Evaluation of mesoscale convective systems in South America using multiple satellite products and an object‐based approach

In this study, an object-based verification method was used to reveal the existence of systematic errors in three satellite precipitation products: Tropical Rainfall Measurement Mission (TRMM), Climate Prediction Center Morphing Technique (CMORPH), and Precipitation Estimation from Remotely Sensed Information Using Artificial Neural Networks (PERSIANN). Mesoscale convective systems (MCSs) for the austral summer 2002–2003 in the La Plata river basin, southeastern South America, were analyzed with the Contiguous Rain Area (CRA) method. Errors in storms intensity, volume, and spatial location were evaluated. A macroscale hydrological model was used to assess the impact of spatially shifted precipitation on streamflows simulations. PERSIANN underestimated the observed average rainfall rate and maximum rainfall consistent with the detection of storm areas systematically larger than observed. CMORPH overestimated the average rainfall rate while the maximum rainfall was slightly underestimated. TRMM average rainfall rate and rainfall volume correlated extremely well with ground observations whereas the maximum rainfall was systematically overestimated suggesting deficiencies in the bias correction procedure to filter noisy measurements. The preferential direction of error displacement in satellite-estimated MCSs was in the east-west direction for CMORPH and TRMM. Discrepancies in the fine structure of the storms dominated the error decomposition of all satellite products. Errors in the spatial location of the systems influenced the magnitude of simulated peaks but did not have a significant impact on the timing indicating that the system's response to precipitation was mitigating the effect of the errors.Fil: Demaria, E. M. C.. University Of Arizona; Estados UnidosFil: Rodriguez, D. A.. Centro de Previsao de Tempo e Estudos Climaticos. Instituto Nacional de Pesquisas Espaciais; BrasilFil: Ebert, E. E.. Centre for Australian Weather and Climate Research; AustraliaFil: Salio, Paola Veronica. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Centro de Investigaciones del Mar y la Atmosfera. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Centro de Investigaciones del Mar y la Atmosfera; ArgentinaFil: Su, F.. University of Washington; Estados UnidosFil: Valdes, J. B.. University Of Arizona; Estados Unido

Interleukin 23-Helper T Cell 17 Axis as a Treatment Target for Pityriasis Rubra Pilaris.

Treatment of pityriasis rubra pilaris (PRP) is solely based on its resemblance to psoriasis rather than any knowledge of its pathomechanism. Insight into pathogenic mediators of inflammation is essential for targeted and valid treatment options that could replace previous serendipitous therapeutic approaches in refractory PRP. To determine whether blockade of the interleukin 23-helper T cell 17 (IL-23-TH17) pathway with ustekinumab represents an efficacious and, based on its proinflammatory cytokine profile, targeted treatment option in PRP. In this case report, a patient with PRP received outpatient treatment at a university hospital department of dermatology with ustekinumab according to the dosing regimen approved for psoriasis. Lesional skin biopsy samples were taken from this patient and 2 others with refractory PRP. Messenger RNA (mRNA) expression of proinflammatory innate and T-cell-derived cytokines were measured and compared with skin samples from patients with psoriasis and healthy donors. From 1 patient, lesional skin samples were taken before ustekinumab treatment and 4 and 28 weeks after treatment initiation. Follow-up was completed after 6 months. Subcutaneous ustekinumab, 45 mg, at weeks 0 and 4 and quarterly thereafter. The primary outcome was to determine the changes in expression of proinflammatory innate and T-cell-derived cytokines during ustekinumab therapy. The secondary objective was to evaluate the clinical and histopathologic phenotype in relation to the mRNA expression profile of proinflammatory cytokines. In lesional PRP skin samples from a single patient, upregulated expression levels were found for most proinflammatory innate cytokines, including tumor necrosis factor (TNF), IL-6, IL-12, IL-23, and IL-1β. Among adaptive T-cell cytokines, an increase of TH1 cytokines and, in particular, TH17 cytokines IL-17A, IL-17F, and IL-22 was seen in PRP. The patient with PRP who received ustekinumab showed regression of skin lesions after 2 weeks and almost complete resolution after 1 month. Clinical and histopathologic improvement paralleled the expression levels of TH17 cytokines but not of interferon-γ and TNF, which lagged behind the amelioration. In this case report, a role of the IL-23-TH17-axis in PRP was identified, suggesting a shared pathogenic inflammatory pathway with psoriasis, despite evident clinical and histopathologic differences. In addition, this report provides a rationale for targeting the IL-23-TH17-pathway as a treatment option for refractory PRP

