Digital Doppler-cancellation servo for ultra-stable optical frequency dissemination over fiber

Progress made in optical references, including ultra-stable Fabry-Perot cavities, optical frequency combs and optical atomic clocks, have driven the need for ultra-stable optical fiber networks. Telecom-wavelength ultra-pure optical signal transport has been demonstrated on distances ranging from the laboratory scale to the continental scale. In this manuscript, we present a Doppler-cancellation setup based on a digital phase-locked loop for ultra-stable optical signal dissemination over fiber. The optical phase stabilization setup is based on a usual heterodyne Michelson-interferometer setup, while the Software Defined Radio (SDR) implementation of the phase-locked loop is based on a compact commercial board embedding a field programmable gate array, analog-to-digital and digital-to-analog converters. Using three different configurations including an undersampling method, we demonstrate a 20 m long fiber link with residual fractional frequency instability as low as $10^{-18}$ at 1000 s, and an optical phase noise of $-70$ dBc/Hz at 1 Hz with a telecom frequency carrier.Comment: 11 pages, 6 figure

Interventions for the treatment of oral cavity and oropharyngeal cancer:chemotherapy

<b>Background:</b> Oral cavity and oropharyngeal cancers are frequently described as part of a group of oral cancers or head and neck cancer. Treatment of oral cavity cancer is generally surgery followed by radiotherapy, whereas oropharyngeal cancers, which are more likely to be advanced at the time of diagnosis, are managed with radiotherapy or chemoradiation. Surgery for oral cancers can be disfiguring and both surgery and radiotherapy have significant functional side effects, notably impaired ability to eat, drink and talk. The development of new chemotherapy agents, new combinations of agents and changes in the relative timing of surgery, radiotherapy, and chemotherapy treatments may potentially bring about increases in both survival and quality of life for this group of patients.<p></p> <b>Objectives:</b> To determine whether chemotherapy, in addition to radiotherapy and/or surgery for oral cavity and oropharyngeal cancer results in improved survival, disease free survival, progression free survival, locoregional control and reduced recurrence of disease. To determine which regimen and time of administration (induction, concomitant or adjuvant) is associated with better outcomes.<p></p> <b>Search strategy:</b> Electronic searches of the Cochrane Oral Health Group's Trials Register, CENTRAL, MEDLINE, EMBASE, AMED were undertaken on 28th July 2010. Reference lists of recent reviews and included studies were also searched to identify further trials.<p></p> <b>Selection criteria:</b> Randomised controlled trials where more than 50% of participants had primary tumours in the oral cavity or oropharynx, and which compared the addition of chemotherapy to other treatments such as radiotherapy and/or surgery, or compared two or more chemotherapy regimens or modes of administration, were included.<p></p> <b>Data collection and analysis:</b> Trials which met the inclusion criteria were assessed for risk of bias using six domains: sequence generation, allocation concealment, blinding, completeness of outcome data, selective reporting and other possible sources of bias. Data were extracted using a specially designed form and entered into the characteristics of included studies table and the analysis sections of the review. The proportion of participants in each trial with oral cavity and oropharyngeal cancers are recorded in Additional Table 1.<p></p> <b>Main results:</b> There was no statistically significant improvement in overall survival associated with induction chemotherapy compared to locoregional treatment alone in 25 trials (hazard ratio (HR) of mortality 0.92, 95% confidence interval (CI) 0.84 to 1.00). Post-surgery adjuvant chemotherapy was associated with improved overall survival compared to surgery +/- radiotherapy alone in 10 trials (HR of mortality 0.88, 95% CI 0.79 to 0.99), and there was an additional benefit of adjuvant concomitant chemoradiotherapy compared to radiotherapy in 4 of these trials (HR of mortality 0.84, 95% CI 0.72 to 0.98). Concomitant chemoradiotherapy resulted in improved survival compared to radiotherapy alone in patients whose tumours were considered unresectable in 25 trials (HR of mortality 0.79, 95% CI 0.74 to 0.84). However, the additional toxicity attributable to chemotherapy in the combined regimens remains unquantified.<p></p> <b>Authors' conclusions:</b> Chemotherapy, in addition to radiotherapy and surgery, is associated with improved overall survival in patients with oral cavity and oropharyngeal cancers. Induction chemotherapy is associated with a 9% increase in survival and adjuvant concomitant chemoradiotherapy is associated with a 16% increase in overall survival following surgery. In patients with unresectable tumours, concomitant chemoradiotherapy showed a 22% benefit in overall survival compared with radiotherapy alone.<p></p&gt

Why Are Outcomes Different for Registry Patients Enrolled Prospectively and Retrospectively? Insights from the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF).

