Determining robustness of synchronous programs under stuttering

Robustness of embedded systems under potential changes in their environment is crucial for reliable behaviour. One typical environmental impact is that of the inputs being slowed down — due to which, the system may no longer satisfy its specification. In this paper, we present a framework for analysing the behaviour of synchronous programs written in Lustre under such environmental interference. Representing slow input by stuttering, we introduce both strong and weak slowdown robustness constraints with respect to this phenomenon. Furthermore, static and dynamic algorithmic techniques are used to deduce whether such constraints are satisfied, and the relationship between stateful programs and the slowdown model considered is explored.peer-reviewe

Expert opinion on managing chronic HCV in patients with mixed cryoglobulinaemia vasculitis

International audienceMixed cryoglobulinaemia vasculitis (CryoVas) is a small-vessel systemic vasculitis caused by deposition of mixed cryoglobulins and is characterized by a wide range of clinical symptoms. HCV is the primary cause of CryoVas, which is associated with significant morbidity and mortality. The mortality rate among patients with HCV-associated CryoVas is 3× that of the general population, with a 63% 10-year survival rate. First-line treatment for CryoVas is anti-HCV therapy because viral clearance is associated with clinical improvement. The introduction of highly effective, interferon-free, direct-acting antiviral regimens provides additional treatment options for these patients. Here, we review recent studies investigating the effect of antiviral therapy on HCV-associated CryoVas and provide expert opinion for health-care professionals managing these patients

Two- and three-dimensional simulations of core-collapse supernovae with CHIMERA

Ascertaining the core-collapse supernova mechanism is a complex, and yet unsolved, problem dependent on the interaction of general relativity, hydrodynamics, neutrino transport, neutrino-matter interactions, and nuclear equations of state and reaction kinetics. Ab initio modeling of core-collapse supernovae and their nucleosynthetic outcomes requires care in the coupling and approximations of the physical components. We have built our multi-physics CHIMERA code for supernova modeling in 1-, 2-, and 3-D, using ray-by-ray neutrino transport, approximate general relativity, and detailed neutrino and nuclear physics. We discuss some early results from our current series of exploding 2D simulations and our work to perform computationally tractable simulations in 3D using the "Yin-Yang" grid.Comment: Proceedings of the 12th Symposium on Nuclei in the Cosmos. 5-12 August 2012. Cairns, Australia. Published online at http://pos.sissa.it/archive/conferences/146/208/NIC%20XII_208.pdf Corrected typ

Static and dynamic analysis for robustness under slowdown

Robustness of embedded systems to potential changes in their environment, which may result in the inputs being affected, is crucial for reliable behaviour. One typical possible change is that the system’s inputs are slowed down, altering its temporal behaviour. Algorithmic analysis of systems to be able to deduce their robustness under such environmental interference is desirable. In this paper, we present a framework for the analysis of synchronous systems to analyse their behaviour when the inputs slow down through stuttering. We identify different types of slowdown robustness constraints and present static and dynamic analysis techniques for determining whether systems written in Lustre satisfy these robustness properties.peer-reviewe

Slowdown invariance of timed regular expressions

In critical systems, it is frequently essential to know whether the system satisfies a number of real-time constraints, usually specified in a real-time logic such as timed regular expressions. However, after having verified a system correct, changes in its environment may slow it down or speed it up, possibly invalidating the properties. Colombo et al. (1) have presented a theory of slowdown and speedup invariance to determine which specifications are safe with respect to system retiming, and applied the approach to duration calculus. In this paper we build upon their approach, applying it to timed regular expressions. We hence identify a fragment of the logic which is invariant under the speedup or slowdown of a system, enabling more resilient verification of properties written in the logic.peer-reviewe

Estimate of the Sources of Plutonium-Containing Wastes Generated from MOX Fuel Production in Russia

