Effects of propagation conditions on radar beam-ground interaction: impact on data quality

International audienceA large part of the research in the radar meteorology is devoted to the evaluation of the radar data quality and to the radar data processing. Even when, a set of absolute quality indexes can be produced (like as ground clutter presence, beam blockage rate, distance from radar, etc.), the final product quality has to be determined as a function of the task and of all the processing steps. In this paper the emphasis lies on the estimate of the rainfall at the ground level taking extra care for the correction for ground clutter and beam blockage, that are two main problems affecting radar reflectivity data in complex orography. In this work a combined algorithm is presented that avoids and/or corrects for these two effects. To achieve this existing methods are modified and integrated with the analysis of radar signal propagation in different atmospheric conditions. The atmospheric refractivity profile is retrieved from the nearest in space and time radiosounding. This measured profile is then used to define the `dynamic map' used as a declutter base-field. Then beam blockage correction is applied to the data at the scan elevations computed from this map. Two case studies are used to illustrate the proposed algorithm. One is a summer event with anomalous propagation conditions and the other one is a winter event. The new algorithm is compared to a previous method of clutter removal based only on static maps of clear air and vertical reflectivity continuity test. The improvement in rain estimate is evaluated applying statistical analysis and using rain gauges data. The better scores are related mostly to the ``optimum" choice of the elevation maps, introduced by the more accurate description of the signal propagation. Finally, a data quality indicator is introduced as an output of this scheme. This indicator has been obtained from the general scheme, which takes into account all radar data processing steps

HIV-associated neurocognitive impairment in the modern ART era : are we close to discovering reliable biomarkers in the setting of virological suppression?

The prevalence of the most severe forms of HIV-associated neurocognitive disorders (HAND) is decreasing due to worldwide availability and high efficacy of antiretroviral treatment (ART). However, several grades of HIV-related cognitive impairment persist with effective ART and remain a clinical concern for people with HIV (PWH). The pathogenesis of these cognitive impairments has yet to be fully understood and probably multifactorial. In PWH with undetectable peripheral HIV-RNA, the presence of viral escapes in cerebrospinal fluid (CSF) might explain a proportion of cases, but not all. Many other mechanisms have been hypothesized to be involved in disease progression, in order to identify possible therapeutic targets. As potential indicators of disease staging and progression, numerous biomarkers have been used to characterize and implicate chronic inflammation in the pathogenesis of neuronal injuries, such as certain phenotypes of activated monocytes/macrophages, in the context of persistent immune activation. Despite none of them being disease-specific, the correlation of several CSF cellular biomarkers to HIV-induced neuronal damage has been investigated. Furthermore, recent studies have been evaluating specific microRNA (miRNA) profiles in the CSF of PWH with neurocognitive impairment (NCI). The aim of the present study is to review the body of evidence on different biomarkers use in research and clinical settings, focusing on PWH on ART with undetectable plasma HIV-RNA

Ten Years of Medical Informatics and Standards Support for Clinical Research in an Infectious Diseases Network

Background It is 30 years since evidence-based medicine became a great support for individual clinical expertise in daily practice and scientific research. Electronic systems can be used to achieve the goal of collecting data from heterogeneous datasets and to support multicenter clinical trials. The Ligurian Infectious Diseases Network (LIDN) is a web-based platform for data collection and reuse originating from a regional effort and involving many professionals from different fields. Objectives The objective of this work is to present an integrated system of ad hoc interfaces and tools that we use to perform pseudonymous clinical data collection, both manually and automatically, to support clinical trials. Methods The project comprehends different scenarios of data collection systems, according to the degree of information technology of the involved centers. To be compliant with national regulations, the last developed connection is based on the standard Clinical Document Architecture Release 2 by Health Level 7 guidelines, interoperability is supported by the involvement of a terminology service. Results Since 2011, the LIDN platform has involved more than 8,000 patients from eight different hospitals, treated or under treatment for at least one infectious disease among human immunodeficiency virus (HIV), hepatitis C virus, severe acute respiratory syndrome coronavirus 2, and tuberculosis. Since 2013, systems for the automatic transfer of laboratory data have been updating patients' information for three centers, daily. Direct communication was set up between the LIDN architecture and three of the main national cohorts of HIV-infected patients. Conclusion The LIDN was originally developed to support clinicians involved in the project in the management of data from HIV-infected patients through a web-based tool that could be easily used in primary-care units. Then, the developed system grew modularly to respond to the specific needs that arose over a time span of more than 10 years

Lipid profile changings after switching from rilpivirine/tenofovir disoproxil fumarate/emtricitabine to rilpivirine/tenofovir alafenamide/emtricitabine: different effects in different patients populations. Results from a large observational study

