Mapping landslides from space: a review

Landslide hazards have significant social, economic, and environmental impact. This work provides a critical review of the main existing literature using satellite data for mapping landslides. We created and examined an extensive bibliographic database from Web of Science (WoS) consisting in 291 outputs from > 1,000 authors who studied almost 700,000 landslides across all continents, for a total of 52 countries represented with China and Italy on top of the list with more authors. The outputs are equivalent to ~ 5% of the whole landslide-related production for the period 1996–2022, with a 600% increase in the number of papers after 2014 driven by the availability of Sentinel-1 and Sentinel-2 data. Analysis of the geographical location across the 66 different countries analysed shows that, within the total number of contributions, the satellite imagery was used to detect and map two main types of landslides: flows and slides. When specified in the manuscripts, the events have been triggered by rainfall (104 cases), earthquakes (32 cases), or both (17 cases). Slope instabilities in these areas were predominantly identified through manual detection (40%); but since 2020, the advent of artificial intelligence is suppressing all other techniques. Despite the undisputed progress of EO-based landslide mapping over the last 26 years, which makes it a consolidated tool for many landslide-related applications, challenges still remain for an effective and operational use of EO images for landslide detection and mapping, and we provide a perspective for future applications considering the existing and the planned SAR satellite missions

Skuteczność i bezpieczeństwo leczenia toksyną botulinową typu A (abobotulinum toxin A) pacjentów ze spastycznością kończyny dolnej. Randomizowane badanie kliniczne

Cel: Wykazanie skuteczności jednorazowego wstrzyknięcia toksy­ny botulinowej typu A (abobotulinum toxin A [Dysport]) podawanej do mięśni kończyny dolnej w porównaniu z placebo u dorosłych z przewlekłym niedowładem połowiczym. Ocena długotrwałego bezpieczeństwa i skuteczności wielokrotnych wstrzyknięć. Metody: W wieloośrodkowym badaniu klinicznym prowadzonym metodą podwójnie ślepej próby, z randomizacją, kontrolą placebo i pojedynczym cyklem leczenia dorośli uczestnicy po co najmniej 6 miesiącach od udaru/uszkodzenia mózgu otrzymali pojedynczą iniekcję badanego leku (abobotulinum toxin A 1000 j., 1500 j., placebo) do mięśni kończyny dolnej. Po badaniu zasadniczym badanie przedłużono o rok w fazie otwartej, w trakcie której uczestnicy otrzymywali nie więcej niż 4 cykle leczenia (1000 j., 1500 j.) podawane w co najmniej 12-tygodniowych odstępach. Skuteczność leczenia oceniano według zmodyfikowanej skali Ashwortha (MAS, Modified Ashworth Scale) dla kompleksu mięśnia trójgłowego łydki (GSC, gastrocnemius-soleus complex; pierwszorzędowy punkt końcowy badania metodą podwójnie śle­pej próby). W badaniu określono również odpowiedź na leczenie w łącznej ocenie lekarzy (PGA, physician global assessment), a także szybkość swobodnego chodu boso. Bezpieczeństwo leczenia stanowiło pierwszorzędowy punkt końcowy badania prowadzonego metodą próby otwartej. Wyniki: Średnia zmiana (95-proc. przedział ufności) wartości MAS GSC w okresie od początku do 4. tygodnia (faza leczenia metodą podwójnie ślepej próby, n = 381) po jednokrotnym podaniu leku wyniosła: –0,5 (od –0,7 do –0,4) (placebo, n = 128), –0,6 (od –0,8 do –0,5) (toksyna botulinowa typu A 1000 j., n = 125; p = = 0,28 wobec placebo) i –0,8 (od –0,9 do –0,7) (toksyna abobotu­linowa typu A 1500 j., n = 128; p = 0,009 wobec placebo). Średnie wartości oceny PGA w 4. tygodniu były następujące: 0,7 (0,5–0,9) (placebo), 0,9 (0,7–1,1) (1000 j.; p = 0,067 wobec placebo) i 0,9 (0,7–1,1) (1500 j.; p = 0,067). Szybkość chodu nie poprawiła się statystycznie znamiennie w porównaniu z placebo. W 4. tygodniu 4. cyklu leczenia (faza otwarta) średnia zmiana oceny MAS GSC wyniosła –1,0. W cyklach badania w fazie otwartej odnotowano stopniową poprawę oceny PGA i szybkości chodu. W 4. tygodniu 4. cyklu leczenia średnia ocena PGA wyniosła 1,9, a szybkość chodu wzrosła o 25,3% (17,5–33,2), przy czym 16% uczestni­ków badania osiągnęło szybkość ponad 0,8 m/s (odpowiadającą chodowi samodzielnemu; 0% na początku badania). Tolerancja leczenia była dobra i zgodna ze znanym profilem bezpieczeństwa toksyny abobotulinowej typu A. Wnioski: Wśród pacjentów z przewlekłym niedowładem po­łowiczym jednokrotne podanie toksyny abobotulinowej typu A (Dysport, Ipsen) spowodowało obniżenie napięcia mięśniowego. Wielokrotne podanie leku w fazie rocznego przedłużenia badania zasadniczego było dobrze tolerowane oraz przyczyniło się do zwiększenia szybkości chodu i prawdopodobieństwa osiągnięcia chodu samodzielnego. Numery identyfikacyjne na portalu Clinicaltrial.gov: NCT01249404, NCT01251367. Klasyfikacja dowodu naukowego: z fazy badania prowadzonej metodą podwójnie ślepej próby uzyskano dane naukowe klasy I, na podstawie których stwierdza się, że jednokrotne wstrzyknięcie toksyny botulinowej typu A u dorosłych z przewlekłym niedowładem spastycznym zmniejsza napięcie mięśniowe w kończynie dolnej. Neurology® 2017; 89: 2245–225

