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This paper describes the main characteristics of CNRM‐CM6‐1, the fully coupled atmosphere‐ocean general circulation model of sixth generation jointly developed by Centre National de Recherches Météorologiques (CNRM) and Cerfacs for the sixth phase of the Coupled Model Intercomparison Project 6 (CMIP6). The paper provides a description of each component of CNRM‐CM6‐1, including the coupling method and the new online output software. We emphasize where model's components have been updated with respect to the former model version, CNRM‐CM5.1. In particular, we highlight major improvements in the representation of atmospheric and land processes. A particular attention has also been devoted to mass and energy conservation in the simulated climate system to limit long‐term drifts. The climate simulated by CNRM‐CM6‐1 is then evaluated using CMIP6 historical and Diagnostic, Evaluation and Characterization of Klima (DECK) experiments in comparison with CMIP5 CNRM‐CM5.1 equivalent experiments. Overall, the mean surface biases are of similar magnitude but with different spatial patterns. Deep ocean biases are generally reduced, whereas sea ice is too thin in the Arctic. Although the simulated climate variability remains roughly consistent with CNRM‐CM5.1, its sensitivity to rising CO2 has increased: the equilibrium climate sensitivity is 4.9 K, which is now close to the upper bound of the range estimated from CMIP5 models. Key Points Description of CNRM‐CM6‐1 model components, their coupling, and tuning procedures are described Historical simulations and DECK experiments are assessed Preindustrial simulation is stable and mean climate and variability in historical runs is realistic

A new version of the general circulation model CNRM-CM has been developed jointly by CNRM-GAME (Centre National de Recherches Météorologiques—Groupe d’études de l’Atmosphère Météorologique) and Cerfacs (Centre Européen de Recherche et de Formation Avancée) in order to contribute to phase 5 of the Coupled Model Intercomparison Project (CMIP5). The purpose of the study is to describe its main features and to provide a preliminary assessment of its mean climatology. CNRM-CM5.1 includes the atmospheric model ARPEGE-Climat (v5.2), the ocean model NEMO (v3.2), the land surface scheme ISBA and the sea ice model GELATO (v5) coupled through the OASIS (v3) system. The main improvements since CMIP3 are the following. Horizontal resolution has been increased both in the atmosphere (from 2.8° to 1.4°) and in the ocean (from 2° to 1°). The dynamical core of the atmospheric component has been revised. A new radiation scheme has been introduced and the treatments of tropospheric and stratospheric aerosols have been improved. Particular care has been devoted to ensure mass/water conservation in the atmospheric component. The land surface scheme ISBA has been externalised from the atmospheric model through the SURFEX platform and includes new developments such as a parameterization of sub-grid hydrology, a new freezing scheme and a new bulk parameterisation for ocean surface fluxes. The ocean model is based on the state-of-the-art version of NEMO, which has greatly progressed since the OPA8.0 version used in the CMIP3 version of CNRM-CM. Finally, the coupling between the different components through OASIS has also received a particular attention to avoid energy loss and spurious drifts. These developments generally lead to a more realistic representation of the mean recent climate and to a reduction of drifts in a preindustrial integration. The large-scale dynamics is generally improved both in the atmosphere and in the ocean, and the bias in mean surface temperature is clearly reduced. However, some flaws remain such as significant precipitation and radiative biases in many regions, or a pronounced drift in three dimensional salinity.

