Investigation of the Luco dei Marsi DSGSD revealing the first evidence of a basal shear zone in the central Apennine belt (Italy)

Deep-seated gravitational slope deformations (DSGSDs) show a wide range of geomorphological characteristics and kinematic behaviours. In many cases, deforming rock masses move on a continuous surface or a thick basal shear zone (BSZ) overlying the stable bedrock. The nature of this boundary is a significant issue in scientific debates since examples of BSZs have been observed or inferred in some DSGSDs worldwide. In the central Apennines, although several cases of DSGSDs have been described in recent decades, no evidence of BSZs has been documented thus far. This work presents the first case of a BSZ found in the region at the bottom of a large-scale gravitational deformation that affects the Mesozoic-Cenozoic carbonate ridge overhanging the Luco dei Marsi village (Abruzzi region). The BSZ consists of several metres-thick, cataclastic breccia developed within middle-Upper Cretaceous biodetritic limestone. The breccia level is exposed for approximately 200 m with a subhorizontal geometry and shows severe rock damage and weathering. The DSGSD hosting the BSZ affects an NNW-SSE-oriented and wide Miocene anticline whose eastern limb is dismembered by Pliocene-Quaternary normal faults delimiting the edge of a large Quaternary intermontane basin (the Fucino Basin). Field survey, aerial photointerpretation, and remote sensing (DInSAR technique) analyses outline an active gravity-driven process. This is characterized by several kinds of geomorphological features, including downhill- and uphill-facing scarps, ridge-top depressions, gravitational grabens and trenches in the upper and middle parts of the ridge, and bulging at the toe of the slope. These features, which can be distinguished from tectonic elements due to their shape and extension, are an indication of a high degree of internal deformation and a compound sagging geometry for the Luco dei Marsi DSGSD. The short-term activity of the process was revealed by DInSAR time series covering almost thirty years of satellite datasets, including ERS1/2, ENVISAT, COSMO-SkyMed, and SENTINEL 1 constellations. Strain rates on the order of a few mm/yr were inferred, with a marked difference between different sectors of the DSGSD area. The long-term (y > 102) lifespan of the DSGSD was framed into a multiple-step conceptual model summarizing the Early Pleistocene-Holocene geological evolution of the area. The model results outline the control exercised by extensional tectonics on DSGSD development, as progressive displacements along normal faults in the latest Pleistocene were the cause of lateral unconfinement at the toe of the slope. This work further contributes to the increasing knowledge on DSGSDs in the central Apennines and the understanding of the relationship between deformation features induced by slope morphogenesis, such as the BSZ, and Quaternary tectonics within the mountain belt

Report from the third international consensus meeting to harmonise core outcome measures for atopic eczema/dermatitis clinical trials (HOME).

This report provides a summary of the third meeting of the Harmonising Outcome Measures for Eczema (HOME) initiative held in San Diego, CA, U.S.A., 6-7 April 2013 (HOME III). The meeting addressed the four domains that had previously been agreed should be measured in every eczema clinical trial: clinical signs, patient-reported symptoms, long-term control and quality of life. Formal presentations and nominal group techniques were used at this working meeting, attended by 56 voting participants (31 of whom were dermatologists). Significant progress was made on the domain of clinical signs. Without reference to any named scales, it was agreed that the intensity and extent of erythema, excoriation, oedema/papulation and lichenification should be included in the core outcome measure for the scale to have content validity. The group then discussed a systematic review of all scales measuring the clinical signs of eczema and their measurement properties, followed by a consensus vote on which scale to recommend for inclusion in the core outcome set. Research into the remaining three domains was presented, followed by discussions. The symptoms group and quality of life groups need to systematically identify all available tools and rate the quality of the tools. A definition of long-term control is needed before progress can be made towards recommending a core outcome measure

Outcomes after pediatric open, laparoscopic, and robotic pyeloplasty at academic institutions

INTRODUCTION: Patient age and hospital volume have been shown to affect perioperative outcomes after pediatric pyeloplasty. However, to date, there are few multicenter studies that focus on outcomes at teaching hospitals, where many of the operations are performed. OBJECTIVE: The goal was to determine if surgical approach, age, case volume, or other factors influence perioperative outcomes in a large contemporary cohort. STUDY DESIGN: Using the clinical database/resource manager (CDB/RM) of the University Health-System Consortium (UHC), children who underwent open, laparoscopic, or robotic pyeloplasty from 2011 to 2014 were identified at 102 academic institutions. Surgery type, age, race, gender, insurance type, geographic region, comorbidities, surgeon volume, and hospital volume were measured. Multivariable mixed-effects logistic regression analysis was used to analyze independent variables associated with complication rates, length of stay (LOS), readmission rates, and ICU admission. RESULTS: A total of 2,219 patients were identified. Complication rates were 2.1%, 2.2%, and 3% after open, laparoscopic, and robotic pyeloplasty, respectively. Approximately 12% of patients had underlying comorbidities. Comorbidities were associated with 3.1 times increased odds for complication (p = 0.001) and a 35% longer length of stay (p < 0.001). Age, gender, insurance type, and hospital volume had no effect on complication rates. A trend was seen towards a lower rate of complications with higher surgeon volume (p = 0.08). The mean LOS was 2.0 days in the open pyeloplasty group, 2.4 days in the laparoscopic group and 1.8 days in the robotic group. Patients who underwent robotic surgery had an estimated LOS 11% shorter than those after open surgery (p = 0.03) (table). Patients aged 5 years and under who had robotic surgery had an estimated LOS 14% shorter than those after open surgery (p = 0.06). ICU admission and hospital readmission were not associated with any variables. DISCUSSION: The study is limited by the accuracy of the data submitted by the hospitals and is subject to coding error. Complication rates remain low in all three approaches, validating their safety. Patients, including younger patients, had shorter lengths of stay after robotic surgery. The statistically significant differences between approaches were small so clinically there may not be a difference. CONCLUSIONS: This large multicenter analysis demonstrates that patient comorbidity had the greatest impact upon complication rates and length of stay. Previous work showed that the benefits of laparoscopy were limited to older children. However, this large multicenter study suggests that these benefits now extend to young children with the application of robotics

Report from the third international consensus meeting to harmonise core outcome measures for atopic eczema/dermatitis clinical trials (HOME)

This report provides a summary of the third meeting of the Harmonising Outcome Measures for Eczema (HOME) initiative held in San Diego, CA, U.S.A., 6-7 April 2013 (HOME III). The meeting addressed the four domains that had previously been agreed should be measured in every eczema clinical trial: clinical signs, patient-reported symptoms, long-term control and quality of life. Formal presentations and nominal group techniques were used at this working meeting, attended by 56 voting participants (31 of whom were dermatologists). Significant progress was made on the domain of clinical signs. Without reference to any named scales, it was agreed that the intensity and extent of erythema, excoriation, oedema/papulation and lichenification should be included in the core outcome measure for the scale to have content validity. The group then discussed a systematic review of all scales measuring the clinical signs of eczema and their measurement properties, followed by a consensus vote on which scale to recommend for inclusion in the core outcome set. Research into the remaining three domains was presented, followed by discussions. The symptoms group and quality of life groups need to systematically identify all available tools and rate the quality of the tools. A definition of long-term control is needed before progress can be made towards recommending a core outcome measur