Search

The final components of the durum wheat tool are here discussed together with an implementation into the existing decision supporting system granoduro.net® to showcase the main functionalities and possibilities.

Working alongside local stakeholders, members of the French-African Pediatric Oncology Group developed a 3-year program to train pediatric oncology teams from 15 French-speaking countries in Africa in using analgesics and providing palliative care. This program was rolled out in three phases: initial training, in situ assessment, and advanced training in selected topics. To access this program, multidisciplinary teams had to come up with a project to improve their existing palliative care and pain management practices, and commit themselves to implementing it. All the teams invited agreed to take part in the program, which explicitly broached a subject that is often avoided in oncology teaching. The first phase was rolled out in 2017, with 65 trainees from 19 units attending one of three sessions held in Dakar, Senegal, Abidjan, Cote d'Ivoire, and Rabat, Morocco. The subsequent assessment revealed that only half the teams had started to implement their projects. The advanced training phase was therefore adjusted accordingly. A collective training session held in Marseille was attended by 15 trainees from seven teams whose projects were already underway, while in situ mentoring was provided for six other teams, through French-African twinnings in four cases. The length and openness of the program meant that we were able to identify and share the units' diverse realities, and fine-tune their projects accordingly, as well as plan ways of continuing the training both locally and collectively.

Precipitation extremes and small-scale variability are essential drivers in many climate change impact studies. However, the spatial resolution currently achieved by global climate models (GCMs) and regional climate models (RCMs) is still insufficient to correctly identify the fine structure of precipitation intensity fields. In the absence of a proper physically based representation, this scale gap can be at least temporarily bridged by adopting a stochastic rainfall downscaling technique. In this work, a precipitation downscaling chain is introduced where the global 40-yr ECMWF Re-Analysis (ERA-40) (at about 120-km resolution) is dynamically downscaled using the Protheus RCM at 30-km resolution. The RCM precipitation is then further downscaled using a stochastic downscaling technique, the Rainfall Filtered Autoregressive Model (RainFARM), which has been extended for application to long climate simulations. The application of the stochastic downscaling technique directly to the larger-scale reanalysis field at about 120-km resolution is also discussed. To assess the ability of this approach in reproducing the main statistical properties of precipitation, the downscaled model results are compared with the precipitation data provided by a dense network of 122 rain gauges in northwestern Italy, in the time period from 1958 to 2001. The high-resolution precipitation fields obtained by stochastically downscaling the RCM outputs reproduce well the seasonality and amplitude distribution of the observed precipitation during most of the year, including extreme events and variance. In addition, the RainFARM outputs compare more favorably to observations when the procedure is applied to the RCM output rather than to the global reanalyses, highlighting the added value of reaching high enough resolution with a dynamical model.

e20665 Background: During the last 30 years, polychemotherapies, surgery and radiotherapy have been established as standard therapies for treating pediatric cancers thus leading to a significant improvement in terms of 5-year-overall-survival which is now around 70% among children and adolescents. On the other hand, these treatments cause severe sequelae such as ovarian failure (OF) in young girls leading to a premature menopause and infertility. Methods: 29 patients treated at the Institute Gustave Roussy (Villejuif, France) have been investigated in an attempt to find biological and/or clinical markers, and imaging predictive of a partial ovarian insufficiency leading to an early menopause. Eligibility criteria: age >12 years at time of analysis; peripheral stem cell graft between 2–20 years; high dose chemotherapy. Results: 23/29 were eligible for this analysis (6 withdrawn due to oral contraception). 13/23 patients (56.5%) show no clinical evidence of ovarian treatment-related toxicity with a 13 years median time to transplant. 10/23 (43.5%) have complete ovarian insufficiency, among whom the majority have already received substitution hormone therapy (SHT). Out of 75% of pre-pubescent patients at transplant, only 2 have OF. All patients grafted at puberty (15.3 years) have high-dose chemotherapy-related immediate or definitive OF. Thiotepa >900mg/mq is castrating (odds ratio-10.1; p-0.04). Dosages of anti-müllerian hormone (AMH) collapses in patients with IO (p=0.002). Mensed patients have lower AMH dosages compared to normal population (p=2.10-e9) as for antral follicule count (>2mm). Conclusions: 1) 13/23 patients show no evidence of OF. 2) Main risk factors of OF: age ≥ 12 years; post pubertal status; thiotepa >900 mg/m2 (OR=10.1 and p=0.04). 3) Despite normal menses, many women who underwent high dose chemotherapy exhibit low AMH and Inhibine B levels and low count of follicles at a young age. These are possible markers of ovarian depletion. Cryopreservation of the ovarian cortex should be proposed to patients grafted due to a cancer independently of the age at which they have undergone high-dose chemotherapy. No significant financial relationships to disclose.