LIFE Med Hiss: An innovative cohort design for public health

The aim of MED HISS methodology was to test the effectiveness of a low-cost approach to study long-term effects of air pollution, applicable in all European countries. This approach is potentially exportable to other environmental issues where a cohort representative of the country population is needed. The cohort is derived from the National Health Interview Survey, compulsory in European countries, which has information on individual lifestyle factors. In Life Med Hiss approach, subjects recruited have been linked at individual level with health data and have been then followed-up for mortality and hospital admissions outcomes. Exposure values of air pollution (PM2.5 and NO 2 ) have been assigned using national dispersion models, enhanced by the information derived from monitoring station with data fusion techniques, and then upscaled at municipality level (highest level of detail achievable for the Italian Survey). Results for mortality have been used to test the effectiveness of this methodology and are encouraging if compared with European ones. The advantages of this technique are summarized below: • It uses a cohort already available and compulsory in European countries• It uses air quality modelling data, available for most of the countries• It permits to implement versatile environmental surveillance system

Long term effect of air pollution on incident hospital admissions: Results from the Italian Longitudinal Study within LIFE MED HISS project

Background: The LIFE MED HISS project aims at setting up a surveillance system on the long term effects of air pollution on health, using data from National Health Interview Surveys and other currently available sources of information in most European countries. Few studies assessed the long term effect of air pollution on hospital admissions in European cohorts. Objective: The objective of this paper is to estimate the long term effect of fine particulate matter (PM2.5) and nitrogen dioxide (NO2) on first-ever (incident) cause-specific hospitalizations in Italy. Methods: We used data from the Italian Longitudinal Study (ILS), a cohort study based on the 1999–2000 National Health Interview Survey (NHIS), followed up for hospitalization (2001–2008) at individual level. The survey contains information on crucial potential confounders: occupational/educational/marital status, body mass index (BMI), smoking habit and physical activity. Annual mean exposure to PM2.5 and NO2 was assigned starting from simulated gridded data at spatial resolution of 4 × 4 km2 firstly integrated with data from monitoring stations and then up-scaled at municipality level. Statistical analyses were conducted using Cox proportional hazard models with robust variance estimator. Results: For each cause of hospitalization we estimated the hazard ratios (HRs) adjusted for confounders with 95% Confidence Interval (CI) related to a 10 μg/m3 increase in pollutants. For PM2.5 and NO2, respectively, we found positive associations for circulatory system diseases [1.05(1.03–1.06); 1.05(1.03–1.07)], myocardial infarction [1.15(1.12–1.18); 1.15(1.12–1.18)], lung cancer [1.18(1.10–1.26); 1.20(1.12–1.28)], kidney cancer [1.24(1.11–1.29); 1.20(1.07–1.33)], all cancers (but lung) [1.06(1.04–1.08); 1.06(1.04–1.08)] and Low Respiratory Tract Infections (LRTI) [1.07 (1.04–1.11); 1.05 (1.02–1.08)]. Discussion: Our results add new evidence on the effects of air pollution on first-ever (incident) hospitalizations, both in urban and rural areas. We demonstrated the feasibility of a low-cost monitoring system based on available data

Local control by radiotherapy: is that all there is?