Addressing global ruminant agricultural challenges through understanding the rumen microbiome::Past, present and future

The rumen is a complex ecosystem composed of anaerobic bacteria, protozoa, fungi, methanogenic archaea and phages. These microbes interact closely to breakdown plant material that cannot be digested by humans, whilst providing metabolic energy to the host and, in the case of archaea, producing methane. Consequently, ruminants produce meat and milk, which are rich in high-quality protein, vitamins and minerals, and therefore contribute to food security. As the world population is predicted to reach approximately 9.7 billion by 2050, an increase in ruminant production to satisfy global protein demand is necessary, despite limited land availability, and whilst ensuring environmental impact is minimized. Although challenging, these goals can be met, but depend on our understanding of the rumen microbiome. Attempts to manipulate the rumen microbiome to benefit global agricultural challenges have been ongoing for decades with limited success, mostly due to the lack of a detailed understanding of this microbiome and our limited ability to culture most of these microbes outside the rumen. The potential to manipulate the rumen microbiome and meet global livestock challenges through animal breeding and introduction of dietary interventions during early life have recently emerged as promising new technologies. Our inability to phenotype ruminants in a high-throughput manner has also hampered progress, although the recent increase in “omic” data may allow further development of mathematical models and rumen microbial gene biomarkers as proxies. Advances in computational tools, high-throughput sequencing technologies and cultivation-independent “omics” approaches continue to revolutionize our understanding of the rumen microbiome. This will ultimately provide the knowledge framework needed to solve current and future ruminant livestock challenges

Exome sequencing of individuals with Huntington’s disease implicates FAN1 nuclease activity in slowing CAG expansion and disease onset

The age at onset of motor symptoms in Huntington’s disease (HD) is driven by HTT CAG repeat length but modified by other genes. In this study, we used exome sequencing of 683 patients with HD with extremes of onset or phenotype relative to CAG length to identify rare variants associated with clinical effect. We discovered damaging coding variants in candidate modifier genes identified in previous genome-wide association studies associated with altered HD onset or severity. Variants in FAN1 clustered in its DNA-binding and nuclease domains and were associated predominantly with earlier-onset HD. Nuclease activities of purified variants in vitro correlated with residual age at motor onset of HD. Mutating endogenous FAN1 to a nuclease-inactive form in an induced pluripotent stem cell model of HD led to rates of CAG expansion similar to those observed with complete FAN1 knockout. Together, these data implicate FAN1 nuclease activity in slowing somatic repeat expansion and hence onset of HD

Exploring UK medical school differences: the MedDifs study of selection, teaching, student and F1 perceptions, postgraduate outcomes and fitness to practise.

BACKGROUND: Medical schools differ, particularly in their teaching, but it is unclear whether such differences matter, although influential claims are often made. The Medical School Differences (MedDifs) study brings together a wide range of measures of UK medical schools, including postgraduate performance, fitness to practise issues, specialty choice, preparedness, satisfaction, teaching styles, entry criteria and institutional factors. METHOD: Aggregated data were collected for 50 measures across 29 UK medical schools. Data include institutional history (e.g. rate of production of hospital and GP specialists in the past), curricular influences (e.g. PBL schools, spend per student, staff-student ratio), selection measures (e.g. entry grades), teaching and assessment (e.g. traditional vs PBL, specialty teaching, self-regulated learning), student satisfaction, Foundation selection scores, Foundation satisfaction, postgraduate examination performance and fitness to practise (postgraduate progression, GMC sanctions). Six specialties (General Practice, Psychiatry, Anaesthetics, Obstetrics and Gynaecology, Internal Medicine, Surgery) were examined in more detail. RESULTS: Medical school differences are stable across time (median alpha = 0.835). The 50 measures were highly correlated, 395 (32.2%) of 1225 correlations being significant with p < 0.05, and 201 (16.4%) reached a Tukey-adjusted criterion of p < 0.0025. Problem-based learning (PBL) schools differ on many measures, including lower performance on postgraduate assessments. While these are in part explained by lower entry grades, a surprising finding is that schools such as PBL schools which reported greater student satisfaction with feedback also showed lower performance at postgraduate examinations. More medical school teaching of psychiatry, surgery and anaesthetics did not result in more specialist trainees. Schools that taught more general practice did have more graduates entering GP training, but those graduates performed less well in MRCGP examinations, the negative correlation resulting from numbers of GP trainees and exam outcomes being affected both by non-traditional teaching and by greater historical production of GPs. Postgraduate exam outcomes were also higher in schools with more self-regulated learning, but lower in larger medical schools. A path model for 29 measures found a complex causal nexus, most measures causing or being caused by other measures. Postgraduate exam performance was influenced by earlier attainment, at entry to Foundation and entry to medical school (the so-called academic backbone), and by self-regulated learning. Foundation measures of satisfaction, including preparedness, had no subsequent influence on outcomes. Fitness to practise issues were more frequent in schools producing more male graduates and more GPs. CONCLUSIONS: Medical schools differ in large numbers of ways that are causally interconnected. Differences between schools in postgraduate examination performance, training problems and GMC sanctions have important implications for the quality of patient care and patient safety