International audience; SummaryBackground High doses of intravenous methylprednisolone are recommended to treat relapses in patients with multiple sclerosis, but can be inconvenient and expensive. We aimed to assess whether oral administration of high-dose methylprednisolone was non-inferior to intravenous administration. Methods We did this multicentre, double-blind, randomised, controlled, non-inferiority trial at 13 centres for multiple sclerosis in France. We enrolled patients aged 18–55 years with relapsing-remitting multiple sclerosis who reported a relapse within the previous 15 days that caused an increase of at least one point in one or more scores on the Kurtzke Functional System Scale. With use of a computer-generated randomisation list and in blocks of four, we randomly assigned (1:1) patients to either oral or intravenous methylprednisolone, 1000 mg, once a day for 3 days. Patients, treating physicians and nurses, and data and outcome assessors were all masked to treatment allocation, which was achieved with the use of saline solution and placebo capsules. The primary endpoint was the proportion of patients who had improved by day 28 (decrease of at least one point in most affected score on Kurtzke Functional System Scale), without need for retreatment with corticosteroids, in the per-protocol population. The trial was powered to assess non-inferiority of oral compared with intravenous methylprednisolone with a predetermined non-inferiority margin of 15%. This trial is registered with ClinicalTrials.gov, number NCT00984984. Findings Between Jan 29, 2008, and June 14, 2013, we screened 200 patients and enrolled 199. We randomly assigned 100 patients to oral methylprednisolone and 99 patients to intravenous methylprednisolone with a mean time from relapse onset to treatment of 7·0 days (SD 3·6) and 7·4 days (3·9), respectively. In the per-protocol population, 66 (81%) of 82 patients in the oral group and 72 (80%) of 90 patients in the intravenous group achieved the primary endpoint (absolute treatment difference 0·5%, 90% CI −9·5 to 10·4). Rates of adverse events were similar, but insomnia was more frequently reported in the oral group (77 [77%]) than in the intravenous group (63 [64%]). Interpretation Oral administration of high-dose methylprednisolone for 3 days was not inferior to intravenous administration for improvement of disability scores 1 month after treatment and had a similar safety profile. This finding could have implications for access to treatment, patient comfort, and cost, but indication should always be properly considered by clinicians. Funding French Health Ministry, Ligue Française contre la SEP, Teva

[1] We compare the representation of the Southern Hemisphere midlatitude winter variability in the NCEP-NCAR and ERA40 reanalyses by using the Hayashi spectral technique. We find important discrepancies in the description of the atmospheric waves at different spatial and temporal scales. ERA40 is generally characterized by a larger variance, especially in the high-frequency spectral region. Compared to the Northern Hemisphere, the assimilated data are relatively scarce particularly over the oceans, and they provide a weak constraint to the assimilation system even in the period when satellite data are available. In the presatellite period the discrepancies between the two reanalyses are large and randomly distributed; after 1979 the discrepancies are systematic. This study suggests that, as for the winter midlatitude variability in the Southern Hemisphere, a well-defined picture to be used in the evaluation of climate model simulations is still lacking because of the nonconsistency of the reanalyses.