In Russia, mixed oxide (MOX) fuel is produced in a pilot facility ''Paket'' at ''MAYAK'' Production Association. The Mining-Chemical Combine (MCC) has developed plans to design and build a dedicated industrial-scale plant to produce MOX fuel and fuel assemblies (FA) for VVER-1000 water reactors and the BN-600 fast-breeder reactor, which is pending an official Russian Federation (RF) site-selection decision. The design output of the plant is based on a production capacity of 2.75 tons of weapons plutonium per year to produce the resulting fuel assemblies: 1.25 tons for the BN-600 reactor FAs and the remaining 1.5 tons for VVER-1000 FAs. It is likely the quantity of BN-600 FAs will be reduced in actual practice. The process of nuclear disarmament frees a significant amount of weapons plutonium for other uses, which, if unutilized, represents a constant general threat. In France, Great Britain, Belgium, Russia, and Japan, reactor-grade plutonium is used in MOX-fuel production. Making MOX-fuel for CANDU (Canada) and pressurized water reactors (PWR) (Europe) is under consideration in Russia. If this latter production is added, as many as 5 tons of Pu per year might be processed into new FAs in Russia. Many years of work and experience are represented in the estimates of MOX fuel production wastes derived in this report. Prior engineering studies and sludge treatment investigations and comparisons have determined how best to treat Pu sludges and MOX fuel wastes. Based upon analyses of the production processes established by these efforts, we can estimate that there will be approximately 1200 kg of residual wastes subject to immobilization per MT of plutonium processed, of which approximately 6 to 7 kg is Pu in the residuals per MT of Pu processed. The wastes are various and complicated in composition. Because organic wastes constitute both the major portion of total waste and of the Pu to be immobilized, the recommended treatment of MOX-fuel production waste is incineration or calcination, alkali sintering, and dissolution of sintered products in nitric acid. Insoluble residues are then mixed with vitrifying components and Pu sludges, vitrified, and sent for storage and disposal. Implementation of the intergovernmental agreement between Russia and the United States (US) regarding the utilization of 34 tons of weapons plutonium will also require treatment of Pu containing MOX fabrication wastes at the MCC radiochemical production plant

Efficacy and safety of glecaprevir/pibrentasvir in patients with chronic HCV infection and psychiatric disorders: An integrated analysis

Although direct-acting antivirals (DAAs) for chronic hepatitis C virus (HCV) infection are highly efficacious and safe, treatment initiation is often limited in patients with neuropsychiatric disorders due to concerns over reduced treatment adherence and drug-drug interactions. Here, we report adherence, efficacy, safety and patient-reported outcomes (PROs) from an integrated analysis of registrational studies using the pangenotypic DAA regimen of glecaprevir and pibrentasvir (G/P). Patients with chronic HCV genotypes 1-6 infection with compensated liver disease (with or without cirrhosis) receiving G/P for 8, 12 or 16 weeks were included in this analysis. Patients were classified as having a psychiatric disorder based on medical history and/or co-medications. Primary analyses assessed treatment adherence, efficacy (sustained virologic response at post-treatment week 12; SVR12), safety and PROs. Among 2522 patients receiving G/P, 789 (31%) had a psychiatric disorder with the most common diagnoses being depression (64%; 506/789) and anxiety disorders (27%; 216/789). Treatment adherence was comparably high (>95%) in patients with and without psychiatric disorders. SVR12 rates were 97.3% (768/789; 95% CI = 96.2-98.5) and 97.5% (1689/1733; 95% CI = 96.7-98.2) in patients with and without psychiatric disorders, respectively. Among patients with psychiatric disorders, SVR12 rates remained >96% by individual psychiatric diagnoses and co-medication classes. Overall, most adverse events (AEs) were mild-to-moderate in severity with serious AEs and AEs leading to G/P discontinuation occurring at similarly low rates in both patient populations. In conclusion, G/P treatment was highly efficacious, well-tolerated and demonstrated high adherence rates in patients with chronic HCV infection and psychiatric disorders

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially