Model Error and Predictability over Different Timescales in the Lorenz '96 Systems

Prediction problems have been described by Lorenz as falling into two categories. Problems which depend on the initial condition, such as short to medium range weather forecasting, are described as ‘predictions of the first kind’, while problems that depend on boundary rather than initial con-ditions, such as in many cases the longer term climatology, are referred to as predictions of the second kind. Both kinds of prediction will be af-fected by error in the model equations used to approximate the true sys-tem. In this paper, we examine predictability over different time scales for the medium-dimensional Lorenz ’96 systems. Models are constructed for the purposes of optimising both short-range prediction and climatological behavior, and studied over a range of forcings for which they show peri-odic, quasi-periodic, or chaotic behavior. It is shown that, for the models discussed here, there is a link between short and long-range predictability, which holds independently of the effects of chaos. The role of stochas-tic terms is considered, and the possible implications for atmospheric or oceanographic modelling are discussed. 2

Rates of switching antiretroviral drugs in a primary care service in South Africa before and after introduction of tenofovir

Introduction Antiretroviral changes (single drug substitutions and regimen switches) limit treatment options and introduce challenges such as increased cost, monitoring and adherence difficulties. Patterns of drug substitutions and regimen switches from stavudine (d4T) and zidovudine (AZT) regimens have been well described but data on tenofovir (TDF) are more limited. This study describes the patterns and risk factors for drug changes of these antiretroviral drugs in adults. Method This retrospective cohort study included HIV positive, antiretroviral treatment (ART) naïve adults aged ≥18 years who started ART with two nucleoside reverse transcriptase inhibitors (NRTIs) and a non-nucleoside reverse transcriptase inhibitor. Follow-up was censored at first drug change and analysis focused on NRTI changes only. RESULTS: Between September 2002 and April 2011, 5095 adults initiated ART in Gugulethu. This comprised 948 subjects on TDF, 3438 on d4T and 709 subjects on AZT. Virological suppression rates at 1 year, regimen switching due to virological failure and overall losses to the programme were similar across the three groups. TDF had the lowest incidence rate of drug substitutions (2.6 per 100 P/Ys) compared to 17.9 for d4T and 8.5 per 100 P/Ys for AZT. Adverse drug reactions (ADRs) accounted for the majority of drug substitutions of d4T. Multivariate analysis showed that increasing age, female sex and d4T exposure were associated with increased hazard of drug substitution due to ADRs. Conversely, TDF exposure was associated with a substantially lower risk of substitution (adjusted hazards ratio 0.38; 95% CI 0.20-0.72). CONCLUSION: Regimen switches and virological suppression were similar for patients exposed to TDF, d4T and AZT, suggesting all regimens were equally effective. However, TDF was better tolerated with a substantially lower rate of drug substitutions due to ADRs

The role of large-scale spatial patterns in the chaotic amplification of perturbations in a Lorenz’96 model

The preparation of perturbed initial conditions to initialize an ensemble of numerical weather forecasts is a crucial task in current ensemble prediction systems (EPSs). Perturbations are added in the places where they are expected to grow faster, in order to provide an envelope of uncertainty along with the deterministic forecast. This work analyses the influence of large-scale spatial patterns on the growth of small perturbations. Therefore, we compare Lyapunov vector (LV) definitions, used in the initialization of state-of-the-art EPSs, with the so-called characteristic LVs. We test the dynamical behaviour of these LVs in the two-scale Lorenz’96 system. We find that the commonly used definitions of LVs include non-intrinsic and spurious effects due to their mutual orthogonality. We also find that the spatial locations where the small-scale perturbations are growing are ‘quantized’ by the large-scale pattern. This ‘quantization’ enhances the artificial disposition of the LVs, which is only avoided using the characteristic LVs, an unambiguous basis which may also be of great use in realistic models for assessing or initializing EPSs

The experience of family carers attending a joint reminiscence group with people with dementia: A thematic analysis

Reminiscence therapy has the potential to improve quality of life for people with dementia. In recent years reminiscence groups have extended to include family members, but carers' experience of attending joint sessions is undocumented. This qualitative study explored the experience of 18 family carers attending 'Remembering Yesterday Caring Today' groups. Semi-structured interviews were transcribed and subjected to thematic analysis. Five themes were identified: experiencing carer support; shared experience; expectations (met and unmet), carer perspectives of the person with dementia's experience; and learning and comparing. Family carers' experiences varied, with some experiencing the intervention as entirely positive whereas others had more mixed feelings. Negative aspects included the lack of respite from their relative, the lack of emphasis on their own needs, and experiencing additional stress and guilt through not being able to implement newly acquired skills. These findings may explain the failure of a recent trial of joint reminiscence groups to replicate previous findings of positive benefit. More targeted research within subgroups of carers is required to justify the continued use of joint reminiscence groups in dementia care