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Sub-Arctic glacierized catchments play a key role for the downstream regions sustaining withtheir runoff the baseflow in dry periods, influencing the timing and magnitude of floods andaffecting the water quality and nutrient transport for the biological production in the river upto the sea.Tracers such as the stable isotopes of the water (18O and 2H) are useful tools to reveal thewater flow paths and understand the runoff generation mechanisms. By collecting daily orsub daily water samples from baseflow, rainfall and stormflow at the catchmentoutlet it is possible to separate the hydrograph and infer which component eventor pre-event water contribute to streamflow. The underlying assumption of thisapproach is that the stream water, collected at the catchment outlet, represents thewater composition of the entire catchment. We question whether this assumptionis valid for runoff process or monitoring of sub-arctic glacierized catchments orwhether it is necessary to consider the spatial variability of isotopic composition. Toassess this, we collected water samples of streamflow, snow or firn, ice, glaciermeltwater, lake water, exfiltrating soil water and groundwater in three baseflowsnapshot campaigns during August-September 2018 in the Tarfala catchment (part ofthe SITES Water - Swedish Infrastructure for Ecosystem Science). The differentwater samples were analysed for their stable isotope composition to explore 1)the spatial variability of the baseflow isotopic composition in northern glacierizedcatchments and 2) changes of the isotopic signal of the different baseflow elements (e.g.glacier, lake, shallow and deep groundwater storages) within the catchment anddownstream.Our results show that the isotopic composition of streamflow within the catchment wasspatially variable and the sources snow, glacier ice, glacier meltwater, lake water,streamflow could be identified due to their isotopic composition. Differences inthe isotopic signal were found among the three campaigns reflecting differencesin the catchment states and indicating temporal changing contributing sources.The isotopic composition of the lake water remained largely stable and did notshow fractionation due to evaporation. Tracing the water through the catchmentrevealed, that some springs were fed by nearby melting snow patches, due to a similarisotopic composition, and did not change their isotopic signature until the mainstream was reached. Other springs instead were dissimilar to the snow isotopiccomposition indicating the contribution of deeper groundwater, which ceased duringlonger dry periods. Overall, the isotopic signal at the catchment outlet was similar toglacier melt water due to the high glacier melt at that time. This result highlights theimportance of glaciers providing baseflow to downstream regions. Our snapshotdata complement the long-term ones available for the catchment (SITES Water,www.fieldsites.se) highlighting the large variability of spatial and temporal pools of water,that needs to be investigated to accurately predict future changes in runoff contributingsources. [ABSTRACT FROM AUTHOR]

Housing instability negatively impacts outcomes in people [living] with human immunodeficiency virus (PLHIV), yet the effect of diverse living arrangements has not previously been evaluated. Using 6 dwelling types to measure housing status, we found a strong inverse association between housing instability and viral suppression across a spectrum of unstable housing arrangements. [ABSTRACT FROM AUTHOR]

Jointing in bedded siliciclastic sedimentary successions has been mainly analyzed in terms of fractured layers thickness-normalized joint spacing and related probability distributions, commonly neglecting the influence of primary structures on the petrophysical properties, joint height patterns, spatial arrangements and best-fitted spacing distributions. Taking into account the depositional controls on mechanical and fracture stratigraphy is crucial for improving the predictive potential of geological modelling in exploration and exploitation of underground resources, gas injection and storage. Here, we present a high-resolution, structural-stratigraphic study carried out on a 72 m-thick succession of the Marnoso-arenacea foredeep turbidites, exposed in the Northern Apennines of Italy. The systematic integration of the structural and sedimentological characterization of this basin-plain turbiditic succession, coupled with petrophysical and geomechanical measurements, represents the fracture and mechanical stratigraphy database onto which we tested the standardly used fracture density parameters and the best-fitted probability distributions, i.e. normal, log-normal, gamma and exponential, applied to fracture spacing analysis. Our results document that cumulative analysis does not identify the variability of joint height patterns and spacing distributions in siliciclastic turbidites, which instead requires considering single sedimentary facies types. Specifically, sandstones are affected by facies bounded joints and gamma spacing distributions while clay-rich and poorly sorted facies show a higher abundance of top bounded and throughgoing joints, and are best fitted by log-normal spacing distributions. We suggest that the fracture and mechanical stratigraphy should be studied at the facies scale resolution to unravel the strong control of the sedimentary facies for improving the characterization of siliciclastic reservoirs. • Joint density and spacing distribution are controlled by the facies, characterized by different grain size and sorting. • Facies determine the mechanical coupling and joint height pattern; slurries and mudstones favor throughgoing joints. • The vertical pattern of joint density and spacing distribution are imparted by the facies tract. [ABSTRACT FROM AUTHOR]

