A model for assessing the systemic vulnerability in landslide prone areas

Abstract. The objectives of spatial planning should include the definition and assessment of possible mitigation strategies regarding the effects of natural hazards on the surrounding territory. Unfortunately, however, there is often a lack of adequate tools to provide necessary support to the local bodies responsible for land management. This paper deals with the conception, the development and the validation of an integrated numerical model for assessing systemic vulnerability in complex and urbanized landslide-prone areas. The proposed model considers this vulnerability not as a characteristic of a particular element at risk, but as a peculiarity of a complex territorial system, in which the elements are reciprocally linked in a functional way. It is an index of the tendency of a given territorial element to suffer damage (usually of a functional kind) due to its interconnections with other elements of the same territorial system. The innovative nature of this work also lies in the formalization of a procedure based on a network of influences for an adequate assessment of such "systemic" vulnerability. This approach can be used to obtain information which is useful, in any given situation of a territory hit by a landslide event, for the identification of the element which has suffered the most functional damage, ie the most "critical" element and the element which has the greatest repercussions on other elements of the system and thus a "decisive" role in the management of the emergency. This model was developed within a GIS system through the following phases: 1. the topological characterization of the territorial system studied and the assessment of the scenarios in terms of spatial landslide hazard. A statistical method, based on neural networks was proposed for the assessment of landslide hazard; 2. the analysis of the direct consequences of a scenario event on the system; 3. the definition of the assessment model of systemic vulnerability in landslide-prone areas. To highlight the potentialities of the proposed approach we have described a specific case study of landslide hazard in the local council area of Potenza

Unusual skin toxicity associated with sustained disease response induced by nivolumab in a patient with non-small cell lung cancer

Introduction: Immunotherapy has shown efficacy in the treatment of different malignancies. Nivolumab, an immune checkpoint inhibitor directed against programmed death-1, has been approved for non-small cell lung cancer (NSCLC) in pretreated patients. Although it is generally well-tolerated, immunotherapy may be complicated by a wide range of immune-mediated adverse events. We describe the case of an uncommon skin toxicity arising as alopecia universalis induced by nivolumab in a patient with NSCLC. Case description: A 58-year-old man received nivolumab for metastatic NSCLC after progression to 3 lines of chemotherapy. The treatment was prescribed in June 2016, and induced a rapid and significant disease response. Nivolumab was well-tolerated until May 2017, when partial alopecia at hair and eyelashes appeared. In the next months, alopecia became complete and extended to the whole body surface. The dermatologic picture was compatible with alopecia areata. A topical steroid therapy was attempted, without benefit. The patient refused systemic treatments and is still undergoing nivolumab without new toxicities and with persistent disease response. Conclusions: This case suggests that alopecia areata may be a rare immune-related adverse event of immune checkpoint agents. Its late onset in our patient is uncommon and unexpected, underlining that the risk of nivolumab-induced toxicity is not limited to the beginning of treatment. Despite its rarity, alopecia areata should be considered in the range of adverse events potentially induced by immune checkpoint inhibitors even in the long term. Potential association between toxicity and efficacy of immunotherapy in NSCLC warrants further investigation

Repair versus shaving of partial-thickness articular-sided tears of the upper subscapularis tendon : a prospective randomized controlled trial

Purpose: The purpose of this study was to evaluate whether treating partial-thickness articular-sided tears of the upper subscapularis (ssC) tendon with a dedicated suture anchor would result in an internal rotation strength improvement compared with simple shaving of the ssC tendon and footprint. Methods: Twenty-six patients with a limited ssC tendon tear (equal or inferior to the most superior centimeter) in association with a posterosuperior cuff lesion were prospectively randomized to two treatments: repair with a dedicated suture anchor versus shaving of the tendon and footprint. the patients also underwent long head of the biceps (LHB) treatment and posterosuperior cuff tear repair. in each patient the following parameters were measured both preoperatively and at a minimum follow-up of 2.5 years: strength in internal rotation in the bear-hug testing position (using a digital tensiometer), DAsH score and Constant scores. MRi assessment of tendon healing was performed at the final follow-up. Results: Twenty of the 26 patients (76%) were reviewed after a mean follow-up time of 42 months: 11 patients had undergone ssC tendon repair and nine simple shaving. At final follow-up no significant differences were found between the repaired and shaving group in strength in internal rotation (9.5 \ub1 3.8 kg versus 10.3\ub15.4 kg; p=0.7). the DAsH score and Constant score also failed to show significant differences between the two groups. Furthermore, no significant difference in ssC tendon healing rate was observed on MRi evaluation. Conclusions: Partial-thickness articular-sided tear of the upper ssC tendon in association with a posterosuperior rotator cuff repair and LHB treatment, when limited to the superior centimeter of the ssC tendon, shows a comparable performance in terms of strength in internal rotation either after simple shaving or a tendon-to-bone repair. Level of evidence: Level II, prospective comparative study

