An operational flash-flood forecasting chain applied to the test cases of the EU project HYDROPTIMET

International audience The application of a flash-flood prediction chain, developed by CIMA, to some testcases for the Tanaro river basin in the framework of the EU project HYDROPTIMET is presented here. The components of the CIMA chain are: forecast rainfall depths, a stochastic downscaling procedure and a hydrological model. Different meteorological Limited Area Models (LAMs) provide the rainfall input to the hydrological component. The flash-flood prediction chain is run both in a deterministic and in a probabilistic configuration. The sensitivity of forecasting chain performances to different LAMs providing rainfall forecasts is discussed. The results of the application show how the probabilistic forecasting system can give, especially in the case of convective events, a valuable contribution in addressing the uncertainty at different spatio-temporal scales involved in the flash flood forecasting problem in small and medium basins with complex orography

Effects of propagation conditions on radar beam-ground interaction: impact on data quality

International audienceA large part of the research in the radar meteorology is devoted to the evaluation of the radar data quality and to the radar data processing. Even when, a set of absolute quality indexes can be produced (like as ground clutter presence, beam blockage rate, distance from radar, etc.), the final product quality has to be determined as a function of the task and of all the processing steps. In this paper the emphasis lies on the estimate of the rainfall at the ground level taking extra care for the correction for ground clutter and beam blockage, that are two main problems affecting radar reflectivity data in complex orography. In this work a combined algorithm is presented that avoids and/or corrects for these two effects. To achieve this existing methods are modified and integrated with the analysis of radar signal propagation in different atmospheric conditions. The atmospheric refractivity profile is retrieved from the nearest in space and time radiosounding. This measured profile is then used to define the `dynamic map' used as a declutter base-field. Then beam blockage correction is applied to the data at the scan elevations computed from this map. Two case studies are used to illustrate the proposed algorithm. One is a summer event with anomalous propagation conditions and the other one is a winter event. The new algorithm is compared to a previous method of clutter removal based only on static maps of clear air and vertical reflectivity continuity test. The improvement in rain estimate is evaluated applying statistical analysis and using rain gauges data. The better scores are related mostly to the ``optimum" choice of the elevation maps, introduced by the more accurate description of the signal propagation. Finally, a data quality indicator is introduced as an output of this scheme. This indicator has been obtained from the general scheme, which takes into account all radar data processing steps

3DVAR assimilation of SSM/I data over the sea for the IOP2b MAP case

International audienceData assimilation by 3DVAR of data from the Special Sensor Microwave/Imager (SSM/I) has been performed to study the IOP2b case (19-21 September 1999) of the Mesoscale Alpine Programme (MAP). Only data over the sea surface are used to avoid the contamination of the surface emissivity. Moreover, the rainy data are filtered out because the assimilation algorithm of 3DVAR does not take into account the scattering processes. SSM/I data are assimilated in two different ways: as Brightness Temperature directly, or as Precipitable Water and surface wind speed retrieved from the Brightness Temperature. The effect of the thinning of the observations has been studied and a set of sensitivity test cases has been carried out; the one by one removal of the SSM/I frequencies from the initial dataset allows to evaluate their impact on the Initial Conditions. A few experiments are performed using these new Initial Conditions to initialize the MM5 (PSU/NCAR) model. The results show that the assimilation of the retrieved quantities, i.e. Precipitable Water and surface wind speed, does not produces large improvement in the Initial Conditions. Vice versa, the assimilation of the Brightness temperatures produces a large variability of the Initial Conditions. The forecast experiments show that the model is very sensitive to the 22GHz and 37GHz frequencies

Applicability of a forecasting chain in a different morphological environment in Italy

International audienceThe operational meteo-hydrological forecasting chain of the Liguria Region (NW Italy) is applied to a different morphoclimatic environment, such as the Emilia Romagna Region (N Italy). Modification to the chain, both in models and in procedures, are introduced to overcome problems related to medium dimension catchments (A?1000km2), characterized by complex altimetry profiles and antropical interventions along the river. The main feature of the original operational procedure, that is the probabilistic approach, is maintained. Hydraulic hazard reduction through artificial reservoirs management is exploited with reference to a specific event occurred on the Reno basin (Emilia Romagna Region)