Background: People with HIV experiencing homelessness have low rates of viral suppression, driven by sociostructural barriers and traditional care system limitations. Informed by the capability-opportunity-motivation-behavior (COM-B) model and patient preference research, we developed POP-UP, an integrated drop-in (nonappointment-based) HIV clinic with wrap-around services for persons with housing instability and viral nonsuppression in San Francisco.Methods: We report HIV viral suppression (VS; <200 copies/mL), care engagement, and mortality at 12 months postenrollment. We used logistic regression to determine participant characteristics associated with VS.Results: We enrolled 112 patients with viral nonsuppression and housing instability: 52% experiencing street-homelessness, 100% with a substance use disorder, and 70% with mental health diagnoses. At 12 months postenrollment, 70% had ≥1 visit each 4-month period, although 59% had a 90-day care gap; 44% had VS, 24% had viral nonsuppression, 23% missing, and 9% died (6 overdose, 2 AIDS-associated, 2 other). No baseline characteristics were associated with VS.Conclusions: The POP-UP low-barrier HIV care model successfully reached and retained some of our clinic's highest-risk patients. It was associated with VS improvement from 0% at baseline to 44% at 12 months among people with housing instability. Care gaps and high mortality from overdose remain major challenges to achieving optimal HIV treatment outcomes in this population. [ABSTRACT FROM AUTHOR]

Supplemental Digital Content is Available in the Text. Background/Setting: In San Francisco, HIV viral suppression is 71% among housed individuals but only 20% among unhoused individuals. We conducted a discrete choice experiment at a San Francisco public HIV clinic to evaluate care preferences among people living with HIV (PLH) experiencing homelessness/unstable housing during the COVID-19 pandemic. Methods: From July to November 2020, we conducted a discrete choice experiment among PLH experiencing homelessness/unstable housing who accessed care through (1) an incentivized, drop-in program (POP-UP) or (2) traditional primary care. We investigated 5 program features: single provider vs team of providers; visit incentives ($0, $10, and $20); location (current site vs current + additional site); drop-in vs scheduled visits; in-person only vs optional telehealth visits; and navigator assistance. We estimated relative preferences using mixed-effects logistic regression and conducted latent class analysis to evaluate preference heterogeneity. Results: We enrolled 115 PLH experiencing homelessness/unstable housing, 40% of whom lived outdoors. The strongest preferences were for the same provider (β = 0.94, 95% CI: 0.48 to 1.41), visit incentives (β = 0.56 per $5; 95% CI: 0.47 to 0.66), and drop-in visits (β = 0.47, 95% CI: 0.12 to 0.82). Telehealth was not preferred. Latent class analysis revealed 2 distinct groups: 78 (68%) preferred a flexible care model, whereas 37 (32%) preferred a single provider. Conclusions: We identified heterogeneous care preferences among PLH experiencing homelessness/unstable housing during the COVID-19 pandemic, with two-thirds preferring greater flexibility and one-third preferring provider continuity. Telehealth was not preferred, even with navigator facilitation. Including patient choice in service delivery design can improve care engagement, particularly for marginalized populations, and is an essential tool for ending the HIV epidemic. [ABSTRACT FROM AUTHOR]