Background: Retrospective and prospective observational studies are designed to reflect real-world evidence on clinical practice, but can yield conflicting results. The GARFIELD-AF Registry includes both methods of enrolment and allows analysis of differences in patient characteristics and outcomes that may result. Methods and Results: Patients with atrial fibrillation (AF) and ≥1 risk factor for stroke at diagnosis of AF were recruited either retrospectively (n = 5069) or prospectively (n = 5501) from 19 countries and then followed prospectively. The retrospectively enrolled cohort comprised patients with established AF (for a least 6, and up to 24 months before enrolment), who were identified retrospectively (and baseline and partial follow-up data were collected from the emedical records) and then followed prospectively between 0-18 months (such that the total time of follow-up was 24 months; data collection Dec-2009 and Oct-2010). In the prospectively enrolled cohort, patients with newly diagnosed AF (≤6 weeks after diagnosis) were recruited between Mar-2010 and Oct-2011 and were followed for 24 months after enrolment. Differences between the cohorts were observed in clinical characteristics, including type of AF, stroke prevention strategies, and event rates. More patients in the retrospectively identified cohort received vitamin K antagonists (62.1% vs. 53.2%) and fewer received non-vitamin K oral anticoagulants (1.8% vs . 4.2%). All-cause mortality rates per 100 person-years during the prospective follow-up (starting the first study visit up to 1 year) were significantly lower in the retrospective than prospectively identified cohort (3.04 [95% CI 2.51 to 3.67] vs . 4.05 [95% CI 3.53 to 4.63]; p = 0.016). Conclusions: Interpretations of data from registries that aim to evaluate the characteristics and outcomes of patients with AF must take account of differences in registry design and the impact of recall bias and survivorship bias that is incurred with retrospective enrolment. Clinical Trial Registration: - URL: http://www.clinicaltrials.gov . Unique identifier for GARFIELD-AF (NCT01090362)

Improved risk stratification of patients with atrial fibrillation: an integrated GARFIELD-AF tool for the prediction of mortality, stroke and bleed in patients with and without anticoagulation.

OBJECTIVES: To provide an accurate, web-based tool for stratifying patients with atrial fibrillation to facilitate decisions on the potential benefits/risks of anticoagulation, based on mortality, stroke and bleeding risks. DESIGN: The new tool was developed, using stepwise regression, for all and then applied to lower risk patients. C-statistics were compared with CHA2DS2-VASc using 30-fold cross-validation to control for overfitting. External validation was undertaken in an independent dataset, Outcome Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF). PARTICIPANTS: Data from 39 898 patients enrolled in the prospective GARFIELD-AF registry provided the basis for deriving and validating an integrated risk tool to predict stroke risk, mortality and bleeding risk. RESULTS: The discriminatory value of the GARFIELD-AF risk model was superior to CHA2DS2-VASc for patients with or without anticoagulation. C-statistics (95% CI) for all-cause mortality, ischaemic stroke/systemic embolism and haemorrhagic stroke/major bleeding (treated patients) were: 0.77 (0.76 to 0.78), 0.69 (0.67 to 0.71) and 0.66 (0.62 to 0.69), respectively, for the GARFIELD-AF risk models, and 0.66 (0.64-0.67), 0.64 (0.61-0.66) and 0.64 (0.61-0.68), respectively, for CHA2DS2-VASc (or HAS-BLED for bleeding). In very low to low risk patients (CHA2DS2-VASc 0 or 1 (men) and 1 or 2 (women)), the CHA2DS2-VASc and HAS-BLED (for bleeding) scores offered weak discriminatory value for mortality, stroke/systemic embolism and major bleeding. C-statistics for the GARFIELD-AF risk tool were 0.69 (0.64 to 0.75), 0.65 (0.56 to 0.73) and 0.60 (0.47 to 0.73) for each end point, respectively, versus 0.50 (0.45 to 0.55), 0.59 (0.50 to 0.67) and 0.55 (0.53 to 0.56) for CHA2DS2-VASc (or HAS-BLED for bleeding). Upon validation in the ORBIT-AF population, C-statistics showed that the GARFIELD-AF risk tool was effective for predicting 1-year all-cause mortality using the full and simplified model for all-cause mortality: C-statistics 0.75 (0.73 to 0.77) and 0.75 (0.73 to 0.77), respectively, and for predicting for any stroke or systemic embolism over 1 year, C-statistics 0.68 (0.62 to 0.74). CONCLUSIONS: Performance of the GARFIELD-AF risk tool was superior to CHA2DS2-VASc in predicting stroke and mortality and superior to HAS-BLED for bleeding, overall and in lower risk patients. The GARFIELD-AF tool has the potential for incorporation in routine electronic systems, and for the first time, permits simultaneous evaluation of ischaemic stroke, mortality and bleeding risks. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier for GARFIELD-AF (NCT01090362) and for ORBIT-AF (NCT01165710)

Two-year outcomes of patients with newly diagnosed atrial fibrillation: results from GARFIELD-AF.