Tenofovir alafenamide (TAF) has similar efficacy compared to tenofovir disoproxil fumarate (TDF), but a less favorable effect on lipids. Aim of this study was to evaluate the impact on lipids of switching from rilpivirine (RPV)/ emtricitabine (FTC)/TDF to RPV/FTC/TAF in a large cohort of HIV-1 infected patients

Lipid profile changings after switching from rilpivirine/tenofovir disoproxil fumarate/ emtricitabine to rilpivirine/tenofovir alafenamide/emtricitabine: Different effects in patients with or without baseline hypercholesterolemia

open10noTenofovir alafenamide (TAF) has similar efficacy compared to tenofovir disoproxil fumarate (TDF), but a less favorable effect on lipids. Aim of this retrospective multicentre study was to evaluate the impact on lipids of switching from rilpivirine (RPV)/ emtricitabine (FTC)/TDF to RPV/FTC/TAF in a cohort of HIV-1 infected patients. Total cholesterol (TC), high density lipoproteins (HDL) and low density lipoproteins (LDL) were compared at the moment of the switch and at the first following evaluation, by using paired t-test. Overall, 573 patients were considered, 99% with HIV-RNA <50 copies/ml, with mean age of 49.7 (±0.4) years and median 13.4 (6.9-22.5) years of HIV infection. In the study population with available data (431/573, 75%), mean TC changed from 173 ±1.7 to 188 ±1.8 mg/dl; mean HDL from 46 ±0.7 to 51± 0.7 mg/dl; mean LDL from 111 ±1.5 to 120 ±1.8 mg/dl (p<0.0001 for all). Neither LDL/HDL nor TC/HDL ratio changed significantly, with LDL/HDL from 2.6 ±0.5 to 2.5 ±0.5 (p = 0.12) and TC/HDL from 4.0 ±0.6 to 3.9 ±0.6 (p = 0.11). In patients with baseline diagnosis of hypercholesterolemia (TC>200 mg/dl, N = 87), there was no significant change in TC (224 ±2.2 to 228 ±3.4 mg/dl, p = 0.286) or LDL (150±2.5 to 151±3.2 mg/dl, p = 0.751), while HDL increased from 51 ±1.6 to 55 ±1.7 mg/dl (p<0.0001) and both LDL/HDL and TC/HDL ratio decreased significantly, from 3.2±0.1 to 3.0 ±0.1 (p = 0.025) and from 4.7±0.1 to 4.4 ±0.1 (p = 0.004). In this real life study, a slight increase in lipids was found after switching from RPV/FTC/TDF to RPV/FTC/TAF, but these results were not confirmed in people with hypercholesterolemia, in which lipids did not change and LDL/HDL and TC/HDL ratio decreased.openTaramasso L.; Di Biagio A.; Riccardi N.; Briano F.; Di Filippo E.; Comi L.; Mora S.; Giacomini M.; Gori A.; Maggiolo F.Taramasso, L.; Di Biagio, A.; Riccardi, N.; Briano, F.; Di Filippo, E.; Comi, L.; Mora, S.; Giacomini, M.; Gori, A.; Maggiolo, F

Aumento del peso nelle persone che vivono con infezione da HIV: ritorno al benessere o effetto indesiderato della terapia antiretrovirale? = Weight gain in people living with HIV infection : return to health or adverse event of antiretroviral therapy?

L\u2019aumento di peso in corso di terapia antiretrovirale \ue8 stato considerato in passato un evento predittivo di aumentata sopravvivenza e migliori outcome a lungo termine nelle persone che vivono con infezione da HIV. In epoca recente, tuttavia, si \ue8 assistito ad un incremento della sopravvivenza e ad un aumento dell\u2019invecchiamento e della prevalenza dei fattori di rischio cardiovascolari in questa popolazione, contesto in cui l\u2019aumento di peso non \ue8 pi\uf9 considerato univocamente come un effetto benefico della terapia, ma piuttosto come un effetto collaterale non desiderato della stessa. In questa revisione narrativa della letteratura, riassumiamo i principali studi che hanno valutato l\u2019effetto delle moderne terapie antiretrovirali sull\u2019aumento di peso nei pazienti che vivono con infezione da HIV.Weight gain during antiretroviral therapy has been considered a predictive factor for increased survival and improved long-term outcomes in people living with HIV. In recent times, however, there has been an increase in survival, aging and cardiovascular risk in this population, and weight gain is no longer regarded as a beneficial effect of the therapy, but rather considered an undesired side effect. In this narrative review, we summarize the main studies that have assessed the effect of modern antiretroviral therapies on weight gain and discuss its main implications in patients living with HIV infection

