Home- vs Office-Based Narrowband UV-B Phototherapy for Patients With Psoriasis: The LITE Randomized Clinical Trial.

Importance: Office-based phototherapy is cost-effective for psoriasis but difficult to access. Home-based phototherapy is patient preferred but has limited clinical data, particularly in patients with darker skin. Objective: To compare the effectiveness of home- vs office-based narrowband UV-B phototherapy for psoriasis. Design, Setting, and Participants: The Light Treatment Effectiveness study was an investigator-initiated, pragmatic, open-label, parallel-group, multicenter, noninferiority randomized clinical trial embedded in routine care at 42 academic and private clinical dermatology practices in the US. Enrollment occurred from March 1, 2019, to December 4, 2023, with follow-up through June 2024. Participants were 12 years and older with plaque or guttate psoriasis who were candidates for home- and office-based phototherapy. Interventions: Participants were randomized to receive a home narrowband UV-B machine with guided mode dosimetry or routine care with office-based narrowband UV-B for 12 weeks, followed by an additional 12-week observation period. Main Outcomes and Measures: The coprimary effectiveness outcomes were Physician Global Assessment (PGA) dichotomized as clear/almost clear skin (score of ≤1) at the end of the intervention period and Dermatology Life Quality Index (DLQI) score of 5 or lower (no to small effect on quality of life) at week 12. Results: Of 783 patients enrolled (mean [SD] age, 48.0 [15.5] years; 376 [48.0%] female), 393 received home-based phototherapy and 390 received office-based phototherapy, with 350 (44.7%) having skin phototype (SPT) I/II, 350 (44.7%) having SPT III/IV, and 83 (10.6%) having SPT V/VI. A total of 93 patients (11.9%) were receiving systemic treatment. At baseline, mean (SD) PGA was 2.7 (0.8) and DLQI was 12.2 (7.2). At week 12, 129 patients (32.8%) receiving home-based phototherapy and 100 patients (25.6%) receiving office-based phototherapy achieved clear/almost clear skin, and 206 (52.4%) and 131 (33.6%) achieved DLQI of 5 or lower, respectively. Home-based phototherapy was noninferior to office-based phototherapy for PGA and DLQI in the overall population and across all SPTs. Home-based phototherapy, compared to office-based phototherapy, was associated with better treatment adherence (202 patients [51.4%] vs 62 patients [15.9%]; P < .001), lower burden of indirect costs to patients, and more episodes of persistent erythema (466 of 7957 treatments [5.9%] vs 46 of 3934 treatments [1.2%]; P < .001). Both treatments were well tolerated with no discontinuations due to adverse events. Conclusions and Relevance: In this randomized clinical trial, home-based phototherapy was as effective as office-based phototherapy for plaque or guttate psoriasis in everyday clinical practice and had less burden to patients. Trial Registration: ClinicalTrials.gov Identifier: NCT03726489.

Landslide Sensitivity and Response to Precipitation Changes in Wet and Dry Climates.

Slow-moving landslides are hydrologically driven. Yet, landslide sensitivity to precipitation, and in particular, precipitation extremes, is difficult to constrain because landslides occur under diverse hydroclimatological conditions. Here we use standardized open-access satellite radar interferometry data to quantify the sensitivity of 38 landslides to both a record drought and extreme rainfall that occurred in California between 2015 and 2020. These landslides are hosted in similar rock types, but span more than ∼2 m/yr in mean annual rainfall. Despite the large differences in hydroclimate, we found these landslides exhibited surprisingly similar behaviors and hydrologic sensitivity, which was characterized by faster (slower) than average velocities during wetter (drier) than average years, once the impact of the drought diminished. Our findings may be representative of future landslide behaviors in California where precipitation extremes are predicted to become more frequent with climate change.

Four-dimensional surface motions of the Slumgullion landslide and quantification of hydrometeorological forcing.

Landslides modify the natural landscape and cause fatalities and property damage worldwide. Quantifying landslide dynamics is challenging due to the stochastic nature of the environment. With its large area of ~1 km2 and perennial motions at ~10-20 mm per day, the Slumgullion landslide in Colorado, USA, represents an ideal natural laboratory to better understand landslide behavior. Here, we use hybrid remote sensing data and methods to recover the four-dimensional surface motions during 2011-2018. We refine the boundaries of an area of ~0.35 km2 below the crest of the prehistoric landslide. We construct a mechanical framework to quantify the rheology, subsurface channel geometry, mass flow rate, and spatiotemporally dependent pore-water pressure feedback through a joint analysis of displacement and hydrometeorological measurements from ground, air and space. Our study demonstrates the importance of remotely characterizing often inaccessible, dangerous slopes to better understand landslides and other quasi-static mass fluxes in natural and industrial environments, which will ultimately help reduce associated hazards.

Hierarchical interlocked orthogonal faulting in the 2019 Ridgecrest earthquake sequence.