Spontaneous canalith jam is an uncommon form of benign paroxysmal positional vertigo mimicking acute vestibular neuritis. We described for the first time a spontaneous horizontal semicircular canalith jam associated with a typical canalolithiasis involving contralateral posterior semicircular canal (PSC), illustrating how the latter condition modified direction-fixed nystagmus during head movements. An 81-year-old woman with persistent vertigo referred to our center. Video-Frenzel examination showed horizontal direction-fixed right-beating nystagmus in primary gaze position, inhibited by visual fixation. She exhibited corrective saccades after leftward head impulses. Chin-to-chest positioning at the head-pitch test did not modify spontaneous nystagmus, whereas slight torsional components with the top pole of the eye beating toward the right ear appeared in backward head-bending, resulting in mixed horizontal-torsional nystagmus. At supine positioning tests, direction-fixed nystagmus turned into direction-changing geotropic horizontal nystagmus, which was stronger on the left side, while overlapping upbeat nystagmus with torsional right-beating components appeared on the right. Primary clinical findings were consistent with a left horizontal semicircular canalith jam, inducing a persistent utriculofugal cupular displacement, combined with a typical right-sided PSC-canalolithiasis. Once canalith jam crumbled, resulting in a non-ampullary arm canalolithiasis of the horizontal semicircular canal, both involved canals were freed by debris with appropriate repositioning procedures. [ABSTRACT FROM AUTHOR]

Background: Homelessness and unstable housing (HUH) negatively impact care outcomes for people living with HIV (PLWH). To inform the design of a clinic program for PLWH experiencing HUH, we quantified patient preferences and trade-offs across multiple HIVservice domains using a discrete choice experiment (DCE). Methods: We sequentially sampled PLWH experiencing HUH presenting at an urban HIV clinic with $1 missed primary care visit and viremia in the last year to conduct a DCE. Participants chose between 2 hypothetical clinics varying across 5 service attributes: care team "get to know me as a person" versus not; receiving $10, $15, or $20 gift cards for clinic visits; drop-in versus scheduled visits; direct phone communication to care team versus front-desk staff; and staying 2 versus 20 blocks from the clinic. We estimated attribute relative utility (ie, preference) using mixed-effects logistic regression and calculated the monetary trade-off of preferred options. Results: Among 65 individuals interviewed, 61% were .40 years old, 45% White, 77% men, 25% heterosexual, 56% lived outdoors/emergency housing, and 44% in temporary housing. Strongest preferences were for patient-centered care team [b = 3.80; 95% confidence interval (CI): 2.57 to 5.02] and drop-in clinic appointments (b = 1.33; 95% CI: 0.85 to 1.80), with a willingness to trade $32.79 (95% CI: 14.75 to 50.81) and $11.45 (95% CI: 2.95 to 19.95) in gift cards/visit, respectively. Conclusions: In this DCE, PLWH experiencing HUH were willing to trade significant financial gain to have a personal relationship with and drop-in access to their care team rather than more resourceintensive services. These findings informed Ward 86's "POP-UP" program for PLWH-HUH and can inform "ending the HIV epidemic" efforts. [ABSTRACT FROM AUTHOR]

Recently WHO has declared novel coronavirus disease 2019 (COVID-19) outbreak a pandemic. Acute respiratory syndrome seems to be the most common manifestation of COVID-19. Besides pneumonia, it has been demonstrated that SARS-CoV-2 infection affects multiple organs, including brain tissues, causing different neurological manifestations, especially acute cerebrovascular disease (ischemic and hemorrhagic stroke), impaired consciousness and skeletal muscle injury. To our knowledge, among neurological disorders associated with SARS-CoV2 infection, no Posterior Reversible Encephalopathy Syndrome (PRES) has been described yet. Herein, we report a case of a 64-year old woman with COVID19 infection who developed a PRES, and we suggest that it could be explained by the disruption of the blood brain barrier induced by the cerebrovascular endothelial dysfunction caused by SARS-CoV-2. [ABSTRACT FROM AUTHOR]

Background Staphylococcus aureus is a leading cause of bacteremia, yet there remains a significant knowledge gap in the identification of relevant biomarkers that predict clinical outcomes. Heterogeneity in the host response to invasive S. aureus infection suggests that specific biomarker signatures could be utilized to differentiate patients prone to severe disease, thereby facilitating earlier implementation of more aggressive therapies. Methods To further elucidate the inflammatory correlates of poor clinical outcomes in patients with S. aureus bacteremia, we evaluated the association between a panel of blood proteins at initial presentation of bacteremia and disease severity outcomes using 2 cohorts of patients with S. aureus bacteremia (n = 32 and n = 124). Results We identified 13 candidate proteins that were correlated with mortality and persistent bacteremia. Prognostic modeling identified interleukin (IL)-8 and CCL2 as the strongest individual predictors of mortality, with the combination of these biomarkers classifying fatal outcome with 89% sensitivity and 77% specificity (P <.0001). Baseline IL-17A levels were elevated in patients with persistent bacteremia (P <.0001), endovascular (P =.026) and metastatic tissue infections (P =.012). Conclusions These results demonstrate the potential utility of selected biomarkers to distinguish patients with the highest risk for treatment failure and bacteremia-related complications, providing a valuable tool for clinicians in the management of S. aureus bacteremia. Additionally, these biomarkers could identify patients with the greatest potential to benefit from novel therapies in clinical trials. [ABSTRACT FROM AUTHOR]

