Surface impacts of the Quasi Biennial Oscillation

Teleconnections between the Quasi Biennial Oscillation (QBO) and the Northern Hemisphere zonally averaged zonal winds, mean sea level pressure (mslp) and tropical precipitation are explored. The standard approach that defines the QBO using the equatorial zonal winds at a single pressure level is compared with the empirical orthogonal function approach that characterizes the vertical profile of the equatorial winds. Results are interpreted in terms of three potential routes of influence, referred to as the tropical, subtropical and polar routes. A novel technique is introduced to separate responses via the polar route that are associated with the stratospheric polar vortex, from the other two routes. A previously reported mslp response in January, with a pattern that resembles the positive phase of the North Atlantic Oscillation under QBO westerly conditions, is confirmed and found to be primarily associated with a QBO modulation of the stratospheric polar vortex. This mid-winter response is relatively insensitive to the exact height of the maximum QBO westerlies and a maximum positive response occurs with westerlies over a relatively deep range between 10 and 70hPa. Two additional mslp responses are reported, in early winter (December) and late winter (February/March). In contrast to the January response the early and late winter responses show maximum sensitivity to the QBO winds at  ∼ 20 and  ∼ 70hPa respectively, but are relatively insensitive to the QBO winds in between ( ∼ 50hPa). The late winter response is centred over the North Pacific and is associated with QBO influence from the lowermost stratosphere at tropical/subtropical latitudes in the Pacific sector. The early winter response consists of anomalies over both the North Pacific and Europe, but the mechanism for this response is unclear. Increased precipitation occurs over the tropical western Pacific under westerly QBO conditions, particularly during boreal summer, with maximum sensitivity to the QBO winds at 70hPa. The band of precipitation across the Pacific associated with the Inter-tropical Convergence Zone (ITCZ) shifts southward under QBO westerly conditions. The empirical orthogonal function (EOF)-based analysis suggests that this ITCZ precipitation response may be particularly sensitive to the vertical wind shear in the vicinity of 70hPa and hence the tropical tropopause temperatures

Coordinated analysis of age, sex, and education effects on change in MMSE scores

Objectives. We describe and compare the expected performance trajectories of older adults on the Mini-Mental Status Examination (MMSE) across six independent studies from four countries in the context of a collaborative network of longitudinal studies of aging. A coordinated analysis approach is used to compare patterns of change conditional on sample composition differences related to age, sex, and education. Such coordination accelerates evaluation of particular hypotheses. In particular, we focus on the effect of educational attainment on cognitive decline.Method. Regular and Tobit mixed models were fit to MMSE scores from each study separately. The effects of age, sex, and education were examined based on more than one centering point.Results. Findings were relatively consistent across studies. On average, MMSE scores were lower for older individuals and declined over time. Education predicted MMSE score, but, with two exceptions, was not associated with decline in MMSE over time.Conclusion. A straightforward association between educational attainment and rate of cognitive decline was not supported. Thoughtful consideration is needed when synthesizing evidence across studies, as methodologies adopted and sample characteristics, such as educational attainment, invariably differ. © 2012 The Author

Intensive care doctors and nurses personal preferences for intensive Care, as compared to the general population: a discrete choice experiment

Background To test the hypothesis that Intensive Care Unit (ICU) doctors and nurses differ in their personal preferences for treatment from the general population, and whether doctors and nurses make different choices when thinking about themselves, as compared to when they are treating a patient. Methods Cross sectional, observational study conducted in 13 ICUs in Australia in 2017 using a discrete choice experiment survey. Respondents completed a series of choice sets, based on hypothetical situations which varied in the severity or likelihood of: death, cognitive impairment, need for prolonged treatment, need for assistance with care or requiring residential care. Results A total of 980 ICU staff (233 doctors and 747 nurses) participated in the study. ICU staff place the highest value on avoiding ending up in a dependent state. The ICU staff were more likely to choose to discontinue therapy when the prognosis was worse, compared with the general population. There was consensus between ICU staff personal views and the treatment pathway likely to be followed in 69% of the choices considered by nurses and 70% of those faced by doctors. In 27% (1614/5945 responses) of the nurses and 23% of the doctors (435/1870 responses), they felt that aggressive treatment would be continued for the hypothetical patient but they would not want that for themselves. Conclusion The likelihood of returning to independence (or not requiring care assistance) was reported as the most important factor for ICU staff (and the general population) in deciding whether to receive ongoing treatments. Goals of care discussions should focus on this, over likelihood of survival