A nearly 20-year hiatus in major seismic activity in southern California ended on 4 July 2019 with a sequence of intersecting earthquakes near the city of Ridgecrest, California. This sequence included a foreshock with a moment magnitude (M w) of 6.4 followed by a M w 7.1 mainshock nearly 34 hours later. Geodetic, seismic, and seismicity data provided an integrative view of this sequence, which ruptured an unmapped multiscale network of interlaced orthogonal faults. This complex fault geometry persists over the entire seismogenic depth range. The rupture of the mainshock terminated only a few kilometers from the major regional Garlock fault, triggering shallow creep and a substantial earthquake swarm. The repeated occurrence of multifault ruptures, as revealed by modern instrumentation and analysis techniques, poses a formidable challenge in quantifying regional seismic hazards.

A shift from drought to extreme rainfall drives a stable landslide to catastrophic failure.

The addition of water on or below the earth's surface generates changes in stress that can trigger both stable and unstable sliding of landslides and faults. While these sliding behaviours are well-described by commonly used mechanical models developed from laboratory testing (e.g., critical-state soil mechanics and rate-and-state friction), less is known about the field-scale environmental conditions or kinematic behaviours that occur during the transition from stable to unstable sliding. Here we use radar interferometry (InSAR) and a simple 1D hydrological model to characterize 8 years of stable sliding of the Mud Creek landslide, California, USA, prior to its rapid acceleration and catastrophic failure on May 20, 2017. Our results suggest a large increase in pore-fluid pressure occurred during a shift from historic drought to record rainfall that triggered a large increase in velocity and drove slip localization, overcoming the stabilizing mechanisms that had previously inhibited landslide acceleration. Given the predicted increase in precipitation extremes with a warming climate, we expect it to become more common for landslides to transition from stable to unstable motion, and therefore a better assessment of this destabilization process is required to prevent loss of life and infrastructure.

National Psoriasis Foundation Priorities for Patient-Centered Research: Proceedings from the 2016 Conference.

The National Psoriasis Foundation (NPF) is developing an agenda for patient-centered research to help patients and their caregivers make more informed health care decisions by engaging psoriasis patients in prioritizing comparative effectiveness research (CER) topics. The NPF has created a novel patient-centered research platform known as Citizen Pscientist (CP), allowing patients with psoriasis and psoriatic arthritis to register and contribute their health data. The CP Governance Council administered an online 23-question CER survey to the CP community and held a structured meeting on December 3, 2016, with patients and researchers to review CER survey results and discuss patient-centered research priorities. Of the 2,945 patients surveyed, 792 patients responded. Three CER topics were deemed to be of high priority for the research agenda: 1) Treat-to-target therapy for psoriasis, 2) Psoriatic arthritis screening questionnaires for early detection and treatment of psoriatic arthritis, and 3) Comparative effectiveness of home-based phototherapy for psoriasis.

Complex multifault rupture during the 2016 Mw 7.8 Kaikoura earthquake, New Zealand.

On 14 November 2016, northeastern South Island of New Zealand was struck by a major moment magnitude (Mw) 7.8 earthquake. Field observations, in conjunction with interferometric synthetic aperture radar, Global Positioning System, and seismology data, reveal this to be one of the most complex earthquakes ever recorded. The rupture propagated northward for more than 170 kilometers along both mapped and unmapped faults before continuing offshore at the island's northeastern extent. Geodetic and field observations reveal surface ruptures along at least 12 major faults, including possible slip along the southern Hikurangi subduction interface; extensive uplift along much of the coastline; and widespread anelastic deformation, including the ~8-meter uplift of a fault-bounded block. This complex earthquake defies many conventional assumptions about the degree to which earthquake ruptures are controlled by fault segmentation and should motivate reevaluation of these issues in seismic hazard models.

Space geodetic monitoring of engineered structures: The ongoing destabilization of the Mosul dam, Iraq.

We present a detailed survey of the ongoing destabilization process of the Mosul dam. The dam is located on the Tigris river and is the biggest hydraulic structure in Iraq. From a geological point of view the dam foundation is poor due to a site geology formed by alternating strata of highly soluble materials including gypsum, anhydrite, marl and limestone. Here we present the first multi-sensor cumulative deformation map for the dam generated from space-based interferometric synthetic aperture radar measurements from the Italian constellation COSMO-SkyMed and the European sensor Sentinel-1a over the period 2014-2016 that we compare to an older dataset spanning 2004-2010 acquired with the European Envisat satellite. We found that deformation was rapid during 2004-2010, slowed in 2012-2014 and increased since August 2014 when grouting operations stopped due to the temporary capture of the dam by the self proclaimed Islamic State. We model the inferred deformation using a Markov chain Monte Carlo approach to solve for change in volume for simple tensile dislocations. Results from recent and historical geodetic datasets suggests that the volume dissolution rate remains constant when the equivalent volume of total concrete injected during re-grouting operations is included in the calculations.