• Malignat proliferating trichilemmal tumor (MPTT) are rare tumors usually presenting in photo-exposed areas, especially on the face, scalp, neck,and dorsal part of the hand; • Differential diagnosis include squamous cell carcinoma, basal-cell carcinoma, keratoacanthoma and malignant nodular melanoma; • Resection in free margins is the treatment of choice; • Adijuvant radiotherapy is indicate in case of high-risk tumors. Malignat proliferating trichilemmal tumor (MPTT) are rare tumors usually presenting in photo-exposed areas, especially on the face, scalp, neck,and dorsal part of the hand. Differential diagnosis include squamous cell carcinoma, basal-cell carcinoma, keratoacanthoma and malignant nodular melanoma, so that only incisional biopsy can lead to pre-operative diagnosis. We present case MPTT misdiagnosed with parotid gland malignant tumor that underwent radical surgical excision and adijuvant radiotherapy. [ABSTRACT FROM AUTHOR]

The Vado di Corno Fault Zone (VCFZ) is an active extensional fault cutting through carbonates in the Italian Central Apennines. The fault zone was exhumed from ∼2 km depth and accommodated a normal throw of ∼2 km since Early-Pleistocene. In the studied area, the master fault of the VCFZ dips N210/54° and juxtaposes Quaternary colluvial deposits in the hangingwall with cataclastic dolostones in the footwall. Detailed mapping of the fault zone rocks within the ∼300 m thick footwall-block evidenced the presence of five main structural units (Low Strain Damage Zone, High Strain Damage Zone, Breccia Unit, Cataclastic Unit 1 and Cataclastic Unit 2). The Breccia Unit results from the Pleistocene extensional reactivation of a pre-existing Pliocene thrust. The Cataclastic Unit 1 forms a ∼40 m thick band lining the master fault and recording in-situ shattering due to the propagation of multiple seismic ruptures. Seismic faulting is suggested also by the occurrence of mirror-like slip surfaces, highly localized sheared calcite-bearing veins and fluidized cataclasites. The VCFZ architecture compares well with seismological studies of the L'Aquila 2009 seismic sequence (mainshock M W 6.1), which imaged the reactivation of shallow-seated low-angle normal faults (Breccia Unit) cut by major high-angle normal faults (Cataclastic Units). [ABSTRACT FROM AUTHOR]

The causes of landslides generally invoked in the Northern Apennines of Italy do not fully explain some observed oriented distributions of large landslides along regional-scale tectonic structures (late orogenic antiforms). The aim of the work is to deeply explore the role of tectonics in controlling the development and arrangement of large landslides. We employed a multidisciplinary approach which took into account geomorphological and geological field data, topographic analysis and deep seismic reflection profiles integrated with previously published apatite fission track cooling ages, shallow geophysical and GPS data. In order to explore these relationships, the Valmozzola area was selected as suitable case study, owing to the presence of clearly expressed relationships between recent extensional faults and related fractures and elements of active landslides. Moreover, in the Valmozzola area contractional tectonics acted to produce rock uplift and thus topographic growth. These processes caused hillslopes to approach their threshold angle, and promoted landslides triggered mainly by climate factors. The geological and geomorphological features characterizing the Valmozzola case study affect the entire study area, as they evolved during the same tectonic and climatic phases that characterized this part of the Northern Apennines. Therefore, the results from the Valmozzola area act as a proxy to constrain the control exerted by tectonics on large landslides across a wider area. The distribution of the large landslides has been controlled by tectonics which determined lines of weakness and failure surfaces (passive role) affecting the slopes. On the other hand, tectonics also caused the topographic growth and over-steepening of the slopes (active role) that promoted the occurrence of large landslides. The distribution of large landslides may, therefore, highlight the existence of tectonic processes and it may be used as an indicator of regional-scale tectonic activity, once the geological and geomorphological framework is well constrained. [ABSTRACT FROM AUTHOR]

