Controlling instabilities along a 3DVar analysis cycle by assimilating in the unstable subspace: a comparison with the EnKF

A hybrid scheme obtained by combining 3DVar with the Assimilation in the Unstable Subspace (3DVar-AUS) is tested in a QG model, under perfect model conditions, with a fixed observational network, with and without observational noise. The AUS scheme, originally formulated to assimilate adaptive observations, is used here to assimilate the fixed observations that are found in the region of local maxima of BDAS vectors (Bred vectors subject to assimilation), while the remaining observations are assimilated by 3DVar. The performance of the hybrid scheme is compared with that of 3DVar and of an EnKF. The improvement gained by 3DVar-AUS and the EnKF with respect to 3DVar alone is similar in the present model and observational configuration, while 3DVar-AUS outperforms the EnKF during the forecast stage. The 3DVar-AUS algorithm is easy to implement and the results obtained in the idealized conditions of this study encourage further investigation toward an implementation in more realistic contexts

New European guidelines for the management of dyslipidaemia in cardiovascular prevention

The new guidelines from the European Atherosclerosis Society and the European Society of Cardiology include a number of updated items. In this paper, we summarize 4 of these changes that we consider to be the most pertinent. Firstly, cardiovascular risk is now stratified according to 4 (previously 2) categories: "very high risk" (patients with cardiovascular disease, patients with diabetes > 40 years old who have at least one other risk factor, patients with kidney failure, or patients in primary prevention with a SCORE value > or = 10%); "high risk" (patients in primary prevention with a SCORE value > or = 5% and or = 1% and < 5%); and "low risk" (primary prevention with SCORE < 1%). The SCORE value for patients in primary prevention is estimated using the SCORE table (calibrated for Belgium). Risk in this table may now be corrected according to HDL cholesterol level. Secondly, the therapeutic targets for each category are now more stringent: LDL cholesterol < 70 mg/dl (or reduced by at least 50%) if the risk is "very high"; < 100 mg/dl if the risk is "high"; and < 115 mg/dl if the risk is "moderate". Thirdly, for patients at "high" or "very high" risk, particularly in patients with combined dyslipidaemia, two further therapeutic targets should be considered: non-HDL cholesterol and apolipoprotein B levels. Fourthly, the follow-up of efficacy (lipid profile) and tolerance (hepatic and muscular enzymes) is described in more details so as to harmonize case management in clinical practice.Peer reviewe

Culture of per-wound bone specimens: a simplified approach for the medical management of diabetic foot osteomyelitis

AbstractSurgical percutaneous bone biopsy specimen after a 14-day antibiotic-free period represents the gold standard of care for diabetic foot osteomyelitis but may be difficult to implement in many institutions. We evaluate a simplified strategy based on the results of per-wound bone specimen culture. For that purpose, we retrospectively reviewed the charts of 80 consecutive patients with diabetic osteomyelitis and bone sample obtained via the wound after a careful debridement. The outcome was defined as favourable if there was a complete healing of the wound with no sign of infection and stable or improved bone X-ray 6 months after antibiotic therapy completion. Culture of bone specimens was positive in 96% of patients, although half of the patients did receive a course of antimicrobials within 14 days of the bone specimen being obtained. A total of 129 bacterial isolates were obtained from bone cultures with a mean of 1.6 ± 1 isolates per patient (Staphylococcus aureus: 33%; coagulase-negative staphylococci: 14%; streptococci: 9%; enterococci: 12%; corynebacteria: 4%; Gram-negative bacilli: 20%; anaerobes: 4%). Forty-six percent of cultures were monomicrobial. The mean duration of follow-up from diagnosis was 17 ± 1 months. Six months after discontinuation of antibiotics, six patients (7.5%) had died, nine were considered as therapeutic failures and 65 were considered as cured. Fifty-four of these 65 patients had follow-up data available at 1 year and remained in remission. In conclusion, a simplified procedure based on the culture of bone sample obtained via the ulcer after a careful debridement of the wound is effective in the medical management of diabetic foot osteomyelitis

Tauroursodeoxycholic acid dampens oncogenic apoptosis induced by endoplasmic reticulum stress during hepatocarcinogen exposure

