Towards a climatology of sensitivities of Mediterranean high impact weather ? first approach

International audienceDuring recent years, great interest has grown within the operational weather community on the adaptable component of observational networks. Decisions regarding where to deploy new observations of special value under threatening weather, or regarding permanent changes in observational strategies need support from sensitivity studies that determine areas where the addition of observations would optimally improve the skill of numerical predictions. Within the context of the MEDEX project (http://medex.inm.uib.es), the sensitivities of a collection of severe weather episodes in the Mediterranean have been computed using the MM5 Adjoint Modeling system. Various approaches are explored trying to summarize the results for the diversity of cases that produce high impact weather (HIW; mainly heavy rain and strong winds) in the Mediterranean region. A first attempt uses an objective classification of the trajectories of the most intense cyclone types from the ERA-40 reanalyses. Sensitivities are then computed for each group of frequent trajectories, providing a prototype sensitivity field for each of the most frequent intense cyclones in the Mediterranean. However, a large portion of HIW episodes in the Mediterranean are not linked to significantly intense cyclones within the climatology. Consequently, a subjective classification of HIW events is also performed and the sensitivity fields for an example case is shown to complete the study. Although the sensitive areas for Mediterranean HIW are not particularly confined, it is remarkable how poorly sampled areas by the regular observing networks such as North Africa and the eastern North-Atlantic are highlighted in the results

Gender differences in mental health during the economic crisis

Background: Economic crises have a negative effect on mental health. Little evidence has been published on the impact of economic downturns on male and female. The aim of the study was to analyze gender differences in specific mental disorders in primary care during the current economic recession in Spain. Method: A total of 7, 914 patients in 2006 and 5, 876 patients in 2010 were recruited to collect sociodemographic data and the Primary Care Evaluation of Mental Disorders. Results: Between 2006 and 2010 the prevalence of Major Depressive Disorder increased 155.7% in men and 104.9% in women; Generalized Anxiety Disorder increased 98.3% in men and 71.3% in women; and Multisomatoform Disorder increased 100.05% in men and 37% in women. The effect of the Employment confounder was significant across all comparisons: Major Depressive Disorder Generalized Odds Ratio=2.557 for Men (p<.001), 2.046 for Women (p=.002); Generalized Anxiety Disorder Generalized Odds Ratio= 2.153 (p<.001) for Men, 1.546 for Women (p<.001); and for Non-specific Multisomatoform Disorder Generalized Odds Ratio=1.680 for Men (p<.001) and 1.301 for women (p=.014). Conclusion: Overall prevalence of mental disorders increased significantly between 2006 and 2010, especially in males, who are more sensitive to the effect of the current economic recession than women. Antecedentes: el impacto de las crisis económicas sobre la salud mental está bien documentado, pero hay poca evidencia sobre el efecto diferencial que pueda tener entre hombres y mujeres. El objetivo fue analizar las diferencias de género en la prevalencia de trastornos mentales en atención primaria durante la recesión económica en España. Método: 7.914 pacientes en 2006-2007 y 5.876 en 2010-2011 fueron encuestados para recoger datos sociodemográficos y completar la entrevista Primary Care Evaluation of Mental Disorders. Resultados: entre 2006 y 2010 la prevalencia del Trastorno Depresivo Mayor incrementó 155, 7% en hombres y un 104, 9% en mujeres; el Trastorno de Ansiedad Generalizada aumentó 98, 3% en hombres y 71, 3% en mujeres; el Trastorno Multisomatomorfo incrementó 100, 05% en hombres y 37% en mujeres. El desempleo fue significativo en todos los análisis: Trastorno Depresivo Odds Ratio Generalizados= 2.557 en hombres (p<.001), 2.046 en mujeres (p= .002); Trastorno de Ansiedad Generalizada Odds Ratio Generalizados= 2.153 (p<.001) en hombres, 1.546 en mujeres (p<.001); Trastorno Multisomatoformo indiferenciado Odds Ratio Generalizados= 1.680 en hombres (p<.001) y 1.301 en mujeres (p= .014). Conclusiones: la prevalencia de los trastornos mentales se incrementó entre 2006 y 2010 en ambos sexos, pero especialmente en hombres, quienes son más sensibles a los efectos de la crisis económica

Therapeutic targeting of HER2–CB2R heteromers in HER2-positive breast cancer

There is a subtype of breast cancer characterized by the overexpression of the oncogene HER2. Although most patients with this diagnosis benefit from HER2-targeted treatments, some do not respond to these therapies and others develop resistance with time. New tools are therefore warranted for the treatment of this patient population, and for early identification of those individuals at a higher risk of developing innate or acquired resistance to current treatments. Here, we show that HER2 forms heteromer complexes with the cannabinoid receptor CB2R, the expression of these structures correlates with poor patient prognosis, and their disruption promotes antitumor responses. Collectively, our results support HER2–CB2R heteromers as new therapeutic targets and prognostic tools in HER2+ breast cancer