Dynamical model forecasts in the Sea Ice Outlook (SIO) of September Arctic sea-ice extent over the last decade have shown lower skill than that found in both idealized model experiments and hindcasts of previous decades. Additionally, it is unclear how different model physics, initial conditions or forecast post-processing (bias correction) techniques contribute to SIO forecast uncertainty. In this work, we have produced a seasonal forecast of 2015 Arctic summer sea ice using SIO dynamical models initialized with identical sea-ice thickness in the central Arctic. Our goals are to calculate the relative contribution of model uncertainty and irreducible error growth to forecast uncertainty and assess the importance of post-processing, and to contrast pan-Arctic forecast uncertainty with regional forecast uncertainty. We find that prior to forecast post-processing, model uncertainty is the main contributor to forecast uncertainty, whereas after forecast post-processing forecast uncertainty is reduced overall, model uncertainty is reduced by an order of magnitude, and irreducible error growth becomes the main contributor to forecast uncertainty. While all models generally agree in their post-processed forecasts of September sea-ice volume and extent, this is not the case for sea-ice concentration. Additionally, forecast uncertainty of sea-ice thickness grows at a much higher rate along Arctic coastlines relative to the central Arctic ocean. Potential ways of offering spatial forecast information based on the timescale over which the forecast signal beats the noise are also explored.

Ficus and their mutualistic pollinating wasps provide a unique model to investigate joint diversification in a high dispersal system. We investigate genetic structuring in an extremely wide-ranging Ficus species, Ficus racemosa, and its pollinating wasp throughout their range, which extends from India to Australia. Our samples were structured into four large, vicariant populations of figs and wasps which may correspond to distinct (sub)species, located in India, China-Thailand, Borneo, and Australia. However, the genetically most divergent group was the Indian population for the figs and the China-Thailand population for the wasps, suggesting different evolutionary histories of populations. Molecular dating for the wasps shows that diversification of the pollinator clade is surprisingly old, beginning about 13.6 Ma. Data on both the host fig species and its pollinating wasps suggest that strong genetic flow within biogeographic groups over several hundreds of kilometers has limited genetic and morphological differentiation and, potentially, local adaptation. This is probably due to long-distance dispersal of pollinating wasps. The genetic clustering into large geographic units observed in F. racemosa and its pollinators is reminiscent of what can be observed in some other high-dispersal organisms characterized by morphology that varies little over huge distances. The implications of strong gene flow for diversification processes and adaptation to different ecological conditions in Ficus and their pollinating wasps are just beginning to emerge.

Background/Objectives: Circulating phospholipids and sphingolipids are implicated in obesity-related comorbidities such as insulin resistance and cardiovascular disease. How bariatric surgery affects these important lipid markers is poorly understood. We sought to determine whether Roux-en-Y gastric bypass (RYGB), which is associated with greater metabolic improvement, differentially affects the phosphosphingolipidome compared with adjustable gastric banding (AGB). Subjects/Methods: Fasting sera were available from 59 obese women (body mass index range 37–51 kg m −2 ; n =37 RYGB and 22 AGB) before surgery, then at 1 (21 RYGB, 12 AGB) and 3 months follow-up (19 RYGB, 12 AGB). HPLC-MS/MS was used to quantify 131 lipids from nine structural classes. DXA measurements and laboratory parameters were also obtained. The associations between lipids and clinical measurements were studied with P -values adjusted for the false discovery rate (FDR). Results: Both surgical procedures rapidly induced weight loss and improved clinical profiles, with RYGB producing better improvements in fat mass, and serum total cholesterol, low-density lipoprotein-cholesterol (LDL-C) and orosomucoid (FDR <10%). Ninety-three (of 131) lipids were altered by surgery—the majority decreasing—with 29 lipids differentially affected by RYGB during the study period. The differential effect of the surgeries remained statistically significant for 20 of these lipids after adjusting for differences in weight loss between surgery types. The RYGB signature consisted of phosphatidylcholine species not exceeding 36 carbons, and ceramides and sphingomyelins containing C22 to C25 fatty acids. RYGB also led to a sustained increase in unsaturated ceramide and sphingomyelin species. The RYGB-specific lipid changes were associated with decreases in body weight, total and LDL-C, orosomucoid and increased HOMA-S (FDR <10%). Conclusions: Concomitant with greater metabolic improvement, RYGB induced early and sustained changes in phosphatidylcholines, sphingomyelins and ceramides that were independent of greater weight loss. These data suggest that RYGB may specifically alter sphingolipid metabolism, which, in part, could explain the better metabolic outcomes of this surgical procedure.

