A method for generating a quasi-linear convective system suitable for observing system simulation experiments

To understand the impact of different assimilated observations on convection-allowing model forecast skill, a diverse range of observing system simulation experiment (OSSE) case studies are required (different storm modes and environments). Many previous convection-allowing OSSEs predicted the evolution of an isolated supercell generated via a warm air perturbation in a horizontally homogenous environment. This study introduces a new methodology in which a quasi-linear convective system is generated in a highly sheared and modestly unstable environment. Wind, temperature, and moisture perturbations superimposed on a horizontally homogeneous environment simulate a cold front that initiates an organized storm system that spawns multiple mesovortices. Mature boundary layer turbulence is also superimposed onto the initial environment to account for typical convective-scale uncertainties. Creating an initial forecast ensemble remains a challenge for convection-allowing OSSEs because mesoscale uncertainties are difficult to quantify and represent. The generation of the forecast ensemble is described in detail. The forecast ensemble is initialized by 24 h full-physics simulations (e.g., radiative forcing, surface friction, and microphysics). The simulations assume different surface conditions to alter surface moisture and heat fluxes and modify the effects of friction. The subsequent forecast ensemble contains robust non-Gaussian errors that persist until corrected by the data assimilation system. This purposely degraded initial forecast ensemble provides an opportunity to assess whether assimilated environmental observations can improve, e.g., the wind profile. An example OSSE suggests that a combination of radar and conventional (surface and soundings) observations are required to produce a skilled quasi-linear convective system forecast, which is consistent with real-world case studies. The OSSE framework introduced in this study will be used to understand the impact of assimilated environmental observations on forecast skill.</p

A large ongoing outbreak of hepatitis A predominantly affecting young males in Lazio, Italy; August 2016 - March 2017

The hepatitis A virus (HAV) is mainly transmitted through the faecal-oral route. In industrialized countries HAV infection generally occurs as either sporadic cases in travelers from endemic areas, local outbreak within closed/semi-closed population and as foodborne community outbreak. Recently, an increasing number of HAV infection clusters have been reported among young men-who-have-sex-with-men (MSM). The Lazio Regional Service for the epidemiology and control for infectious diseases (SeRESMI) has noticed an increase of acute hepatitis A (AHA) since September 2016. Temporal analysis carried out with a discrete Poisson model using surveillance data between January 2016 and March 2017 evidenced an ongoing outbreak of AHA that started at the end of August. Molecular investigation carried out on 130 out of 513 cases AHA reported until March 2017 suggests that this outbreak is mainly supported by an HAV variant which is currently spreading within MSM communities across Europe (VRD_521_2016). The report confirms that AHA is an emerging issue among MSM. In addition through the integration of standard (case based) surveillance with molecular investigation we could discriminate, temporally concomitant but epidemiologically unrelated, clusters due to different HAV variants. As suggested by the WHO, in countries with low HAV circulation, vaccination programmes should be tailored on the local epidemiological patterns to prevent outbreaks among high risk groups and eventual spillover of the infection in the general population

A large ongoing outbreak of hepatitis A predominantly affecting young males in Lazio, Italy; August 2016 - March 2017

The hepatitis A virus (HAV) is mainly transmitted through the faecal-oral route. In industrialized countries HAV infection generally occurs as either sporadic cases in travelers from endemic areas, local outbreak within closed/semi-closed population and as foodborne community outbreak. Recently, an increasing number of HAV infection clusters have been reported among young men-who-have-sex-with-men (MSM). The Lazio Regional Service for the epidemiology and control for infectious diseases (SeRESMI) has noticed an increase of acute hepatitis A (AHA) since September 2016. Temporal analysis carried out with a discrete Poisson model using surveillance data between January 2016 and March 2017 evidenced an ongoing outbreak of AHA that started at the end of August. Molecular investigation carried out on 130 out of 513 cases AHA reported until March 2017 suggests that this outbreak is mainly supported by an HAV variant which is currently spreading within MSM communities across Europe (VRD_521_2016). The report confirms that AHA is an emerging issue among MSM. In addition through the integration of standard (case based) surveillance with molecular investigation we could discriminate, temporally concomitant but epidemiologically unrelated, clusters due to different HAV variants. As suggested by the WHO, in countries with low HAV circulation, vaccination programmes should be tailored on the local epidemiological patterns to prevent outbreaks among high risk groups and eventual spillover of the infection in the general population

Chronic kidney disease and arrhythmias: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference.

