Toward an improved representation of middle atmospheric dynamics thanks to the ARISE project

This paper reviews recent progress toward understanding the dynamics of the middle atmosphere in the framework of the Atmospheric Dynamics Research InfraStructure in Europe (ARISE) initiative. The middle atmosphere, integrating the stratosphere and mesosphere, is a crucial region which influences tropospheric weather and climate. Enhancing the understanding of middle atmosphere dynamics requires improved measurement of the propagation and breaking of planetary and gravity waves originating in the lowest levels of the atmosphere. Inter-comparison studies have shown large discrepancies between observations and models, especially during unresolved disturbances such as sudden stratospheric warmings for which model accuracy is poorer due to a lack of observational constraints. Correctly predicting the variability of the middle atmosphere can lead to improvements in tropospheric weather forecasts on timescales of weeks to season. The ARISE project integrates different station networks providing observations from ground to the lower thermosphere, including the infrasound system developed for the Comprehensive Nuclear-Test-Ban Treaty verification, the Lidar Network for the Detection of Atmospheric Composition Change, complementary meteor radars, wind radiometers, ionospheric sounders and satellites. This paper presents several examples which show how multi-instrument observations can provide a better description of the vertical dynamics structure of the middle atmosphere, especially during large disturbances such as gravity waves activity and stratospheric warming events. The paper then demonstrates the interest of ARISE data in data assimilation for weather forecasting and re-analyzes the determination of dynamics evolution with climate change and the monitoring of atmospheric extreme events which have an atmospheric signature, such as thunderstorms or volcanic eruptions

Clinical Pharmacology and Pharmacokinetics of Levetiracetam

Status epilepticus and acute repetitive seizures still pose a management challenge despite the recent advances in the field of epilepsy. Parenteral formulations of old anticonvulsants are still a cornerstone in acute seizure management and are approved by the FDA. Intravenous levetiracetam, a second generation anticonvulsant, is approved by the FDA as an adjunctive treatment in patients 16 years or older when oral administration is not available. Data have shown that it has a unique mechanism of action, linear pharmacokinetics and no known drug interactions with other anticonvulsants. In this paper, we will review the current literature about the pharmacology and pharmacokinetics of intravenous levetiracetam and the safety profile of this new anticonvulsant in acute seizure management of both adults and children

Efficacy and Tolerability of Intravenous Levetiracetam in Children

Intractable epilepsy in children poses a serious medical challenge. Acute repetitive seizures and status epilepticus leads to frequent emergency room visits and hospital admissions. Permanent neurological damage can occur if there is delay in treatment. It has been shown that these children continue to remain intractable even after acute seizure management with approved FDA agents. Intravenous levetiracetam, a second-generation anticonvulsant was approved by the FDA in 2006 in patients 16 years and older as an alternative when oral treatment is not an option. It has been shown that oral levetiracetam can be used in the treatment of status epilepticus and acute repetitive seizures. Data have been published showing that intravenous levetiracetam is safe and efficacious, and can be used in an acute inpatient setting. This current review will discuss the recent data about the safety and tolerability of intravenous levetiracetam in children and neonates, and emphasize the need for a larger prospective multicenter trial to prove the efficacy of this agent in acute seizure management

Lipid Management in Youth: What Are the Screening and Treatment Trends Within the Pediatric Cardiovascular Research Network?

Background/Aims: Atherosclerotic cardiovascular disease (ASCVD) accounts for 1 in every 3 deaths in the United States, and studies show that the precursors of atherosclerosis are apparent early in life. The correlation between childhood cardiovascular risk factors and the extent of atherosclerosis in adulthood has led to the development of guidelines aimed at attenuating ASCVD risks in youth. One major ASCVD risk factor is dyslipidemia, including both familial hypercholesterolemia (FH) and lifestyle-related hyperlipidemia. Currently, few studies have investigated temporal lipid screening and treatment trends in youth and guideline adherence before and after the 2011 update, which includes universal lipid screening and targeted screening recommendations. The purpose of this study is to identify lipid screening and treatment trends and guideline adherence in a diverse population of children and adolescents across multiple health care systems participating in the Pediatric Cardiovascular Risk Network (P-CVRN) study. This data is also essential to provide up-to-date cost-effective analyses (CEA). Methods: Institutional Review Board approval was obtained for this study. This retrospective database study includes \u3e 600,000 youth age 2 to 21 years with at least one outpatient visit captured across five P-CVRN sites between 2001 and 2013. The following de-identified data was captured and extracted at an individual patient level from inpatient and outpatient claims data: patient demographics, diagnoses, pretreatment laboratory values, initial lipid-lowering medications and doses, initial posttreatment laboratory values and presence of other risk factors or conditions. Results: The data collected was used to analyze trends in pediatric lipid management and inform contemporaneous CEA related to pediatric lipid screening and treatment. Our data revealed that screening rates declined at most sites and varied from a peak of ~25% to a low of ~5% of youth. Lipid-lowering medications were prescribed in 0.02–0.19% of all youth, and prescribing did not generally increase over time. Lipid-lowering medication and dose initiation, pre- and posttreatment laboratory values, and medication possession ratio were analyzed using logistic regression. CEA did not support the benefit of universal lipid screening in youth. Discussion: Current screening trends indicate that health care providers are nonadherent with guideline recommendations, and CEA reveals that universal screening in youth is not cost-effective