Lipid profile improvement in virologically suppressed hiv-1-infected patients switched to dolutegravir/ abacavir/lamivudine: Data from the SCOLTA project

open13noIntroduction: Metabolic disorders are common amongst HIV-infected patients. Data from real-life setting on the impact of DTG/ABC/3TC in virologically suppressed HIV-infected patients are scarce. Methods: We investigated the modification of metabolic profile including fasting glucose, lipid profile and markers of insulin resistance (IR) in experienced patients switching from a boosted protease inhibitors (bPI) or a non-nucleoside reverse transcriptase inhibitor (NNRTI)-based regimen to DTG/ABC/3TC in a prospective, observational, multicenter study. Results: We enrolled 131 HIV-infected patients, of whom 91 (69.5%) males, mean age was 50.5±10.6 years. CDC stage was A in 66 (50.4%) patients, of whom 91 (69.5%) had acquired HIV through sexual contacts. The previous regimen was bPI-based in 79 patients (60.3%) and NNRTI-based in 52 (39.7%). Patients switching from NNRTI showed a significant reduction at week 24 in total cholesterol (TC) and low-density lipoprotein cholesterol (LDL). Triglycerides/high-density lipoprotein cholesterol (TG/HDL) ratio, HDL, median TG and TG/HDL ratio did not show significant modification during follow-up times. Among patients switching from a bPI, we observed a significant reduction in TC and LDL at both follow-up times and a slight increase in HDL. Triglycerides/HDL ratio, median TG and TG/HDL ratio showed a decrease over time that became significant at weeks 24 and 48. Blood glucose levels did not significantly vary during the observation period in patients switching from both bPI and NNRTI-based regimens. Conclusion: Our data suggest an improvement in lipid profile and TG/HDL ratio in pretreated HIV-1-infected patients who switched to DTG/ABC/3TC over 48 weeks, especially in those previously receiving a bPI-based regimen.openBagella P.; Squillace N.; Ricci E.; Gulminetti R.; De Socio G.V.; Taramasso L.; Pellicano G.; Menzaghi B.; Celesia B.M.; Dentone C.; Orofino G.; Bonfanti P.; Madeddu G.Bagella, P.; Squillace, N.; Ricci, Elena; Gulminetti, R.; De Socio, G. V.; Taramasso, L.; Pellicano, G.; Menzaghi, B.; Celesia, B. M.; Dentone, C.; Orofino, G.; Bonfanti, P.; Madeddu, G

Pregnancy and neonatal outcomes among a cohort of HIV-infected women in a large Italian teaching hospital : a 30-year retrospective study

The primary study objective was to investigate three decades from 1985 to 2014 of changes in pregnancies among HIV-infected women. The secondary objective was to assess risk factors associated with preterm delivery and severe small-for-gestational-age (SGA) infants in HIV-infected women. A retrospective review of deliveries among pregnant HIV-infected women at the University of Genoa and IRCCS San Martino-IST in Genoa between 1985 and 2014 was performed. Univariate and multivariable analyses were used to study the variables associated with neonatal outcomes. Overall, 262 deliveries were included in the study. An increase in median age (26 years in 1985-1994 vs. 34 years in 2005-2014), in the proportion of foreigners (none in 1985-1994 vs. 27/70 (38\ub76%) in 2005-2014), and a decrease in intravenous drug use (75\ub72% (91/121) in 1985-1994 vs. 12\ub79% (9/70) in 2005-2014) among pregnant HIV-infected women was observed. Progressively, HIV infections were diagnosed sooner (prior to pregnancy in 80% (56/70) of women in the last decade). An increase in combined antiretroviral therapy (cART) prescription during pregnancy (50% (27/54) in 1995-2004 vs. 92\ub72% (59/64) in 2005-2014) and in HIV-RNA <50 copies/ml at delivery (19\ub72% (5/26) in 1995-2004 vs. 82\ub73% (53/64) in 2005-2014) was observed. The rate of elective caesarean section from 1985 to 1994 was 9\ub71%, which increased to 92\ub73% from 2004 to 2015. Twelve (10\ub71%) mother-to-child transmissions (MTCT) occurred in the first decade, and six (8\ub73%) cases occurred in the second decade, the last of which was in 2000. Preterm delivery (<37 weeks gestation) was 5% (6/121) from 1985 to 1994 and increased to 17\ub71% (12/70) from 2005 to 2014. In univariate and multivariable logistic regression analyses, advancing maternal age and previous pregnancies were associated with preterm delivery (odds ratio (OR) 2\ub77; 95% confidence intervals (CI) 1-7\ub78 and OR 2\ub76; 95% CI 1\ub71-6\ub77, respectively). In the logistic regression analysis, use of heroin or methadone was found to be the only risk factor for severe SGA (OR 3\ub71; 95% CI 1\ub74-6\ub78). In conclusion, significant changes in demographic, clinical and therapeutic characteristics of HIV-infected pregnant women have occurred over the last 30 years. Since 2000, MTCT has decreased to zero. An increased risk of preterm delivery was found to be associated with advancing maternal age and previous pregnancies but not with cART. The use of heroin or methadone has been confirmed as a risk factor associated with severe SGA