Scientific challenges of convective-scale numerical weather prediction

Numerical weather prediction (NWP) models are increasing in resolution and becoming capable of explicitly representing individual convective storms. Is this increase in resolution leading to better forecasts? Unfortunately, we do not have sufficient theoretical understanding about this weather regime to make full use of these NWPs. After extensive efforts over the course of a decade, convective–scale weather forecasts with horizontal grid spacings of 1–5 km are now operational at national weather services around the world, accompanied by ensemble prediction systems (EPSs). However, though already operational, the capacity of forecasts for this scale is still to be fully exploited by overcoming the fundamental difficulty in prediction: the fully three–dimensional and turbulent nature of the atmosphere. The prediction of this scale is totally different from that of the synoptic scale (103 km) with slowly–evolving semi–geostrophic dynamics and relatively long predictability on the order of a few days. Even theoretically, very little is understood about the convective scale compared to our extensive knowledge of the synoptic-scale weather regime as a partial–differential equation system, as well as in terms of the fluid mechanics, predictability, uncertainties, and stochasticity. Furthermore, there is a requirement for a drastic modification of data assimilation methodologies, physics (e.g., microphysics), parameterizations, as well as the numerics for use at the convective scale. We need to focus on more fundamental theoretical issues: the Liouville principle and Bayesian probability for probabilistic forecasts; and more fundamental turbulence research to provide robust numerics for the full variety of turbulent flows. The present essay reviews those basic theoretical challenges as comprehensibly as possible. The breadth of the problems that we face is a challenge in itself: an attempt to reduce these into a single critical agenda should be avoided

Choice of the initial antiretroviral treatment for HIV-positive individuals in the era of integrase inhibitors

BACKGROUND: We aimed to describe the most frequently prescribed initial antiretroviral therapy (ART) regimens in recent years in HIV-positive persons in the Cohort of the Spanish HIV/AIDS Research Network (CoRIS) and to investigate factors associated with the choice of each regimen. METHODS: We analyzed initial ART regimens prescribed in adults participating in CoRIS from 2014 to 2017. Only regimens prescribed in >5% of patients were considered. We used multivariable multinomial regression to estimate Relative Risk Ratios (RRRs) for the association between sociodemographic and clinical characteristics and the choice of the initial regimen. RESULTS: Among 2874 participants, abacavir(ABC)/lamivudine(3TC)/dolutegavir(DTG) was the most frequently prescribed regimen (32.1%), followed by tenofovir disoproxil fumarate (TDF)/emtricitabine (FTC)/elvitegravir(EVG)/cobicistat(COBI) (14.9%), TDF/FTC/rilpivirine (RPV) (14.0%), tenofovir alafenamide (TAF)/FTC/EVG/COBI (13.7%), TDF/FTC+DTG (10.0%), TDF/FTC+darunavir/ritonavir or darunavir/cobicistat (bDRV) (9.8%) and TDF/FTC+raltegravir (RAL) (5.6%). Compared with ABC/3TC/DTG, starting TDF/FTC/RPV was less likely in patients with CD4100.000 copies/mL. TDF/FTC+DTG was more frequent in those with CD4100.000 copies/mL. TDF/FTC+RAL and TDF/FTC+bDRV were also more frequent among patients with CD4<200 cells//muL and with transmission categories other than men who have sex with men. Compared with ABC/3TC/DTG, the prescription of other initial ART regimens decreased from 2014-2015 to 2016-2017 with the exception of TDF/FTC+DTG. Differences in the choice of the initial ART regimen were observed by hospitals' location. CONCLUSIONS: The choice of initial ART regimens is consistent with Spanish guidelines' recommendations, but is also clearly influenced by physician's perception based on patient's clinical and sociodemographic variables and by the prescribing hospital location

Strategies to reengage patients lost to follow up in HIV care in high income countries, a scoping review

Background: Despite remarkable achievements in antiretroviral therapy (ART), losses to follow-up (LTFU) might prevent the long-term success of HIV treatment and might delay the achievement of the 90-90-90 objectives. This scoping review is aimed at the description and analysis of the strategies used in high-income countries to reengage LTFU in HIV care, their implementation and impact. Methods: A scoping review was done following Arksey & O'Malley's methodological framework and recommendations from Joanna Briggs Institute. Peer reviewed articles were searched for in Pubmed, Scopus and Web of Science; and grey literature was searched for in Google and other sources of information. Documents were charted according to the information presented on LTFU, the reengagement procedures used in HIV units in high-income countries, published during the last 15 years. In addition, bibliographies of chosen articles were reviewed for additional articles. Results: Twenty-eight documents were finally included, over 80% of them published in the United States later than 2015. Database searches, phone calls and/or mail contacts were the most common strategies used to locate and track LTFU, while motivational interviews and strengths-based techniques were used most often during reengagement visits. Outcomes like tracing activities efficacy, rates of reengagement and viral load reduction were reported as outcome measures. Conclusions: This review shows a recent and growing trend in developing and implementing patient reengagement strategies in HIV care. However, most of these strategies have been implemented in the United States and little information is available for other high-income countries. The procedures used to trace and contact LTFU are similar across reviewed studies, but their impact and sustainability are widely different depending on the country studied