Reduced cardiac index reserve and hypovolemia in severe falciparum malaria

Background: Impaired microvascular perfusion is central to the development of coma and lactic acidosis in severe falciparum malaria. Refractory hypotension is rare on admission but develops frequently in fatal cases. We assessed cardiac function and volume status in severe falciparum malaria and its prognostic significance. Methods: Patients with severe (N=101) or acute uncomplicated falciparum malaria (N=83) recruited two hospitals in India and Bangladesh and healthy participants (N=44) underwent echocardiography. Results Patients with severe malaria had 38% shorter left ventricular (LV) filling times and 25% shorter LV ejection times than healthy participants because of tachycardia, yet stroke volume, LV internal diameter in diastole (LVIDd) and systole (LVIDs) indices were similar. A low endocardial fraction shortening (eFS) was present in 17% (9/52) of severe malaria patients. Adjusting for preload and afterload, eFS was similar in health and severe malaria. Fatal cases had smaller baseline LVIDd and LVIDs indices, more collapsible inferior vena cavae (IVC) and higher heart rates than survivors. LVIDs and IVC collapsibility were independent predictors for mortality, together with base excess and Glasgow Coma Scale. Conclusions: Patients with severe malaria have rapid ejection of a normal stroke volume. Fatal cases had features of relative hypovolemia and reduced cardiac index reserve

Neighbourhood environments and cognitive health in the longitudinal Personality and Total Health (PATH) through life study: A 12-year follow-up of older Australians

Background: Urban neighbourhood environments may impact older adults’ cognitive health. However, longitudinal studies examining key environmental correlates of cognitive health are lacking. We estimated cross-sectional and longitudinal associations of neighbourhood built and natural environments and ambient air pollution with multiple cognitive health outcomes in Australian urban dwellers aged 60+ years. Methods: The study included 1160 participants of the PATH Through Life study (60+ cohort) who were followed up for 12 years (four assessments; 2001/02 to 2013/15) and with data on socio-demographics, health, cognitive functions and diagnoses, and full residential address. Neighbourhood environmental features encompassed population and street-intersection densities, non-commercial land use mix, transit points, presence of blue space, percentages of commercial land, parkland and tree cover, and annual average PM2.5 and NO2 concentrations. All exposures except for tree cover were assessed at two time points. Generalised additive mixed models estimated associations of person-level average, and within-person changes in, exposures with cognitive functions. Multi-state hidden Markov models estimated the associations of neighbourhood attributes with transitions to/from mild cognitive impairment (MCI). Results: Dense, destination-rich neighbourhoods were associated with a lower likelihood of transition to MCI and reversal to no MCI. Positive cross-sectional and longitudinal associations of non-commercial land use mix, street intersection density and percentage of commercial land were observed especially with global cognition and processing speed. While access to parkland and blue spaces were associated with a lower risk of transition to MCI, the findings related to cognitive functions were mixed and supportive of an effect of parkland on verbal memory only. Higher levels of PM2.5 and NO2 were consistently associated with steeper declines and/or decreases in cognitive functions and worse cognitive states across time. Conclusion: To support cognitive health in ageing populations, neighbourhoods need to provide an optimal mix of environmental complexity, destinations and access to the natural environment and, at the same time, minimise ambient air pollution

A novel, multidomain, primary care nurse-led and mHealth-assisted intervention for dementia risk reduction in middle-aged adults (HAPPI MIND): study protocol for a cluster randomised controlled trial

