictive of CKD. These factors were used to develop a risk score for CKD in HIV infection, externally validated, that has direct clinical relevance for patients and clinicians to weigh the benefits of certain antiretrovirals against the risk of CKD and to identify those at greatest risk of CKD.Peer reviewe

Multiorgan MRI findings after hospitalisation with COVID-19 in the UK (C-MORE): a prospective, multicentre, observational cohort study

Introduction: The multiorgan impact of moderate to severe coronavirus infections in the post-acute phase is still poorly understood. We aimed to evaluate the excess burden of multiorgan abnormalities after hospitalisation with COVID-19, evaluate their determinants, and explore associations with patient-related outcome measures. Methods: In a prospective, UK-wide, multicentre MRI follow-up study (C-MORE), adults (aged ≥18 years) discharged from hospital following COVID-19 who were included in Tier 2 of the Post-hospitalisation COVID-19 study (PHOSP-COVID) and contemporary controls with no evidence of previous COVID-19 (SARS-CoV-2 nucleocapsid antibody negative) underwent multiorgan MRI (lungs, heart, brain, liver, and kidneys) with quantitative and qualitative assessment of images and clinical adjudication when relevant. Individuals with end-stage renal failure or contraindications to MRI were excluded. Participants also underwent detailed recording of symptoms, and physiological and biochemical tests. The primary outcome was the excess burden of multiorgan abnormalities (two or more organs) relative to controls, with further adjustments for potential confounders. The C-MORE study is ongoing and is registered with ClinicalTrials.gov, NCT04510025. Findings: Of 2710 participants in Tier 2 of PHOSP-COVID, 531 were recruited across 13 UK-wide C-MORE sites. After exclusions, 259 C-MORE patients (mean age 57 years [SD 12]; 158 [61%] male and 101 [39%] female) who were discharged from hospital with PCR-confirmed or clinically diagnosed COVID-19 between March 1, 2020, and Nov 1, 2021, and 52 non-COVID-19 controls from the community (mean age 49 years [SD 14]; 30 [58%] male and 22 [42%] female) were included in the analysis. Patients were assessed at a median of 5·0 months (IQR 4·2–6·3) after hospital discharge. Compared with non-COVID-19 controls, patients were older, living with more obesity, and had more comorbidities. Multiorgan abnormalities on MRI were more frequent in patients than in controls (157 [61%] of 259 vs 14 [27%] of 52; p<0·0001) and independently associated with COVID-19 status (odds ratio [OR] 2·9 [95% CI 1·5–5·8]; padjusted=0·0023) after adjusting for relevant confounders. Compared with controls, patients were more likely to have MRI evidence of lung abnormalities (p=0·0001; parenchymal abnormalities), brain abnormalities (p<0·0001; more white matter hyperintensities and regional brain volume reduction), and kidney abnormalities (p=0·014; lower medullary T1 and loss of corticomedullary differentiation), whereas cardiac and liver MRI abnormalities were similar between patients and controls. Patients with multiorgan abnormalities were older (difference in mean age 7 years [95% CI 4–10]; mean age of 59·8 years [SD 11·7] with multiorgan abnormalities vs mean age of 52·8 years [11·9] without multiorgan abnormalities; p<0·0001), more likely to have three or more comorbidities (OR 2·47 [1·32–4·82]; padjusted=0·0059), and more likely to have a more severe acute infection (acute CRP >5mg/L, OR 3·55 [1·23–11·88]; padjusted=0·025) than those without multiorgan abnormalities. Presence of lung MRI abnormalities was associated with a two-fold higher risk of chest tightness, and multiorgan MRI abnormalities were associated with severe and very severe persistent physical and mental health impairment (PHOSP-COVID symptom clusters) after hospitalisation. Interpretation: After hospitalisation for COVID-19, people are at risk of multiorgan abnormalities in the medium term. Our findings emphasise the need for proactive multidisciplinary care pathways, with the potential for imaging to guide surveillance frequency and therapeutic stratification

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