• In case of high risk NMSC intra-operative assessment of resection margins is required. • Intraoperative frozen sections permit to detect the presence of tumor in 72–91% of cases. • In selected cases procedure currently replaced by more effective techniques could be applied. [ABSTRACT FROM AUTHOR]

Objective: To estimate the incidence and describe clinical characteristics and outcome of GBS in COVID-19 patients (COVID19-GBS) in one of the most hit regions during the first pandemic wave, Lombardia., Methods: Adult patients admitted to 20 Neurological Units between 1/3-30/4/2020 with COVID19-GBS were included as part of a multi-center study organized by the Italian society of Hospital Neuroscience (SNO)., Results: Thirty-eight COVID19-GBS patients had a mean age of 60.7 years and male frequency of 86.8%. CSF albuminocytological dissociation was detected in 71.4%, and PCR for SARS-CoV-2 was negative in 19 tested patients. Based on neurophysiology, 81.8% of patients had a diagnosis of AIDP, 12.1% of AMSAN, and 6.1% of AMAN. The course was favorable in 76.3% of patients, stable in 10.5%, while 13.2% worsened, of which 3 died. The estimated occurrence rate in Lombardia ranges from 0.5 to 0.05 GBS cases per 1000 COVID-19 infections depending on whether you consider positive cases or estimated seropositive cases. When we compared GBS cases with the pre-pandemic period, we found a reduction of cases from 165 to 135 cases in the 2-month study period in Lombardia., Conclusions: We detected an increased incidence of GBS in COVID-19 patients which can reflect a higher risk of GBS in COVID-19 patients and a reduction of GBS events during the pandemic period possibly due to a lower spread of more common respiratory infectious diseases determined by an increased use of preventive measures., (© 2022. The Author(s).)

Several studies focused on the role of vitamin D (vitD) in pain chronification. This study focused on vitD level and pain chronification and extension in headache disorders. Eighty patients with primary headache underwent neurological examination, laboratory exams, including serum calcifediol 25(OH)D, and headache features assessment along with three questionnaires investigating depression, anxiety, and allodynia. The 86.8% of the population had migraine (48% episodic and 52% chronic). The 44.1% of patients had extracranial pain, and 47.6% suffered from allodynia. A vitD deficit, namely a serum 25(OH)D level <20 ng/ml, was detectable in 46.1% of the patients, and it occurred more frequently ( p = 0.009) in patients suffering from chronic migraine (CM)-medication overuse migraine (MOH) (62.9%) than in episodic migraine (EM, 25.7%) or tension-type headache (TTH, 11.4%). The occurrence of extracranial pain and allodynia was higher in the CM-MOH than in the EM and in the TTH groups but was not related to the co-occurrence of vitD deficiency (Fisher's exact test p = 0.11 and p = 0.32, respectively). Our findings show that 25(OH)D deficit is also related to chronic headache, probably because of vitD anti-inflammatory and tolerogenic properties, reinforcing the idea of a neuroinflammatory mechanism underpinning migraine chronification., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Rebecchi, Gallo, Princiotta Cariddi, Piantanida, Tabaee Damavandi, Carimati, Gallazzi, Clemenzi, Banfi, Candeloro, Tanda, Mauri and Versino.)

Posterior reversible encephalopathy cases are increasingly being reported in patients affected by COVID-19, but the largest series so far only includes 4 patients. We present a series of 6 patients diagnosed with PRES during COVID-19 hospitalized in 5 Centers in Lombardia, Italy. 5 out of the 6 patients required intensive care assistence and seizures developed at weaning from assisted ventilation. 3 out of 6 patients underwent cerebrospinal fluid analysis which was normal in all cases, with negative PCR for Sars-CoV-2 genome search. PRES occurrence may be less rare than supposed in COVID-19 patients and a high suspicion index is warranted for prompt diagnosis and treatment., (© 2020 Published by Elsevier B.V.)