Introduction Middle-aged multidomain risk reduction interventions targeting modifiable risk factors for dementia may delay or prevent a third of dementia cases in later life. We describe the protocol of a cluster randomised controlled trial (cRCT), HAPPI MIND (Holistic Approach in Primary care for PreventIng Memory Impairment aNd Dementia). HAPPI MIND will evaluate the efficacy of a multidomain, nurse-led, mHealth supported intervention for assessing dementia risk and reducing associated risk factors in middle-aged adults in the Australian primary care setting. Methods and analysis General practice clinics (n≥26) across Victoria and New South Wales, Australia, will be recruited and randomised. Practice nurses will be trained to implement the HAPPI MIND intervention or a brief intervention. Patients of participating practices aged 45–65 years with ≥2 potential dementia risk factors will be identified and recruited (approximately 15 patients/clinic). Brief intervention participants receive a personalised report outlining their risk factors for dementia based on Australian National University Alzheimer’s Disease Risk Index (ANU-ADRI) scores, education booklet and referral to their general practitioner as appropriate. HAPPI MIND participants receive the brief intervention as well as six individualised dementia risk reduction sessions with a nurse trained in motivational interviewing and principles of behaviour change, a personalised risk reduction action plan and access to the purpose-built HAPPI MIND smartphone app for risk factor self-management. Follow-up data collection will occur at 12, 24 and 36 months. Primary outcome is ANU-ADRI score change at 12 months from baseline. Secondary outcomes include change in cognition, quality of life and individual risk factors of dementia

Treating tobacco dependence in older adults: a survey of primary care clinicians’ knowledge, attitudes, and practice

BACKGROUND: The benefits of smoking cessation among older people are well documented. Despite this, evidence suggests that older smokers are rarely engaged in smoking cessation efforts, and that existing tobacco dependence treatments require further tailoring to the specific needs of older smokers. This study assesses the knowledge, attitudes, and clinical practice of primary care clinicians in relation to addressing tobacco dependence among older people. METHODS: A cross-sectional survey of 427 NHS primary care clinicians in a large English city was conducted using modified version of a previously validated questionnaire. RESULTS: One hundred and seventy one clinicians (40 % response rate) completed the survey. While the majority (90.0 %) of respondents reported enquiring regularly about older patients’ smoking status, just over half (59.1 %) reported providing older patients with smoking cessation support. A lack of awareness in relation to the prevalence and impact of smoking in later life were apparent: e.g. only 47 % of respondents were aware of that approximately 10 life years are lost due to smoking related disease, and only 59 % knew that smoking can reduce the effectiveness of medication prescribed for conditions common in later life. Self-reported attendance at smoking-related training was significantly associated with proactive clinical practice. CONCLUSIONS: There is a need to improve clinicians’ knowledge, in relation to smoking and smoking cessation in older patients and to build clinician confidence in seizing teachable moments. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12875-015-0317-7) contains supplementary material, which is available to authorized users

Summary and Highlights of the SPARC-Reanalysis Intercomparison Project

The climate research community uses global atmospheric reanalysis data sets to understand a wide range of processes and variability in the atmosphere; they are a particularly powerful tool for studying phenomena that cannot be directly observed. Different reanalyses may give very different results for the same diagnostics. The Stratosphere troposphere Processes And their Role in Climate (SPARC) Reanalysis Intercomparison Project (S-RIP) is a coordinated activity to compare key diagnostics that are important for stratospheric processes and their tropospheric connections among available reanalyses. S-RIP has been identifying differences among reanalyses and their underlying causes, providing guidance on appropriate usage of reanalysis products in scientific studies (particularly those of relevance to SPARC), and contributing to future improvements in the reanalysis products by establishing collaborative links between reanalysis centres and data users. S-RIP emphasizes diagnostics of the upper troposphere, stratosphere, and lower mesosphere. The draft S-RIP final report is expected to be completed in 2018. This poster gives a summary of the S-RIP project and presents highlights including results on the Brewer-Dobson circulation, stratosphere/troposphere dynamical coupling, the extra-tropical upper troposphere / lower stratosphere, the tropical tropopause layer, the quasi-biennial oscillation, lower stratospheric polar processing, and the upper stratosphere/lower mesosphere