This chapter wishes to propose a description of the statistical properties of midlatitude atmospheric waves for observational data-sets and state-of-the-arts climate models simulations. Therefore, a non-linear theory, accounting for a relevant part of the mid-latitude variability, has been revised in terms of its signature in observational and model data. Theoretical and observational arguments suggest that two main features of mid-latitude northern hemispheric winter variability can be somewhat unambiguously separated, both in terms of signal and physical processes. The synoptic phenomena, which are travelling waves characterized by time scales of the order of 2-7 days and by spatial scales of the order of few thousands Km., can be associated with release of available energy driven by conventional baroclinic conversion. At lower frequencies (10-40 days), the planetary scale variability is related to the non linear orographic resonance processes

We compare, for the overlapping time frame 1962-2000, the estimate of the northern hemisphere (NH) mid-latitude winter atmospheric variability within the XX century simulations of 17 global climate models (GCMs) included in the IPCC-4AR with the NCEP and ECMWF reanalyses. We compute the Hayashi spectra of the 500hPa geopotential height fields and introduce an integral measure of the variability observed in the NH on different spectral sub-domains. Only two high-resolution GCMs have a good agreement with reanalyses. Large biases, in most cases larger than 20%, are found between the wave climatologies of most GCMs and the reanalyses, with a relative span of around 50%. The travelling baroclinic waves are usually overestimated, while the planetary waves are usually underestimated, in agreement with previous studies performed on global weather forecasting models. When comparing the results of various versions of similar GCMs, it is clear that in some cases the vertical resolution of the atmosphere and, somewhat unexpectedly, of the adopted ocean model seem to be critical in determining the agreement with the reanalyses. The GCMs ensemble is biased with respect to the reanalyses but is comparable to the best 5 GCMs. This study suggests serious caveats with respect to the ability of most of the presently available GCMs in representing the statistics of the global scale atmospheric dynamics of the present climate and, a fortiori, in the perspective of modelling climate change., Comment: 39 pages, 8 figures, 2 tables

Understanding the atmospheric low-frequency variability is of crucial importance in fields such as climate studies, climate change detection, and extended-range weather forecast. The Northern Hemisphere climate features the planetary waves as a relevant ingredient of the atmospheric variability. Several observations and theoretical arguments seem to support the idea that winter planetary waves indicator obey a non-Gaussian statistics and may present a multimodal probability density function, thus characterizing the low-frequency portion of the climate system. We show that the upper tropospheric jet strength is a critical parameter in determining whether the planetary waves indicator exhibits a uni- or bimodal behavior, and we determine the relevant threshold value of the jet. These results are obtained by considering the data of the NCEP-NCAR and ECMWF reanalyses for the overlapping period. Our results agree with the non-linear orographic theory, which explains the statistical non-normality of the low-frequency variability of the atmosphere and its possible bimodality., Final version of the paper

We reconsider the problem of the stability of the thermohaline circulation as described by a two-dimensional Boussinesq model with mixed boundary conditions. We determine how the stability properties of the system depend on the intensity of the hydrological cycle. We define a two-dimensional parameters' space descriptive of the hydrology of the system and determine, by considering suitable quasi-static perturbations, a bounded region where multiple equilibria of the system are realized. We then focus on how the response of the system to finite-amplitude surface freshwater forcings depends on their rate of increase. We show that it is possible to define a robust separation between slow and fast regimes of forcing. Such separation is obtained by singling out an estimate of the critical growth rate for the anomalous forcing, which can be related to the characteristic advective time scale of the system., 37 pages, 8 figures, submitted to Clim. Dyn

We compare 45 years of the reanalyses of NCEP-NCAR and ECMWF in terms of their representation of the mid-latitude winter atmospheric variability for the overlapping time frame 1957-2002. We adopt the classical approach of computing the Hayashi spectra of the 500 hPa geopotential height fields. Discrepancies are found especially in the first 15 years of the records in the high-frequency-high wavenumber propagating waves and secondly on low frequency-low wavenumber standing waves. This implies that in the first period the two datasets have a different representation of the baroclinic available energy conversion processes. In the period starting from 1973 a positive impact of the aircraft data on the Euro-Atlantic synoptic waves has been highlighted. Since in the first period the assimilated data are scarcer and of lower quality than later on, they provide a weaker constraint to the model dynamics. Therefore, the resulting discrepancies in the reanalysis products may be mainly attributed to differences in the models' behavior., Comment: 30 pages, 6 figures, 2 tables