Background. Coinfection with hepatitis B virus (HBV) in human immunodeficiency virus (HIV)-infected patients is common. However, little is known about the natural history of chronic hepatitis B in HIV-infected populations, especially the impact of highly active antiretroviral therapy (HAART) on the outcome of HBV early antigen (HBeAg) and HBV surface antigen (HBsAg) status. Methods. The characteristics of 92 patients coinfected with HIV and HBV were retrospectively assessed before and after HAART and lamivudine treatment to determine the impact of treatment on chronic hepatitis B and factors associated with HBeAg and/or HBsAg seroconversion. Results. During follow-up, 82 patients received antiretroviral therapy, 79 of whom received HAART. Twenty-eight of the 76 patients who were administered lamivudine therapy developed lamivudine resistance mutations. While receiving antiretroviral therapy, 10 of 59 HBeAg—positive patients developed antibody to HBeAg, 3 of 10 cleared HBsAg, and 2 of 3 developed antibody to HBsAg. Two of 23 HBeAg-negative patients cleared HBsAg and developed antibody to HBsAg. HBeAg and/or HBsAg seroconversion combined with an undetectable HBV DNA level (i.e., an HBV response) correlated with a sustained HIV response (P = .001), shorter duration of antiretroviral therapy (P = .058), and more-severe disease, as evaluated by Centers for Disease Control and Prevention staging (for stage B vs. stage A, P = .029; for stage C vs. stage A, P = .069). For patients with elevated baseline alanine aminotransferase levels, the HBV response correlated significantly with a greater increase in CD4 cell count while receiving HAART. Conclusions. In HIV-HBV-coinfected patients, HBV response correlated with a sustained HIV response to antiretroviral therapy, usually HAART including lamivudine.

The equilibrium climate sensitivity (ECS) in the latest version of CNRM climate model, CNRM‐CM6‐1, and in its high‐resolution counterpart, CNRM‐CM6‐1‐HR, is significantly larger than in the previous version (CNRM‐CM5.1). The traceability of this climate sensitivity change is investigated using coupled ocean‐atmosphere model climate change simulations. These simulations show that the increase in ECS is the result of changes in the atmospheric component. A particular attention is paid to the method used to decompose the equilibrium temperature response difference, by using a linearized decomposition of the individual radiative agents diagnosed by a radiative kernel technique. The climate sensitivity increase is primarily due to the cloud radiative responses, with a predominant contribution of the tropical longwave response (including both feedback and forcing adjustment) and a significant contribution of the extratropical and tropical shortwave feedback changes. A series of stand‐alone atmosphere experiments is carried out to quantify the contributions of each atmospheric development to this difference between CNRM‐CM5.1 and CNRM‐CM6‐1. The change of the convection scheme appears to play an important role in driving the cloud changes, with a large effect on the tropical longwave cloud feedback change. Plain Language Summary The global equilibrium temperature change in response to a doubling of the atmospheric carbon dioxide concentration is an important characteristic of the climate system known as the equilibrium climate sensitivity (ECS). Many climate models contributing to CMIP6 (Coupled Model Intercomparison Project phase 6) have a larger ECS than their CMIP5 predecessors. Here, we investigate the origins of this increase for the CNRM model and its high‐resolution version. We find that it primarily results from changes in the atmospheric component, in particular in the convection scheme, through its impact on the cloud radiative responses. Key Points The CNRM climate models contributing to Coupled Model Intercomparison Project phase 6 have a larger climate sensitivity than their CMIP5 predecessor The climate sensitivity increase is the result of changes in the atmospheric component, through the dominant role of tropical cloud changes The new convection scheme appears to play an important role in driving the cloud changes