Radiotherapy is a local treatment modality employed in breast cancer to reduce local recurrence following surgery. The observed association of optimal local control with improved survival was not expected in a disease characterized by early systemic spread. The underlying mechanisms whereby the application of ionizing radiation to the primary tumor site can have systemic effects remain unclear and are the subject of much debate. In the present article we discuss the hypothesis that radiotherapy has unique biological effects and that, in addition to killing residual neoplastic cells after surgery is performed, it might favorably alter the microenvironment at the primary tumor site during the process of wound healing and the development of antitumor immune responses

Scaled distribution mapping: a bias correction method that preserves raw climate model projected changes

Commonly used bias correction methods such as quantile mapping (QM) assume the function of error correction values between modeled and observed distributions are stationary or time invariant. This article finds that this function of the error correction values cannot be assumed to be stationary. As a result, QM lacks justification to inflate/deflate various moments of the climate change signal. Previous adaptations of QM, most notably quantile delta mapping (QDM), have been developed that do not rely on this assumption of stationarity. Here, we outline a methodology called scaled distribution mapping (SDM), which is conceptually similar to QDM, but more explicitly accounts for the frequency of rain days and the likelihood of individual events. The SDM method is found to outperform QM, QDM, and detrended QM in its ability to better preserve raw climate model projected changes to meteorological variables such as temperature and precipitation

Prognostic implications of residual disease tumor-infiltrating lymphocytes and residual cancer burden in triple-negative breast cancer patients after neoadjuvant chemotherapy

Abstract Background For primary triple-negative breast cancer (TNBC) treated with neoadjuvant chemotherapy (NAC), higher pretreatment tumor-infiltrating lymphocytes (TILs) correlates with increased pathologic complete response (pCR) rates, and improved survival. We evaluated the added prognostic value of residual disease (RD) TILs to residual cancer burden (RCB) in predicting survival post-NAC. Patients and methods We combined four TNBC NAC patient cohorts who did not achieve pCR. RD TILs were investigated for associations with recurrence-free survival (RFS), and overall survival (OS) using Cox models with stromal TILs as a continuous variable (per 10% increment). The likelihood ratio test was used to evaluate added prognostic value of RD TILs. Results A total of 375 RD TNBC samples were evaluable for TILs and RCB. The median age was 50 years, with 62% receiving anthracycline/taxane chemotherapy. The RCB class after NAC was 11%, 50%, and 39% for I, II, and III, respectively. The median RD TIL level was 20% (IQR 10–40). There was a positive correlation between RD TIL levels and CD8+ T-cell density (ρ = 0.41). TIL levels were significantly lower with increasing post-NAC tumor (P = 0.005), nodal stage (P = 0.032), but did not differ by RCB class (P = 0.84). Higher RD TILs were significantly associated with improved RFS (HR: 0.86; 95% CI 0.79–0.92; P  Conclusions TIL levels in TNBC RD are significantly associated with improved RFS and OS and add further prognostic information to RCB class, particularly in RCB class II

Condiciones y medio ambiente de trabajo en hospitales públicos provinciales de la ciudad de Córdoba, Argentina

Esta investigación se propuso caracterizar las condiciones de empleo, identificar riesgos laborales percibidos el trabajador y estimar la frecuencia de problemas de salud referidos por los integrantes de los equipos de salud de hospitales de la ciudad de Córdoba dependientes del Ministerio de Salud de la provincia de Córdoba. Se realizó un estudio de corte transversal sobre 453 trabajadores pertenecientes a hospitales públicos provinciales de la ciudad de Córdoba, seleccionados mediante muestreo probabilístico aleatorio simple, con un nivel de confianza del 95% y un error muestral del 5%, en quienes se aplicó un cuestionario autoadministrado durante el segundo semestre de 2012. Se halló que el 35% del personal está vinculado laboralmente mediante formas de contratación no permanentes. El pluriempleo alcanza al 36% de los encuestados. La percepción de riesgos biológicos alcanza el 77,9%, el 50,7% se expone a sustancias químicas y el 51,7% manipula cargas físicas de gran volumen. Los problemas de salud más frecuentemente señalados fueron: gastritis (28,3%), obesidad (24,3%), lumbalgia (19,6%), alteraciones del sueño (14,1%), tensión arterial elevada (12,4%). Las proporciones de trabajadores no estables y de pluriempleo, y la elevada percepción de riesgos en el ámbito laboral deberían motivar la formulación de políticas y normativas de mejora de las condiciones de trabajo y empleo