Precipitation frequency in Med-CORDEX and EURO-CORDEX ensembles from 0.44° to convection-permitting resolution: impact of model resolution and convection representation

Recent studies using convection-permitting (CP) climate simulations have demonstrated a step-change in the representation of heavy rainfall and rainfall characteristics (frequency-intensity) compared to coarser resolution Global and Regional climate models. The goal of this study is to better understand what explains the weaker frequency of precipitation in the CP ensemble by assessing the triggering process of precipitation in the different ensembles of regional climate simulations available over Europe. We focus on the statistical relationship between tropospheric temperature, humidity and precipitation to understand how the frequency of precipitation over Europe and the Mediterranean is impacted by model resolution and the representation of convection (parameterized vs. explicit). We employ a multi-model data-set with three different resolutions (0.44°, 0.11° and 0.0275°) produced in the context of the MED-CORDEX, EURO-CORDEX and the CORDEX Flagship Pilot Study "Convective Phenomena over Europe and the Mediterranean" (FPSCONV). The multi-variate approach is applied to all model ensembles, and to several surface stations where the integrated water vapor (IWV) is derived from Global Positioning System (GPS) measurements. The results show that all model ensembles capture the temperature dependence of the critical value of IWV (IWVcv), above which an increase in precipitation frequency occurs, but the differences between the models in terms of the value of IWVcv, and the probability of its being exceeded, can be large at higher temperatures. The lower frequency of precipitation in convection-permitting simulations is not only explained by higher temperatures but also by a higher IWVcv necessary to trigger precipitation at similar temperatures, and a lower probability to exceed this critical value. The spread between models in simulating IWVcv and the probability of exceeding IWVcv is reduced over land in the ensemble of models with explicit convection, especially at high temperatures, when the convective fraction of total precipitation becomes more important and the influence of the representation of entrainment in models thus becomes more important. Over lowlands, both model resolution and convection representation affect precipitation triggering while over mountainous areas, resolution has the highest impact due to orography-induced triggering processes. Over the sea, since lifting is produced by large-scale convergence, the probability to exceed IWVcv does not depend on temperature, and the model resolution does not have a clear impact on the results

Use of Telemedicine Healthcare Systems in Children and Adolescents with Chronic Disease or in Transition Stages of Life: Consensus Document of the Italian Society of Telemedicine (SIT), of the Italian Society of Preventive and Social Pediatrics (SIPPS), of the Italian Society of Pediatric Primary Care (SICuPP), of the Italian Federation of Pediatric Doctors (FIMP) and of the Syndicate of Family Pediatrician Doctors (SIMPeF)

Telemedicine is considered an excellent tool to support the daily and traditional practice of the health profession, especially when referring to the care and management of chronic patients. In a panorama in which chronic pathologies with childhood onset are constantly increasing and the improvement of treatments has allowed survival for them into adulthood, telemedicine and remote assistance are today considered effective and convenient solutions both for the chronic patient, who thus receives personalized and timely assistance, and for the doctors, who reduce the need for direct intervention, hospitalizations and consequent management costs. This Consensus document, written by the main Italian Scientific Societies involved in the use of telemedicine in pediatrics, has the objectives to propose an organizational model based on the relationships between the actors who participate in the provision of a telemedicine service aimed at minors with chronic pathologies, identifying specific project links between the areas of telemedicine in the developmental age from the first 1000 days of life to the age adult. The future scenario will have to be able to integrate digital innovation in order to offer the best care to patients and citizens. It will have to be able to provide the involvement of patients from the very beginning of the design of any care pathway, increasing where possible the proximity of the health service to citizens

Impact of Safety-Related Dose Reductions or Discontinuations on Sustained Virologic Response in HCV-Infected Patients: Results from the GUARD-C Cohort.

BACKGROUND: Despite the introduction of direct-acting antiviral agents for chronic hepatitis C virus (HCV) infection, peginterferon alfa/ribavirin remains relevant in many resource-constrained settings. The non-randomized GUARD-C cohort investigated baseline predictors of safety-related dose reductions or discontinuations (sr-RD) and their impact on sustained virologic response (SVR) in patients receiving peginterferon alfa/ribavirin in routine practice. METHODS: A total of 3181 HCV-mono-infected treatment-naive patients were assigned to 24 or 48 weeks of peginterferon alfa/ribavirin by their physician. Patients were categorized by time-to-first sr-RD (Week 4/12). Detailed analyses of the impact of sr-RD on SVR24 (HCV RNA <50 IU/mL) were conducted in 951 Caucasian, noncirrhotic genotype (G)1 patients assigned to peginterferon alfa-2a/ribavirin for 48 weeks. The probability of SVR24 was identified by a baseline scoring system (range: 0-9 points) on which scores of 5 to 9 and <5 represent high and low probability of SVR24, respectively. RESULTS: SVR24 rates were 46.1% (754/1634), 77.1% (279/362), 68.0% (514/756), and 51.3% (203/396), respectively, in G1, 2, 3, and 4 patients. Overall, 16.9% and 21.8% patients experienced ≥1 sr-RD for peginterferon alfa and ribavirin, respectively. Among Caucasian noncirrhotic G1 patients: female sex, lower body mass index, pre-existing cardiovascular/pulmonary disease, and low hematological indices were prognostic factors of sr-RD; SVR24 was lower in patients with ≥1 vs. no sr-RD by Week 4 (37.9% vs. 54.4%; P = 0.0046) and Week 12 (41.7% vs. 55.3%; P = 0.0016); sr-RD by Week 4/12 significantly reduced SVR24 in patients with scores <5 but not ≥5. CONCLUSIONS: In conclusion, sr-RD to peginterferon alfa-2a/ribavirin significantly impacts on SVR24 rates in treatment-naive G1 noncirrhotic Caucasian patients. Baseline characteristics can help select patients with a high probability of SVR24 and a low probability of sr-RD with peginterferon alfa-2a/ribavirin.This study was sponsored by F. Hoffmann-La Roche Ltd, Basel, Switzerland. Support for third-party writing assistance for this manuscript, furnished by Blair Jarvis MSc, ELS, of Health Interactions, was provided by F. Hoffmann-La Roche Ltd, Basel, Switzerland

