Changes in Atlantic Water circulation patterns and volume transports North of Svalbard over the last 12 years (2008-2020)

Atlantic Water (AW) enters the Arctic through Fram Strait as the West Spitsbergen Current (WSC). When reaching the south of Yermak Plateau, the WSC splits into the Svalbard, Yermak Pass and Yermak Branches. Downstream of Yermak Plateau, AW pathways remain unclear and uncertainties persist on how AW branches eventually merge and contribute to the boundary current along the continental slope. We took advantage of the good performance of the 1/12° Mercator Ocean model in the Western Nansen Basin (WNB) to examine the AW circulation and volume transports in the area. The model showed that the circulation changed in 2008-2020. The Yermak Branch strengthened over the northern Yermak Plateau, feeding the Return Yermak Branch along the eastern flank of the Plateau. West of Yermak Plateau, the Transpolar Drift likely shifted westward while AW recirculations progressed further north. Downstream of the Yermak Plateau, an offshore current developed above the 3800 m isobath, fed by waters from the Yermak Plateau tip. East of 18°E, enhanced mesoscale activity from the boundary current injected additional AW basin-ward, further contributing to the offshore circulation. A recurrent anticyclonic circulation in Sofia Deep developed, which also occasionally fed the western part of the offshore flow. The intensification of the circulation coincided with an overall warming in the upper WNB (0-1000 m), consistent with the progression of AW. This regional description of the changing circulation provides a background for the interpretation of upcoming observations

COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P < 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Postures for non proliferation Arms Limitation and Security Policies to Minimize Nuclear Proliferation Stockholm International Peace Research Institute (SIPRI)

Lellouche. Postures for non proliferation Arms Limitation and Security Policies to Minimize Nuclear Proliferation Stockholm International Peace Research Institute (SIPRI). In: Politique étrangère, n°2 - 1979 - 44ᵉannée. pp. 345-346

Bertrand Goldschmidt. Le complexe atomique Albert Wohlstetter et al. Swords from Plowshares : The Military Potential of Civilian Nuclear Energy Agence internationale de l'énergie atomique. International Nuclear Fuel Cycle Evaluation, INFCE. Summary Volume Ministère de l'industrie. Le cycle du combustible nucléaire Syndicat CFDT de l'énergie atomique. Le dossier électronucléaire Uranium Institute. Uranium and Nuclear Energy International Consultative Group on Nuclear Energy. 7 Rapports Stockholm International Peace Research Institute. Nuclear Energy and Nuclear Weapon Proliferation Gloria Duffy. Soviet Nuclear Energy Domestic and International Policies

Lellouche. Bertrand Goldschmidt. Le complexe atomique Albert Wohlstetter et al. Swords from Plowshares : The Military Potential of Civilian Nuclear Energy Agence internationale de l'énergie atomique. International Nuclear Fuel Cycle Evaluation, INFCE. Summary Volume Ministère de l'industrie. Le cycle du combustible nucléaire Syndicat CFDT de l'énergie atomique. Le dossier électronucléaire Uranium Institute. Uranium and Nuclear Energy International Consultative Group on Nuclear Energy. 7 Rapports Stockholm International Peace Research Institute. Nuclear Energy and Nuclear Weapon Proliferation Gloria Duffy. Soviet Nuclear Energy Domestic and International Policies. In: Politique étrangère, n°2 - 1980 - 45ᵉannée. pp. 522-529

La France et l'option zéro : réflexions sur la position française

Lellouche. La France et l'option zéro : réflexions sur la position française. In: Politique étrangère, n°1 - 1987 - 52ᵉannée. pp. 161-166

Postures for non proliferation Arms Limitation and Security Policies to Minimize Nuclear Proliferation Stockholm International Peace Research Institute (SIPRI)

Lellouche. Postures for non proliferation Arms Limitation and Security Policies to Minimize Nuclear Proliferation Stockholm International Peace Research Institute (SIPRI). In: Politique étrangère, n°2 - 1979 - 44ᵉannée. pp. 345-346