Background: Robotic training is commonly used to assist walking training in patients affected by multiple sclerosis (MS) with non-conclusive results., Objective: To compare the effect of robot-assisted gait training (RAGT) with that of conventional walking training (CWT) on gait competencies, global ability, fatigue and spasticity in a group of severely affected patients with MS., Methods: A pilot, single-blind randomized controlled trial was conducted in 43 severe (Expanded Disability Status Scale (EDSS) score of 6-7.5) and non-autonomous ambulant in-patients with MS. Experimental group performed 12 sessions of RAGT, whereas control group performed the same amount of CWT. Primary outcome measures were gait ability assessed by 2 minutes walking test and Functional Ambulatory Category; secondary outcomes were global ability (modified Barthel Index), global mobility (Rivermead Mobility Index), severity of disease (EDSS) and subjectively perceived fatigue (Fatigue Severity Scale)., Results: The number of subjects who achieved a clinical significant improvement was significantly higher in RAGT than in CWT ( p < 0.05 for both primary outcome measures). RAGT also led to an improvement in all the other clinical parameters (global ability: p < 0.001, global mobility: p < 0.001, EDSS: p = 0.014 and fatigue: p = 0.001)., Conclusions: RAGT improved the walking competencies in non-autonomous ambulant patients with MS, with benefits in terms of perceived fatigue.

Background: Chronic pain is common in persons with multiple sclerosis (MS), but the co-morbidity of fibromyalgia (FM) has yet to be investigated in MS. Objectives of the study were to evaluate, among the various types of chronic pain, the frequency of FM in MS and its impact on MS patients' health-related quality of life (HRQoL)., Material and Methods: 133 MS patients were investigated for the presence and characterization of chronic pain within 1 month of assessment. A rheumatologist assessed the presence FM according to the 1990 ACR diagnostic criteria. Depression, fatigue, and HRQoL were also assessed by means of specific scales., Results: Chronic pain was present in 66.2% of patients (musculoskeletal in 86.3%; neuropathic in 13.7%; absent in 33.8% [called NoP]). Pain was diagnosed with FM (PFM+) in 17.3% of our MS patients, while 48.9% of them had chronic pain not FM type (PFM-); the prevalence of neuropathic pain in these 2 sub-groups was the same. PFM+ patients were prevalently females and had a higher EDSS than NoP. The PFM+ patients had a more pronounced depression than in the NoP group, and scored the worst in both physical and mental QoL., Conclusions: In our sample of MS patients we found a high prevalence of chronic pain, with those patients displaying a higher disability and a more severe depression. Moreover, FM frequency, significantly higher than that observed in the general population, was detected among the MS patients with chronic pain. FM occurrence was associated with a stronger impact on patients' QoL.

Background: Pain is a frequent and disabling symptom in multiple sclerosis (MS) patients. In this study we assess the frequency and intensity of pain, as well as its impact on the quality of life and activities of daily living, in a sample of MS patients., Methods: One hundred and twenty eight MS patients underwent a neurological examination, a structured interview designed to assess pain, and a Medical Outcome 36-item Short Form Health Survey. Functional status was assessed by means of the Barthel Index (BI) and Rivermead Mobility Index. We also assessed the presence of depression, by means of the Montgomery and Asberg Depression Rating Scale, and fatigue, by means of the Fatigue Severity Scale. An algometer was used to measure thermal and discomfort thresholds in all of the patients and a group of 61 age- and sex-matched healthy subjects., Results: Pain was present in 61 patients. No differences were found between patients with and those without pain in disease duration, disease form or Expanded Disability Status Scale and its functional systems. Patients with pain had a lower vitality score (p = 0.008), mental health score (p = 0.03) and physical (p < 0.001) and mental composite scores (p = 0.01) than patients without pain. Furthermore, there was a significant difference between patients with and those without pain in the BI (p = 0.04). Both thermal and discomfort thresholds, as assessed by means of the algometer, were statistically lower in MS patients than in controls, whereas no difference was observed between patients with and those without pain. There was a statistically significant improvement in the thermal threshold in patients with pain who were treated pharmacologically when compared with those who were not treated (p = 0.049)., Conclusion: The results of this study provide further evidence of the negative impact that the presence of pain has on both the quality of life and activities of daily living in MS patients. The lower thermal and discomfort thresholds observed in our MS patients, compared with controls, may represent a predisposition to develop pain during the course of the disease.