The Analysis of Teaching of Medical Schools (AToMS) survey: an analysis of 47,258 timetabled teaching events in 25 UK medical schools relating to timing, duration, teaching formats, teaching content, and problem-based learning.

BACKGROUND: What subjects UK medical schools teach, what ways they teach subjects, and how much they teach those subjects is unclear. Whether teaching differences matter is a separate, important question. This study provides a detailed picture of timetabled undergraduate teaching activity at 25 UK medical schools, particularly in relation to problem-based learning (PBL). METHOD: The Analysis of Teaching of Medical Schools (AToMS) survey used detailed timetables provided by 25 schools with standard 5-year courses. Timetabled teaching events were coded in terms of course year, duration, teaching format, and teaching content. Ten schools used PBL. Teaching times from timetables were validated against two other studies that had assessed GP teaching and lecture, seminar, and tutorial times. RESULTS: A total of 47,258 timetabled teaching events in the academic year 2014/2015 were analysed, including SSCs (student-selected components) and elective studies. A typical UK medical student receives 3960 timetabled hours of teaching during their 5-year course. There was a clear difference between the initial 2 years which mostly contained basic medical science content and the later 3 years which mostly consisted of clinical teaching, although some clinical teaching occurs in the first 2 years. Medical schools differed in duration, format, and content of teaching. Two main factors underlay most of the variation between schools, Traditional vs PBL teaching and Structured vs Unstructured teaching. A curriculum map comparing medical schools was constructed using those factors. PBL schools differed on a number of measures, having more PBL teaching time, fewer lectures, more GP teaching, less surgery, less formal teaching of basic science, and more sessions with unspecified content. DISCUSSION: UK medical schools differ in both format and content of teaching. PBL and non-PBL schools clearly differ, albeit with substantial variation within groups, and overlap in the middle. The important question of whether differences in teaching matter in terms of outcomes is analysed in a companion study (MedDifs) which examines how teaching differences relate to university infrastructure, entry requirements, student perceptions, and outcomes in Foundation Programme and postgraduate training

Global, regional, and national disease burden estimates of acute lower respiratory infections due to respiratory syncytial virus in young children in 2015:a systematic review and modelling study

Background: We have previously estimated that respiratory syncytial virus (RSV) was associated with 22% of all episodes of (severe) acute lower respiratory infection (ALRI) resulting in 55 000 to 199 000 deaths in children younger than 5 years in 2005. In the past 5 years, major research activity on RSV has yielded substantial new data from developing countries. With a considerably expanded dataset from a large international collaboration, we aimed to estimate the global incidence, hospital admission rate, and mortality from RSV-ALRI episodes in young children in 2015. Methods: We estimated the incidence and hospital admission rate of RSV-associated ALRI (RSV-ALRI) in children younger than 5 years stratified by age and World Bank income regions from a systematic review of studies published between Jan 1, 1995, and Dec 31, 2016, and unpublished data from 76 high quality population-based studies. We estimated the RSV-ALRI incidence for 132 developing countries using a risk factor-based model and 2015 population estimates. We estimated the in-hospital RSV-ALRI mortality by combining in-hospital case fatality ratios with hospital admission estimates from hospital-based (published and unpublished) studies. We also estimated overall RSV-ALRI mortality by identifying studies reporting monthly data for ALRI mortality in the community and RSV activity. Findings: We estimated that globally in 2015, 33·1 million (uncertainty range [UR] 21·6–50·3) episodes of RSV-ALRI, resulted in about 3·2 million (2·7–3·8) hospital admissions, and 59 600 (48 000–74 500) in-hospital deaths in children younger than 5 years. In children younger than 6 months, 1·4 million (UR 1·2–1·7) hospital admissions, and 27 300 (UR 20 700–36 200) in-hospital deaths were due to RSV-ALRI. We also estimated that the overall RSV-ALRI mortality could be as high as 118 200 (UR 94 600–149 400). Incidence and mortality varied substantially from year to year in any given population. Interpretation: Globally, RSV is a common cause of childhood ALRI and a major cause of hospital admissions in young children, resulting in a substantial burden on health-care services. About 45% of hospital admissions and in-hospital deaths due to RSV-ALRI occur in children younger than 6 months. An effective maternal RSV vaccine or monoclonal antibody could have a substantial effect on disease burden in this age group

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&lt;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&lt;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&lt;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 &gt;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