Hepatocellular carcinoma (HCC) is characterized by the accumulation of unfolded proteins in the endoplasmic reticulum (ER), which activates the unfolded protein response (UPR). However, the role of ER stress in tumor initiation and progression is controversial. To determine the impact of ER stress, we applied tauroursodeoxycholic acid (TUDCA), a bile acid with chaperone properties. The effects of TUDCA were assessed using a diethylnitrosamine-induced mouse HCC model in preventive and therapeutic settings. Cell metabolic activity, proliferation and invasion were investigated in vitro. Tumor progression was assessed in the HepG2 xenograft model. Administration of TUDCA in the preventive setting reduced carcinogen-induced elevation of alanine and aspartate aminotransferase levels, apoptosis of hepatocytes and tumor burden. TUDCA also reduced eukaryotic initiation factor 2a (eIf2a) phosphorylation, C/EBP homologous protein expression and caspase-12 processing. Thus, TUDCA suppresses carcinogen-induced pro-apoptotic UPR. TUDCA alleviated hepatic inflammation by increasing NF-kappa B inhibitor I kappa Ba. Furthermore, TUDCA altered the invasive phenotype and enhanced metabolic activity but not proliferation in HCC cells. TUDCA administration after tumor development did not alter orthotopic tumor or xenograft growth. Taken together, TUDCA attenuates hepatocarcinogenesis by suppressing carcinogen-induced ER stress-mediated cell death and inflammation without stimulating tumor progression. Therefore, this chemical chaperone could represent a novel chemopreventive agent

Combining short-range dispersion simulations with fine-scale meteorological ensembles: probabilistic indicators and evaluation during a ⁸⁵Kr field campaign

Numerical atmospheric dispersion models (ADMs) are used for predicting the health and environmental consequences of nuclear accidents in order to anticipate countermeasures necessary to protect the populations. However, these simulations suffer from significant uncertainties, arising in particular from input data: weather conditions and source term. Meteorological ensembles are already used operationally to characterize uncertainties in weather predictions. Combined with dispersion models, these ensembles produce different scenarios of radionuclide dispersion, called “members”, representative of the variety of possible forecasts. In this study, the fine-scale operational weather ensemble AROME-EPS (Applications of Research to Operations at Mesoscale-Ensemble Prediction System) from Météo-France is coupled with the Gaussian puff model pX developed by the IRSN (French Institute for Radiation Protection and Nuclear Safety). The source term data are provided at 10 min resolution by the Orano La Hague reprocessing plant (RP) that regularly discharges 85Kr during the spent nuclear fuel reprocessing process. In addition, a continuous measurement campaign of 85Kr air concentration was recently conducted by the Laboratory of Radioecology in Cherbourg (LRC) of the IRSN, within 20 km of the RP in the North-Cotentin peninsula, and is used for model evaluation. This paper presents a probabilistic approach to study the meteorological uncertainties in dispersion simulations at local and medium distances (2–20 km). First, the quality of AROME-EPS forecasts is confirmed by comparison with observations from both Météo-France and the IRSN. Then, the probabilistic performance of the atmospheric dispersion simulations was evaluated by comparison to the 85Kr measurements carried out during a period of 2 months, using two probabilistic scores: relative operating characteristic (ROC) curves and Peirce skill score (PSS). The sensitivity of dispersion results to the method used for the calculation of atmospheric stability and associated Gaussian dispersion standard deviations is also discussed. A desirable feature for a model used in emergency response is the ability to correctly predict exceedance of a given value (for instance, a dose guide level). When using an ensemble of simulations, the “decision threshold” is the number of members predicting an event above which this event should be considered probable. In the case of the 16-member dispersion ensemble used here, the optimal decision threshold was found to be 3 members, above which the ensemble better predicts the observed peaks than the deterministic simulation. These results highlight the added value of ensemble forecasts compared to a single deterministic one and their potential interest in the decision process during crisis situations.</p

On the Stability of the Satellites of Asteroid 87 Sylvia

he triple asteroidal system (87) Sylvia is composed of a 280-km primary and two small moonlets named Romulus and Remus (Marchis et al 2005). Sylvia is located in the main asteroid belt. The satellites are in nearly equatorial circular orbits around the primary. In the present work we study the stability of the satellites Romulus and Remus, in order to identify the effects and the contribution of each perturber. The results from the 3-body problem, Sylvia-Romulus-Remus, show no significant variation of their orbital elements. However, the inclinations of the satellites present a long period evolution, when the Sun is included in the system. Such amplitude is amplified when Jupiter is included. An analysis of these results show that Romulus and Remus are librating in a secular resonance and their longitude of the nodes are locked to each other. The satellites get caught in an evection resonance with Jupiter. However, the orbital evolutions of the satellites became completely stable when the oblateness of Sylvia is included in the simulations.Comment: 11 pages, 8 figures and 1 tabl