AIMS: The relationship between outcomes and time after diagnosis for patients with non-valvular atrial fibrillation (NVAF) is poorly defined, especially beyond the first year. METHODS AND RESULTS: GARFIELD-AF is an ongoing, global observational study of adults with newly diagnosed NVAF. Two-year outcomes of 17 162 patients prospectively enrolled in GARFIELD-AF were analysed in light of baseline characteristics, risk profiles for stroke/systemic embolism (SE), and antithrombotic therapy. The mean (standard deviation) age was 69.8 (11.4) years, 43.8% were women, and the mean CHA2DS2-VASc score was 3.3 (1.6); 60.8% of patients were prescribed anticoagulant therapy with/without antiplatelet (AP) therapy, 27.4% AP monotherapy, and 11.8% no antithrombotic therapy. At 2-year follow-up, all-cause mortality, stroke/SE, and major bleeding had occurred at a rate (95% confidence interval) of 3.83 (3.62; 4.05), 1.25 (1.13; 1.38), and 0.70 (0.62; 0.81) per 100 person-years, respectively. Rates for all three major events were highest during the first 4 months. Congestive heart failure, acute coronary syndromes, sudden/unwitnessed death, malignancy, respiratory failure, and infection/sepsis accounted for 65% of all known causes of death and strokes for <10%. Anticoagulant treatment was associated with a 35% lower risk of death. CONCLUSION: The most frequent of the three major outcome measures was death, whose most common causes are not known to be significantly influenced by anticoagulation. This suggests that a more comprehensive approach to the management of NVAF may be needed to improve outcome. This could include, in addition to anticoagulation, interventions targeting modifiable, cause-specific risk factors for death. CLINICAL TRIAL REGISTRATION: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Expansions et déprises agricoles (?) du Ier siècle av. J.-C. au IVe siècle ap. J.-C. dans une zone humide : la moyenne vallée de l’Oise

1. Présentation générale du site La région concernée est située en Picardie dans le département de l’Oise et fait partie du Bassin parisien (fig. 1). L’Oise, qui coule du nord-est au sud-ouest, sépare le plateau secondaire, ou plaine picarde méridionale, « plaine d’Estrées », du plateau tertiaire du « Valois ». Jusqu’au niveau de La Croix – Saint-Ouen, la vallée est étroite (0,8 à 1,2 km) et incise des assises crayeuses, tandis que plus en aval, elle traverse des argiles ou des sables où la r..

Du drain potentiel au drain réel (utilisation de données satellitales à très haute résolution pour l'étude de l'origine géomorphologique des chemins de l'eau sur des bassins versants méditerranéens soumis aux crues éclair.)