Impact of safety-related dose reductions or discontinuations on sustained virologic response in HCV-infected patients: Results from the GUARD-C Cohort

Background: Despite the introduction of direct-acting antiviral agents for chronic hepatitis C virus (HCV) infection, peginterferon alfa/ribavirin remains relevant in many resource-constrained settings. The non-randomized GUARD-C cohort investigated baseline predictors of safety-related dose reductions or discontinuations (sr-RD) and their impact on sustained virologic response (SVR) in patients receiving peginterferon alfa/ribavirin in routine practice. Methods: A total of 3181 HCV-mono-infected treatment-naive patients were assigned to 24 or 48 weeks of peginterferon alfa/ribavirin by their physician. Patients were categorized by time-to-first sr-RD (Week 4/12). Detailed analyses of the impact of sr-RD on SVR24 (HCV RNA <50 IU/mL) were conducted in 951 Caucasian, noncirrhotic genotype (G)1 patients assigned to peginterferon alfa-2a/ribavirin for 48 weeks. The probability of SVR24 was identified by a baseline scoring system (range: 0-9 points) on which scores of 5 to 9 and <5 represent high and low probability of SVR24, respectively. Results: SVR24 rates were 46.1 % (754/1634), 77.1% (279/362), 68.0% (514/756), and 51.3% (203/396), respectively, in G1,2, 3, and 4 patients. Overall, 16.9% and 21.8% patients experienced 651 sr-RD for peginterferon alfa and ribavirin, respectively. Among Caucasian noncirrhotic G1 patients: female sex, lower body mass index, pre-existing cardiovascular/pulmonary disease, and low hematological indices were prognostic factors of sr-RD; SVR24 was lower in patients with 651 vs. no sr-RD by Week 4 (37.9% vs. 54.4%; P = 0.0046) and Week 12 (41.7% vs. 55.3%; P = 0.0016); sr-RD by Week 4/12 significantly reduced SVR24 in patients with scores <5 but not 655. Conclusions: In conclusion, sr-RD to peginterferon alfa-2a/ribavirin significantly impacts on SVR24 rates in treatment-naive G1 noncirrhotic Caucasian patients. Baseline characteristics can help select patients with a high probability of SVR24 and a low probability of sr-RD with peginter-feron alfa-2a/ribavirin

Interannual variability of the cloud cover in the Paris area : a synoptic regime analysis

International audienceThe major issue here is to understand the role of the cloud interannual variability on the climate. Actually, recent studies show that some temperature anomalies in Europe are not explained by a dynamical regime anomaly: a cloud cover anomaly is then a possible explanation. In particular, responses are expected concerning the mechanisms that relate cloud variability to regional climate variability. The ground-based atmospheric observatory of SIRTA collects data since about ten years, allowing the documentation of the complete atmospheric column: measurements of (i) classical meteorological parameters (temperature, pressure, relative humidity, precipitations. . . ), (ii) water vapour using GPS and other techniques, (iii) vertical structure of clouds using lidar and radar, (iv) downward and upward radiative fluxes. . . The interannual variability of the cloud cover is studied using this database. These observations are classified by synoptic regime in order to differentiate the impact of general circulation from more local elements. This classification is done following two different methods: the first one is based on maps of geopotential height located mostly over the Atlantic Ocean in the North hemisphere, the second one is based on the temporal variation (24- to 48-hours) of local thermodynamical variables such as temperature, relative humidity, and sea-level pressure

A randomized evaluation of different approaches to coronary sinus venography during biventricular pacemaker implants

Aim. Biventricular implantation procedures require contrast venography of the coronary sinus. The aim of our study was to evaluate the efficacy and safety of contrast venography obtained by direct manual contrast injection into the guiding catheter, compared with venography obtained after occlusion of the coronary sinus by a Swan-Ganz catheter. Methods. Eighty-three patients were randomly assigned to direct or occlusive venography technique. The primary endpoint was complication rate. The secondary endpoints were rate of and time required for an adequate venography, total dose of contrast medium and total procedure time. Results. Four dissections of the coronary sinus were observed with the occlusive venography technique group while no complications were observed with the direct venography technique group (p = 0.04). Rate of adequate venography was similar in the two groups (p = NS). The time needed for coronary sinus venography and the total dose of contrast medium was significantly lower in the direct venography technique group compared with the alternative (p < 0.0001 and p = 0.003, respectively); the total procedure time was not significantly different between the two groups (p = NS). Conclusions. The direct venography technique shows a significantly lower incidence of complications and should be considered to be the first line approach to coronary sinus venography during biventricular pacemaker implantation. © 2004 The European Society of Cardiology. Published by Elsevier Ltd. All rights reserved