Reporting rotator cuff tears on magnetic resonance arthrography using the Snyder's arthroscopic classification

AIM: To determine diagnostic performance of magnetic resonance arthrography (MRA) in evaluating rotator cuff tears (RCTs) using Snyder's classification for reporting. METHODS: One hundred and twenty-six patients (64 males, 62 females; median age 55 years) underwent shoulder MRA and arthroscopy, which represented our reference standard. Surgical arthroscopic reports were reviewed and the reported Snyder's classification was recorded. MRA examinations were evaluated by two independent radiologists (14 and 5 years' experience) using Snyder's classification system, blinded to arthroscopy. Agreement between arthroscopy and MRA on partial- and full-thickness tears was calculated, first regardless of their extent. Then, analysis took into account also the extent of the tear. Interobserver agreement was also calculated the quadratically-weighted Cohen kappa statistics. RESULTS: On arthroscopy, 71/126 patients (56%) had a full-thickness RCT. The remaining 55/126 patients (44%) had a partial-thickness RCT. Regardless of tear extent, out of 71 patients with arthroscopically-confirmed full-thickness RCTs, 66 (93%) were correctly scored by both readers. All 55 patients with arthroscopic diagnosis of partial-thickness RCT were correctly assigned as having a partial-thickness RCT at MRA by both readers. Interobserver reproducibility analysis showed total agreement between the two readers in distinguishing partial-thickness from full-thickness RCTs, regardless of tear extent (k = 1.000). With regard to tear extent, in patients in whom a complete tear was correctly diagnosed, correct tear extent was detected in 61/66 cases (92%); in the remaining 5/66 cases (8%), tear extent was underestimated. Agreement was k = 0.955. Interobserver agreement was total (k = 1.000). CONCLUSION: MRA shows high diagnostic accuracy and reproducibility in evaluating RCTs using the Snyder's classification for reporting. Snyder's classification may be adopted for routine reporting of MRA

Assessing urban system vulnerabilities to flooding to improve resilience and adaptation in spatial planning

Fluvial, pluvial and coastal flooding are the most frequent and costly natural hazard. Cities are social hubs and life in cities is reliant on a number of services and functions such as housing, healthcare, education and other key daily facilities. Urban flooding can cause significant disruption to these services and wider impacts on the population. These impacts may be short or long with a variably spatial scale: urban systems are spatially distributed and the nature of this can have significant effects on flood impacts. From an urban-planning perspective, measuring this disruption and its consequences is fundamental in order to develop more resilient cities. Whereas the assessment of physical vulnerabilities and direct damages is commonly addressed, new methodologies for assessing the systemic vulnerability and indirect damages at the urban scale are required. The proposed systemic approach recognizes the city as a collection of sub-systems or functional units (such as neighborhoods and suburbs), interconnected through the road network, providing key daily services to inhabitants (e.g., healthcare facilities, schools, food shops, leisure and cultural services). Each city is part of broader systems—which may or may not match administrative boundaries—and, as such, needs to be connected to its wider surroundings in a multi-scalar perspective. The systemic analysis, herein limited to residential households, is based on network-accessibility measures and evaluates the presence, the distribution among urban units and the redundancy of key daily services. Trying to spatially sketch the existence of systemic interdependences between neighborhoods, suburbs and municipalities, the proposed method highlights how urban systemic vulnerability spreads beyond the flooded areas. The aim is to understand which planning patterns and existing mixed-use developments are more flood resilient, thereby informing future urban development and regeneration projects. The methodology has been developed based on GIS and applied to an Italian municipality (Noale) in the metropolitan area of Venice, NE Italy

Geomorphological features and monitoring of a large and complex landslide near Avigliano urban area (South Italy)

International audienceThis paper reports the results of geological and geomorphological surveys and the first results of a still in progress GPS monitoring campaign, taken on a large and ancient landslide located near Avigliano town (Basilicata region, South Italy). The landslide occurs on structurally complex clayey-marly terrains and it is classifiable as a multiple and complex roto-translational-earthflow landslide. In the last years this landslide has been affected by frequent reactivations that have been the cause of grave damages to the urban structures in the area. During January 2004, in order to monitor the present kinematics of the landslide body, a GPS network was installed. Until today several GPS surveys have been carried out. The results of GPS data analysis show centimetres level motions going on the landslide. The final goal of the research will be to define a hazard evaluation and an evolution model of the landslide, using the integrated information coming from GPS and geomorphological surveys