La France et la politique américaine à l'égard de la sécurité de l'Europe

France and American policy as regards the security of Europe, by Pierre Lellouche After other European countries, France now knows its debate on the defence and future security of Europe. The debate originated from a noted decline of American nuclear guarantee. This noted decline has not strained relations between Paris and Washington, as is the case for Germany. Nevertheless the diminishing credibility of America, even though it confirms the policy of independent dissuasion, followed since General de Gaulle, worries the French confusedly by reason of its effects on the security of our neighbours, Germany in particular. Thus the reason for the present debate on the probable increased role of France in matters of European defence.La France et la politique américaine à l'égard de la sécurité de l'Europe, par Pierre Lellouche Après d'autres Etats européens la France connaît à son tour un débat sur la défense et sur l'avenir de la sécurité de l'Europe. A l'origine de ce débat, est la perception d'un déclin de la garantie nucléaire américaine. La perception de ce déclin ne se traduit pas en France, comme c'est le cas en RFA, par des tensions entre Paris et Washington. Toutefois, l'affaiblissement de la crédibilité américaine, même s'il confirme la politique de dissuasion indépendante suivie depuis le Général de Gaulle, inquiète confusément les Français en raison de ses conséquences sur la sécurité de nos voisins et de l'Allemagne en particulier. D'où le débat actuel sur un rôle éventuellement accru de la France en matière de défense de l'Europe.Lellouche. La France et la politique américaine à l'égard de la sécurité de l'Europe. In: Politique étrangère, n°3 - 1979 - 44ᵉannée. pp. 481-497

La France dans "l'après-Pershing"

France in the « post-Pershing » period, by Pierre Lellouche Even though the Soviets lost the test of wills, the Euromissile issue is by no me ans over now that the first deployment has taken place. Not having made any real concessions in time, the Kremlin's bluff failed. Although the North Atlantic alliance certainly gained an important psychological success, the European democracies must endure another four years internal conflict over this issue. The two big questions which will arise over future Geneva negotiations are : which of the superpowers will give way first ? and : how will political feeling evolve in Western Europe if nothing happens in Geneva before 1985 ? France may be force during this « post-Pershing » period to make fundamental redefinition of its defence and national security policies. This could engender rupture of the « consensus » of opinion in France which has up till now been apparent in matters of defence. The problem of European security in the coming years can only lead once more to the idea of cooperative inter-European defence system. Only France could take far-reaching initiative in this respect and all depends on whether the French who have legitimate worries about the consequences of German feelings of insecurity have the energy to overcome their own inertia as well as that of their fellow Europeans.L'affaire des euromissiles ne s'est pas achevée avec l'installation des premiers Pershing, même si les Soviétiques ont perdu un test de volonté, une fois le premier déploiement effectué. Faute d'avoir su proposer à temps des concessions réelles, le Kremlin a échoué dans sa tentation du bluff. L'Alliance a certes remporté un succès psychologique important, mais les démocraties européennes conserveront-elles l'énergie suffisante pour « tenir » encore quatre années de controverses internes ? Au niveau des négociations, tout peut se ramener à une double question : qui des deux Grands cédera le premier et que se pas sera-t-il sur le « front » politique européen si rien ne se passe à Genève d'ici à 1985 ? Pour la France, l'« après-Pershing », pourrait provoquer une difficile épreuve de redéfinition en profondeur des fondements mêmes de sa politique de défense et de sécurité. Cette redéfinition pourrait provoquer en retour la rupture du « consensus » apparent qui a caractérisé jusqu'ici le débat français en matière de défense. La seule issue au problème posé par la sécurité de l'Europe dans les années à venir passe nécessairement par une relance de l'idée de coopération intra-euro-péenne en matière de défense. Seule la France est capable de prendre une initiative de grande envergure et toute la question est de savoir si les Français, qui ont légitimement peur de la peur des Allemands, auront la force de vaincre leurs propres inerties ainsi que celles des autres.Lellouche. La France dans "l'après-Pershing". In: Politique étrangère, n°4 - 1983 - 48ᵉannée. pp. 859-878