En zone méditerranéenne, d intenses précipitations automnales sont responsables de crues particulièrement violentes : les crues éclair . L intensité et la variabilité des précipitations ainsi que la complexité des processus hydrologiques responsables de la production des écoulements sur ces bassins limitent la prédictibilité de ces phénomènes. Une meilleure compréhension des processus impliqués dans les réponses hydrologiques des bassins versants et responsables de la variabilité spatio-temporelle des chemins de l eau peut permettre d améliorer les modélisations de ce type d évènement. S insérant dans le cadre de l hydrologie spatialisée, cette thèse se propose d'étudier l'apport des potentialités satellitales, et notamment des produits 3D à très haute résolution pour la caractérisation spatiale des bassins et de leurs réseaux hydrographiques, afin d étudier les origines géomorphologiques des variations spatio-temporelles des réponses hydrologiques et en vue d améliorer la compréhension des mécanismes responsables des épisodes de crue. Pour cela, ce travail s articule autour de deux axes. Le premier consiste à caractériser, à partir de données spatiales, le drain potentiel représentant le réseau géomorphologique sec formé par la suite continue des lignes de thalweg des bassins. Un algorithme original utilisant une structure de MNT sous forme triangulaire (TIN) a été développé spécifiquement dans ce but, afin d obtenir un tracé des réseaux fidèle à leur tracé réel et de fournir des éléments sur leur géomorphologie ainsi que sur celle des bassins. Le deuxième axe concerne l étude de la dynamique drain en eau ou réel . Il s agit d améliorer la compréhension des dynamiques spatiales de mise en eau des drains à travers différents épisodes de crue. Dans ce cadre, un réseau spatialisé de capteurs légers a été distribué sur deux bassins expérimentaux (< 1Km ) situés sur le Gardon d Anduze afin de suivre les variations spatio-temporelles des dynamiques hydrologiques au sein des réseaux en eau. La confrontation des caractéristiques géomorphologiques et des réponses hydrologiques observées a permis de confirmer la prédominance des écoulements sub-surfaciques sur les bassins étudiés, de mettre en évidence deux types de réseaux aux fonctionnements différenciés (le réseau principal et le réseau secondaire), l importante influence des pentes et de leur changement sur l initiation et la pérennité des écoulements au sein des réseaux, et de proposer des hypothèses de fonctionnements différenciés en fonction des épisodes.In Mediterranean areas, heavy rainfalls can generate flash floods during fall season. The rainfall intensities and their high spatial variability combined with complex processes of run-off generation reduce drastically the predictability of these phenomena. Although rainfall intensities monitoring techniques are progressing, another way to better understand and predict the hydrological responses of the catchments is to better understand the hydrological processes underlying the spatial and temporal variability of water pathways on upstream elementary catchments where concentrated flows begin. In the framework of spatial hydrology, this PhD proposes to study the potentialities of remote sensing, in particular the emergent high spatial resolution 3D products, to characterize catchments drainage elementary networks in order to relate some derivated geomorphologic traits to the observed hydrological responses all over catchments. This permits to identify the involved hydrological processes during flow dynamics on upstream mountainous catchments. This work is organized in two axes. The first one consists in characterizing, from 3D satellite data, the potential drain corresponding to the dry morphological network of a basin, formed by the continuum of thalweg lines within a catchment. An original algorithm, based on a TIN DEM structure, has been specifically designed for this purpose. This algorithm allows the delineation of thalwegs networks and provides geomorphological traits of catchments and networks. The second axe concern the study of the spatial dynamic of the real drain, which is the drain with effective flow. The goal is to enhance the understanding of flow networks spatial dynamics during rainfall events. A specific sensor network has been specially distributed on two experimental sub-catchments of the Gardon d Anduze watershed in order to monitor the spatio-temporal variations of flow and network dynamics. The relationship between computed geomorphologic features and observed hydrological responses along networks tends to confirm the prevalence of sub-surface flows on the studied catchments. This exhibits two types of hydrographic networks, showing two distinct hydrological behaviors (the principal and secondary networks). Results also show the great influence of slopes and their variations on flow initiation and durability, and to propose hypothesis of hydrological mechanisms, in function of the observed events.ST ETIENNE-ENS des Mines (422182304) / SudocSudocFranceF

Installations à charge réduite en frigorigène

National audienceThis article presents a project carried out jointly by the Cemagref and the CEA-GRETh about the design of refrigerating systems at reduced refrigerant load for small plants of the food cold chain. We intend to implement the compact heat exchangers small channel technology. The refrigerant load reduction that it allows will be associated with a good energy efficiency of the whole system, in order to minimise the total environmental impact in Tewi terms.Cet article présente un projet conduit conjointement par le Cemagref et par le CEA-GRETh sur la conception d'installations frigorifiques à charge réduite pour le secteur du "petit" agroalimentaire. L'objectif est de mettre en oeuvre la technologie des échangeurs compacts à canaux de faible dimension. Il s'agit ainsi d'associer la réduction de la charge en frigorigène à une bonne efficacité énergétique de l'ensemble de l'installation. Cette approche permet de minimiser l'impact environnemental global en termes de Tewi

Impianti a carica ridotta di frigorigeno

International audienceThis article presents a project carried out jointly by the Cemagref and the CEA-GRETh about the design of refrigerating systems at reduced refrigerant load for small plants of the food cold chain. We intend to implement the compact heat exchangers small channel technology. The refrigerant load reduction that it allows will be associated with a good energy efficiency of the whole system, in order to minimise the total environmental impact in term of TEWI.Cet article présente un projet conduit conjointement par le Cemagref et par le CEA-GRETh sur la conception d`installations frigorifiques à charge réduite pour le secteur du « petit » agroalimentaire. L`objectif est de mettre en oeuvre la technologie des échangeurs compacts à canaux de faible dimension. Il s`agit ainsi d`associer la réduction de la charge en réfrigérant à une bonne efficacité énergétique de l`ensemble de l`installation. Cette approche permet de minimiser l`impact environnemental global en terme de TEWI