Ten Years of Medical Informatics and Standards Support for Clinical Research in an Infectious Diseases Network

Background It is 30 years since evidence-based medicine became a great support for individual clinical expertise in daily practice and scientific research. Electronic systems can be used to achieve the goal of collecting data from heterogeneous datasets and to support multicenter clinical trials. The Ligurian Infectious Diseases Network (LIDN) is a web-based platform for data collection and reuse originating from a regional effort and involving many professionals from different fields. Objectives The objective of this work is to present an integrated system of ad hoc interfaces and tools that we use to perform pseudonymous clinical data collection, both manually and automatically, to support clinical trials. Methods The project comprehends different scenarios of data collection systems, according to the degree of information technology of the involved centers. To be compliant with national regulations, the last developed connection is based on the standard Clinical Document Architecture Release 2 by Health Level 7 guidelines, interoperability is supported by the involvement of a terminology service. Results Since 2011, the LIDN platform has involved more than 8,000 patients from eight different hospitals, treated or under treatment for at least one infectious disease among human immunodeficiency virus (HIV), hepatitis C virus, severe acute respiratory syndrome coronavirus 2, and tuberculosis. Since 2013, systems for the automatic transfer of laboratory data have been updating patients' information for three centers, daily. Direct communication was set up between the LIDN architecture and three of the main national cohorts of HIV-infected patients. Conclusion The LIDN was originally developed to support clinicians involved in the project in the management of data from HIV-infected patients through a web-based tool that could be easily used in primary-care units. Then, the developed system grew modularly to respond to the specific needs that arose over a time span of more than 10 years

Pregnancy and neonatal outcomes among a cohort of HIV-infected women in a large Italian teaching hospital : a 30-year retrospective study

The primary study objective was to investigate three decades from 1985 to 2014 of changes in pregnancies among HIV-infected women. The secondary objective was to assess risk factors associated with preterm delivery and severe small-for-gestational-age (SGA) infants in HIV-infected women. A retrospective review of deliveries among pregnant HIV-infected women at the University of Genoa and IRCCS San Martino-IST in Genoa between 1985 and 2014 was performed. Univariate and multivariable analyses were used to study the variables associated with neonatal outcomes. Overall, 262 deliveries were included in the study. An increase in median age (26 years in 1985-1994 vs. 34 years in 2005-2014), in the proportion of foreigners (none in 1985-1994 vs. 27/70 (38\ub76%) in 2005-2014), and a decrease in intravenous drug use (75\ub72% (91/121) in 1985-1994 vs. 12\ub79% (9/70) in 2005-2014) among pregnant HIV-infected women was observed. Progressively, HIV infections were diagnosed sooner (prior to pregnancy in 80% (56/70) of women in the last decade). An increase in combined antiretroviral therapy (cART) prescription during pregnancy (50% (27/54) in 1995-2004 vs. 92\ub72% (59/64) in 2005-2014) and in HIV-RNA <50 copies/ml at delivery (19\ub72% (5/26) in 1995-2004 vs. 82\ub73% (53/64) in 2005-2014) was observed. The rate of elective caesarean section from 1985 to 1994 was 9\ub71%, which increased to 92\ub73% from 2004 to 2015. Twelve (10\ub71%) mother-to-child transmissions (MTCT) occurred in the first decade, and six (8\ub73%) cases occurred in the second decade, the last of which was in 2000. Preterm delivery (<37 weeks gestation) was 5% (6/121) from 1985 to 1994 and increased to 17\ub71% (12/70) from 2005 to 2014. In univariate and multivariable logistic regression analyses, advancing maternal age and previous pregnancies were associated with preterm delivery (odds ratio (OR) 2\ub77; 95% confidence intervals (CI) 1-7\ub78 and OR 2\ub76; 95% CI 1\ub71-6\ub77, respectively). In the logistic regression analysis, use of heroin or methadone was found to be the only risk factor for severe SGA (OR 3\ub71; 95% CI 1\ub74-6\ub78). In conclusion, significant changes in demographic, clinical and therapeutic characteristics of HIV-infected pregnant women have occurred over the last 30 years. Since 2000, MTCT has decreased to zero. An increased risk of preterm delivery was found to be associated with advancing maternal age and previous pregnancies but not with cART. The use of heroin or methadone has been confirmed as a risk factor associated with severe SGA