Near-field deformation from the El Mayor-Cucapah earthquake revealed by differential LIDAR.

Large [moment magnitude (M(w)) ≥ 7] continental earthquakes often generate complex, multifault ruptures linked by enigmatic zones of distributed deformation. Here, we report the collection and results of a high-resolution (≥nine returns per square meter) airborne light detection and ranging (LIDAR) topographic survey of the 2010 M(w) 7.2 El Mayor-Cucapah earthquake that produced a 120-kilometer-long multifault rupture through northernmost Baja California, Mexico. This differential LIDAR survey completely captures an earthquake surface rupture in a sparsely vegetated region with pre-earthquake lower-resolution (5-meter-pixel) LIDAR data. The postevent survey reveals numerous surface ruptures, including previously undocumented blind faults within thick sediments of the Colorado River delta. Differential elevation changes show distributed, kilometer-scale bending strains as large as ~10(3) microstrains in response to slip along discontinuous faults cutting crystalline bedrock of the Sierra Cucapah.

Shallow fault-zone dilatancy recovery after the 2003 Bam earthquake in Iran.

Earthquakes radiate from slip on discrete faults, but also commonly involve distributed deformation within a broader fault zone, especially near the surface. Variations in rock strain during an earthquake are caused by heterogeneity in the elastic stress before the earthquake, by variable material properties and geometry of the fault zones, and by dynamic processes during the rupture. Stress changes due to the earthquake slip, both dynamic and static, have long been thought to cause dilatancy in the fault zone that recovers after the earthquake. Decreases in the velocity of seismic waves passing through the fault zone due to coseismic dilatancy have been observed followed by postseismic seismic velocity increases during healing. Dilatancy and its recovery have not previously been observed geodetically. Here we use interferometric analysis of synthetic aperture radar images to measure postseismic surface deformation after the 2003 Bam, Iran, earthquake and show reversal of coseismic dilatancy in the shallow fault zone that causes subsidence of the surface. This compaction of the fault zone is directly above the patch of greatest coseismic slip at depth. The dilatancy and compaction probably reflects distributed shear and damage to the material during the earthquake that heals afterwards. Coseismic and postseismic deformation spread through a fault zone volume may resolve the paradox of shallow slip deficits for some strike-slip fault ruptures.

Partial rupture of a locked patch of the Sumatra megathrust during the 2007 earthquake sequence.

The great Sumatra-Andaman earthquake and tsunami of 2004 was a dramatic reminder of the importance of understanding the seismic and tsunami hazards of subduction zones. In March 2005, the Sunda megathrust ruptured again, producing an event of moment magnitude (M(w)) 8.6 south of the 2004 rupture area, which was the site of a similar event in 1861 (ref. 6). Concern was then focused on the Mentawai area, where large earthquakes had occurred in 1797 (M(w) = 8.8) and 1833 (M(w) = 9.0). Two earthquakes, one of M(w) = 8.4 and, twelve hours later, one of M(w) = 7.9, indeed occurred there on 12 September 2007. Here we show that these earthquakes ruptured only a fraction of the area ruptured in 1833 and consist of distinct asperities within a patch of the megathrust that had remained locked in the interseismic period. This indicates that the same portion of a megathrust can rupture in different patterns depending on whether asperities break as isolated seismic events or cooperate to produce a larger rupture. This variability probably arises from the influence of non-permanent barriers, zones with locally lower pre-stress due to the past earthquakes. The stress state of the portion of the Sunda megathrust that had ruptured in 1833 and 1797 was probably not adequate for the development of a single large rupture in 2007. The moment released in 2007 amounts to only a fraction both of that released in 1833 and of the deficit of moment that had accumulated as a result of interseismic strain since 1833. The potential for a large megathrust event in the Mentawai area thus remains large.

Multiple aortocoronary bypass saphenous vein graft aneurysms in a 77-year-old man.

Aneurysms of aortocoronary saphenous vein bypass grafts are a rare complication of coronary artery bypass grafts. The authors report the incidental finding of four aneurysms in two aortocoronary saphenous vein bypass grafts in a 77-year-old man with progressive generalized weakness, left facial drooping, and digitalis toxicity. A brief review of the literature on this rare condition is also provided.

InSAR observations of low slip rates on the major faults of western Tibet.

Two contrasting views of the active deformation of Asia dominate the debate about how continents deform: (i) The deformation is primarily localized on major faults separating crustal blocks or (ii) deformation is distributed throughout the continental lithosphere. In the first model, western Tibet is being extruded eastward between the major faults bounding the region. Surface displacement measurements across the western Tibetan plateau using satellite radar interferometry (InSAR) indicate that slip rates on the Karakoram and Altyn Tagh faults are lower than would be expected for the extrusion model and suggest a significant amount of internal deformation in Tibet.