Glucocorticoids for acute urticaria: study protocol for a double-blind non-inferiority randomised controlled trial

INTRODUCTION: This study protocol describes a trial designed to investigate whether antihistamine alone in patients with acute urticaria does not increase the 7-day Urticaria Activity Score (UAS7) in comparison with an association of antihistamine and glucocorticoids and reduces short-term relapses and chronic-induced urticaria. METHODS AND ANALYSIS: This is a prospective, double-blind, parallel-group, multicentre non-inferiority randomised controlled trial. Two-hundred and forty patients with acute urticaria admitted to emergency department will be randomised in a 1:1 ratio to receive levocetirizine or an association of levocetirizine and prednisone. Randomisation will be stratified by centre. The primary outcome will be the UAS7 at day 7. The secondary outcomes will encompass recurrence of hives and/or itch at day 7; occurrence of spontaneous hives or itch for &gt;6 weeks; patients with angioedema at day 7, and 2, 6, 12 and 24 weeks; new emergency visits for acute urticaria recurrences at days 7 and 14, and 3 months; Dermatology Life Quality Index at days 7 and 14, and 3 and 6 months; and Chronic Urticaria Quality of Life Questionnaire at 6 weeks. ETHICS AND DISSEMINATION: The protocol has been approved by the and will be carried out in accordance with the Declaration of Helsinki and Good Clinical Practice guidelines. A steering committee will oversee the progress of the study. Findings will be disseminated through national and international scientific conferences and publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER: NCT03545464

Detecting a stochastic gravitational wave background with the Laser Interferometer Space Antenna

The random superposition of many weak sources will produce a stochastic background of gravitational waves that may dominate the response of the LISA (Laser Interferometer Space Antenna) gravitational wave observatory. Unless something can be done to distinguish between a stochastic background and detector noise, the two will combine to form an effective noise floor for the detector. Two methods have been proposed to solve this problem. The first is to cross-correlate the output of two independent interferometers. The second is an ingenious scheme for monitoring the instrument noise by operating LISA as a Sagnac interferometer. Here we derive the optimal orbital alignment for cross-correlating a pair of LISA detectors, and provide the first analytic derivation of the Sagnac sensitivity curve.Comment: 9 pages, 11 figures. Significant changes to the noise estimate

Multi-center evaluation of the hepatitis B surface antigen (HBsAg) assay and HbsAg confirmatory assay for the family of Access immunoassay systems

BACKGROUND: Accurate detection of Hepatitis B Surface Antigen (HBsAg) is an important aid in the diagnosis of patients infected with the hepatitis B virus (HBV). A multi-center study was conducted to characterize the performance of the HBsAg assay on the family of Access immunoassay systems from Beckman Coulter. METHODS: The Access HBsAg assay was characterized in a multi-center study and compared to the Abbott AxSYM* and PRISM* HBsAg assays. The bioMérieux VIDAS* assay was used to resolve discrepant results. Reproducibility studies (intra-assay, inter-assay and inter-lot) were performed with pooled serum samples (negative sample, close to cut off, low, medium and high positive samples). Analytical sensitivity, subtype and genotype detection were studied with various commercial panels (SFTS panel, WHO 80/549, WHO 00/588, Teragenix HBV Genotype panel). A panel of recombinant HBsAg mutant proteins was tested to investigate reactivity towards genetic mutations. Clinical sensitivity was verified with seroconversion panels and samples from subjects with known HBV infection. Analytical specificity was studied with samples from patients with potential cross-reactive infections. Clinical specificity was validated among blood donors and a hospitalized population. RESULTS: The imprecision was &lt; 10%. Analytical sensitivity was &lt; or = 0.1 ng/mL (SFTS panel), 0.020 PEI Units/mL (ad panel), 0.024 PEI Units/mL (ay panel), 0.092 IU/mL with WHO 80/549 and 0.056 IU/mL with WHO 00/588. All genotype samples and HBsAg mutants were reactive with the Access HBsAg assay. Seroconversion panels tested showed no significant difference with the reference method. Sensitivity for subjects with known HBV infection was 100%. No interference with potentially cross-reactive infections was observed after confirmatory testing. Specificity was 99.96% (100% after confirmatory testing) in a blood donor population and 99.5% (100% after confirmatory testing) in a hospitalized population. Excellent separation of positive and negative populations was observed. CONCLUSIONS: The Access HBsAg and HBsAg Confirmatory assays meet all clinical and analytical performance requirements of assays for the detection of HBsAg