Weight gain: A possible side effect of all antiretrovirals

Weight gain and body mass index (BMI) increase are central issues in patients living with HIV who need to minimize the risk of metabolic disease. Information collected through the SCOLTA cohort revealed significant 1-year BMI increase in patients treated with dolutegravir (P = .004), raltegravir (P = .0004), elvitegravir (P = .004), darunavir (P = .0006), and rilpivirine (P = .029). BMI gain correlated with low baseline BMI (P = .002) and older age (P = .0007) in Centers for Disease Control and Prevention stages A/B, with lower BMI (P = .005) and CD4+ T-cell count (P = .007) at enrollment in stage C

Causes of HIV Treatment Interruption during the Last 20 Years: A Multi-Cohort Real-Life Study

In the last years, many antiretroviral drugs (ART) have been developed with increased efficacy. Nowadays, the main reasons for treatment switches are adverse events, proactive strategy or simplification. We conducted a retrospective cohort study to investigate the reason for treatment interruption in the last 20 years. We merged data of eight cohorts of the SCOLTA project: lopinavir/r (LPV), atazanavir/r (ATV), darunavir/r or /c (DRV), rilpivirine (RPV), raltegravir (RAL), elvitegravir/c (EVG), dolutegravir (DTG) and bictegravir (BIC). We included 4405 people with HIV (PWH). Overall, 664 (15.1%), 489 (11.1%), and 271 (6.2%) PWH interrupted the treatment in the first, second, and third years after starting a new ART. Looking at the interruption in the first year, the most frequent causes were adverse events (3.8%), loss to follow-up (3.7%), patients’ decisions (2.6%), treatment failure (1.7%), and simplification (1.3%). In the multivariate analysis regarding experienced patients, treatment with LPV, ATV, RPV or EVG/c, having less than 250 CD4 cells/mL, history of intravenous drug use, and HCV positivity were associated with an increased risk of interruption. In naive people, only LPV/r was associated with an increased risk of interruption, while RPV was associated with a lower risk. In conclusion, our data on more than 4400 PWH show that adverse events have represented the most frequent cause of treatment interruptions in the first year of ART (3.84%). Treatment discontinuations were more frequent during the first year of follow-up and decreased thereafter. First-generation PI in both naïve and experienced PWH, and EVG/c, in experienced PWH, were associated with a higher risk of treatment interruptions

Ventricular arrhythmias in patients with functional mitral regurgitation and implantable cardiac devices: implications of mitral valve repair with Mitraclip

Background: Limited information has been reported regarding the impact of percutaneous mitral valve repair (PMVR) on ventricular arrhythmic (VA) burden. The aim of this study was to address the incidence of VA and appropriate antitachycardia implantable cardiac defibrillator (ICD) therapies before and after PMVR. Methods: We retrospectively analyzed all consecutive patients with heart failure with reduce left ventricular ejection fraction (LVEF), functional mitral regurgitation (FMR) grade 3+ or 4+ and an active ICD or cardiac resynchronizer who underwent PMVR in any of the eleven recruiting centers. Only patients with complete available device VA monitoring from one-year before to one year after PMVR were included. Baseline clinical and echocardiographic characteristics were collected before PMVR and at 12-months follow-up. Results: Ninety-three patients (68.2+/-10.9 years old, male 88.2%) were enrolled. PMVR was successfully performed in all patients and device success at discharge was 91.4%. At 12-month follow-up, we observed a significant reduction in mitral regurgitation severity, NT-proBNP and prevalence of severe pulmonary hypertension and severe kidney disease. Patients also referred a significant improvement in NYHA functional class and showed a non-significant trend to reserve left ventricular remodeling. After PMVR a significant decrease in the incidence of non-sustained ventricular tachycardia (VT) (5.0+/-17.8 vs. 2.7+/-13.5, P=0.002), sustained VT or ventricular fibrillation (0.9+/-2.5 vs. 0.5+/-2.9, P=0.012) and ICD antitachycardia therapies (2.5+/-12.0 vs. 0.9+/-5.0, P=0.033) were observed. Conclusions: PMVR was related to a reduction in arrhythmic burden and ICD therapies in our cohort