The increasing prevalence of morbid obesity together with the development of laparoscopic approaches has led to a steep rise in the number of bariatric operations. These guidelines intend to define the comparative effectiveness and surrounding circumstances of the various types of obesity surgery. A consensus panel representing the fields of general/endoscopic surgery, nutrition and epidemiology convened to agree on specific questions in obesity surgery. Databases were systematically searched for clinical trial results in order to produce evidence-based recommendations. Following two days of discussion by the experts and a plenary discussion, the final statements were issued. After the patient's multidisciplinary evaluation, obesity surgery should be considered in adults with a documented BMI greater than or equal to 35 and related comorbidity, or a BMI of at least 40. In addition to standard laboratory testing, chest radiography, electrocardiography, spirometry, and abdominal ultrasonography, the preoperative evaluation of obesity surgery patients also includes upper gastrointestinal endoscopy or radiologic evaluation with a barium meal. Psychiatric consultation and polysomnography can safely be restricted to patients with clinical symptoms on preoperative screening. Adjustable gastric banding (GB), vertical banded gastroplasty (VBG), Roux-en-Y gastric bypass (RYGB) and biliopancreatic diversion (BPD) are all effective in the treatment of morbid obesity, but differ in degree of weight loss and range of complications. The choice of procedure therefore should be tailored to the individual situation. There is evidence that a laparoscopic approach is advantageous for LAGB, VBG, and GB (and probably also for BPD). Antibiotic and antithromboembolic prophylaxis should be used routinely. Patients should be seen 3 to 8 times during the first postoperative year, 1 to 4 times during the second year and once or twice a year thereafter. Outcome assessment after surgery should include weight loss and maintainance, nutritional status, comorbidities and quality-of-life.

For real-time monitoring of the longitudinal position of the Bragg-peak during an ion therapy treatment, a novel non-invasive technique has been recently proposed that exploits the detection of prompt γ-rays issued from nuclear fragmentation. Two series of experiments have been performed at the GANIL and GSI facilities with 95 and 305 MeV/u ¹²C⁶⁺ ion beams stopped in PMMA and water phantoms. In both experiments, a clear correlation was obtained between the carbon ion range and the prompt photon profile. Additionally, an extensive study has been performed to investigate whether a prompt neutron component may be correlated with the carbon ion range. No such correlation was found. The present paper demonstrates that a collimated set-up can be used to detect single photons by means of time-of-flight measurements, at those high energies typical for ion therapy. Moreover, the applicability of the technique both at cyclotron and at synchrotron facilities is shown. It is concluded that the detected photon count rates provide sufficiently high statistics to allow real-time control of the longitudinal position of the Bragg-peak under clinical conditions.

In tropical forests, selective logging removes large trees that are often the main contributors to pollination. We studied pollination patterns of the African mahogany, Entandrophragma cylindricum (Sapelli). We investigated two plots in Cameroon corresponding to three tree densities: unlogged forest (Ndama 2002), a mildly logged forest 1 year after logging (Ndama 2003) and a severely logged forest 30 years after logging (Dimako). We used four microsatellite markers to perform paternity analysis. Selfing remained below 2% in all treatments. Pollen flow was mainly long distance but with some proximity effects. Average observed within-plot pollination distances were 338, 266 and 385 m, and pollination by trees outside the plots was 70% (Ndama 2002), 74% (Ndama 2003) and 66% (Dimako). Despite sampling a limited number of seeds from a limited number of mother trees, we obtained seeds sired by 35.6-38.3% of the potential within-plot pollen donors. While trees 20 cm in diameter contributed to pollination, results in Dimako suggest that individual larger trees contribute more to pollination than small ones. This effect was not detected in the other treatments. The results suggest extensive pollen flow in Sapelli. Hence, in Sapelli, the main limiting factor for regeneration after logging may be a reduction in the number of trees capable of producing seeds rather genetic effects due to limits to pollen dispersal.