Patients with chronic kidney disease (CKD) are predisposed to heart rhythm disorders, including atrial fibrillation (AF)/atrial flutter, supraventricular tachycardias, ventricular arrhythmias, and sudden cardiac death (SCD). While treatment options, including drug, device, and procedural therapies, are available, their use in the setting of CKD is complex and limited. Patients with CKD and end-stage kidney disease (ESKD) have historically been under-represented or excluded from randomized trials of arrhythmia treatment strategies,1 although this situation is changing.2 Cardiovascular society consensus documents have recently identified evidence gaps for treating patients with CKD and heart rhythm disorders [...

Systematic review of interventions targeting sickness absence among pregnant women in healthcare settings and workplaces

Objectives: The high rate of sickness absence from work during pregnancy is recognised as a problem, and may be higher than necessary from a health perspective. The aim was to evaluate the effectiveness of interventions in healthcare settings and workplaces targeting sickness absence among pregnant women. Methods: Studies were eligible if they included pregnant women participating in any intervention in healthcare settings or workplaces. The outcome was length of sickness absence in days or number of episodes. Study design had to be either randomised controlled trials (RCTs) or quasi-experimental studies. The search for studies was conducted in PubMed, Scopus, CINAHL, PsycINFO, ClinicalTrials.gov and WHO trial registry. Risk of bias was assessed by the Joanna Briggs Institute standardised quality assessment instrument. Results: A total of nine studies were quality assessed and of these, four were excluded due to insufficient methodological quality. Five RCTs conducted in healthcare settings in Sweden and Norway were included. Due to heterogeneity, meta-analysis was not performed. Two RCTs examined complementary and alternative medicine and three RCTs the effect of physical exercise. In general, the frequency of women on sickness absence was lower in the intervention groups than the control groups, however, only among pregnant women who participated in a 12-week exercise programme, the frequency was significantly lower (22% vs 30%, p=0.04). Conclusion: The evidence of interventions targeting sickness absence among pregnant women in healthcare settings is sparse, and no studies were conducted at workplaces. Future interventions including physical activity provided in collaboration with healthcare settings and workplaces are requested. Studies should measure sickness absence based on valid methods, measure compliance to the intervention and provide transparency of statistical methods

How Work Impairments and Reduced Work Ability are Associated with Health Care Use in Workers with Musculoskeletal Disorders, Cardiovascular Disorders or Mental Disorders

__Abstract__ Purpose the aim of this study was to explore how work impairments and work ability are associated with health care use by workers with musculoskeletal disorders (MSD), cardiovascular disorders (CVD), or mental disorders (MD). Methods in this cross-sectional study, subjects with MSD (n = 2,074), CVD (n = 714), and MD (n = 443) were selected among health care workers in 12 Dutch organizations. Using an online questionnaire, data were collected on in

Byzantine wall paintings from San Marco d’Alunzio, Sicily: non-invasive diagnostics and microanalytical investigation of pigments and plasters

A diagnostic investigation was carried out on twelfth century Byzantine wall paintings preserved in the Museum of Byzantine and Norman Culture and Figurative Arts of San Marco d’Alunzio (Messina, Italy) on the occasion of recent restoration works. First, the wall paintings were analyzed using portable X-Ray Fluorescence (p-XRF) and Fiber Optics Reflectance Spectroscopy (FORS) to obtain a non-invasive preliminary identification of the original palette. Then, five fragments were sampled for a micro-stratigraphy study using Digital Optical Microscope (DOM), Polarizing Optical Microscope (POM), and Scanning Electron Microscopy (SEM) combined with Energy Dispersive X-ray Spectrometry (EDS) to characterize the mortars and the blue and black pigments non unequivocally identified through non-invasive techniques. The palette included mainly earthen pigments like red and yellow ochres, green earth, and more valuable lapis lazuli blue applied on a bone black layer; while the analysis of mortars found on the different apses showed the same manufacturing technique and constitutive materials: lime-based binder with the addition of quartz, and rare calcareous lithic fragments as aggregate. The obtained results shed light on the pictorial technique used for the wall paintings and allowed us to compare the Sicilian pictorial cycle with the coeval Byzantine wall paintings preserved in Sardinia and Southern Italy