Glacial-interglacial changes in bottom-water oxygen content on the Portuguese margin

During the last and penultimate glacial maxima, atmospheric CO2 concentrations were lower than present, possibly in part because of increased storage of respired carbon in the deep oceans. The amount of respired carbon present in a water mass can be calculated from its oxygen content through apparent oxygen utilization; the oxygen content can in turn be calculated from the carbon isotope gradient within the sediment column. Here we analyse the shells of benthic foraminifera occurring at the sediment surface and the oxic/anoxic interface on the Portuguese Margin to reconstruct the carbon isotope gradient and hence bottom-water oxygenation over the past 150,000 years. We find that bottom-water oxygen concentrations were 45 and 65 μmol kg−1 lower than present during the last and penultimate glacial maxima, respectively. We calculate that concentrations of remineralized organic carbon were at least twice as high as today during the glacial maxima. We attribute these changes to decreased ventilation linked to a reorganization of ocean circulation and a strengthened global biological pump. If the respired carbon pool was of a similar size throughout the entire glacial deep Atlantic basin, then this sink could account for 15 and 20 per cent of the glacial PCO2 drawdown during the last and penultimate glacial maxima

Terrestrial biosphere changes over the last 120 kyr

A new global synthesis and biomization of long (> 40 kyr) pollen-data records is presented and used with simulations from the HadCM3 and FAMOUS climate models and the BIOME4 vegetation model to analyse the dynamics of the global terrestrial biosphere and carbon storage over the last glacial–interglacial cycle. Simulated biome distributions using BIOME4 driven by HadCM3 and FAMOUS at the global scale over time generally agree well with those inferred from pollen data. Global average areas of grassland and dry shrubland, desert, and tundra biomes show large-scale increases during the Last Glacial Maximum, between ca. 64 and 74 ka BP and cool substages of Marine Isotope Stage 5, at the expense of the tropical forest, warm-temperate forest, and temperate forest biomes. These changes are reflected in BIOME4 simulations of global net primary productivity, showing good agreement between the two models. Such changes are likely to affect terrestrial carbon storage, which in turn influences the stable carbon isotopic composition of seawater as terrestrial carbon is depleted in 13C

Geological Society of London Scientific Statement: what the geological record tells us about our present and future climate

Geology is the science of how the Earth functions and has evolved and, as such, it can contribute to our understanding of the climate system and how it responds to the addition of carbon dioxide (CO2) to the atmosphere and oceans. Observations from the geological record show that atmospheric CO2 concentrations are now at their highest levels in at least the past 3 million years. Furthermore, the current speed of human-induced CO2 change and warming is nearly without precedent in the entire geological record, with the only known exception being the instantaneous, meteorite-induced event that caused the extinction of non-bird-like dinosaurs 66 million years ago. In short, whilst atmospheric CO2 concentrations have varied dramatically during the geological past due to natural processes, and have often been higher than today, the current rate of CO2 (and therefore temperature) change is unprecedented in almost the entire geological past. The geological record shows that changes in temperature and greenhouse gas concentrations have direct impacts on sea-level, the hydrological cycle, marine and terrestrial ecosystems, and the acidification and oxygen depletion of the oceans. Important climate phenomena, such as the El Niño–Southern Oscillation (ENSO) and the monsoons, which today affect the socio-economic stability and food and water security of billions of people, have varied markedly with past changes in climate. Climate reconstructions from around the globe show that climate change is not globally uniform, but tends to exhibit a consistent pattern, with changes at the poles larger than elsewhere. This polar amplification is seen in ancient warmer-than-modern time intervals like the Eocene epoch, about 50 million years ago and, more recently, in the Pliocene, about 3 million years ago. The warmest intervals of the Pliocene saw the disappearance of summer sea ice from the Arctic. The loss of ice cover during the Pliocene was one of the many rapid climate changes observed in the record, which are ften called climate tipping points. The geological record can be used to calculate a quantity called Equilibrium Climate Sensitivity, which is the amount of warming caused by a doubling of atmospheric CO2, after various processes in the climate system have reached equilibrium. Recent estimates suggest that global mean climate warms between 2.6 and 3.9°C per doubling of CO2 once all slow Earth system processes have reached equilibrium. The geological record provides powerful evidence that atmospheric CO2 concentrations drive climate change, and supports multiple lines of evidence that greenhouse gases emitted by human activities are altering the Earth’s climate. Moreover, the amount of anthropogenic greenhouse gases already in the atmosphere means that Earth is committed to a certain degree of warming. As the Earth’s climate changes due to the burning of fossil fuels and changes in land-use, the planet we live on will experience further changes that will have increasingly drastic effects on human societies. An assessment of past climate changes helps to inform policy decisions regarding future climate change. Earth scientists will also have an important role to play in the delivery of any policies aimed at limiting future climate change

Eastern Mediterranean hydroclimate over the late glacial and Holocene, reconstructed from the sediments of Nar lake, central Turkey, using stable isotopes and carbonate mineralogy

There is a lack of high-resolution records of hydroclimate variability in the Eastern Mediterranean from the late glacial and early Holocene. More knowledge of the speed of climate shifts and the degree to which they were synchronous with changes in the North Atlantic or elsewhere is required to understand better the controls on Eastern Mediterranean climate. Using endogenic carbonate from a sediment sequence from Nar Gölü, a maar lake in central Turkey, dated by varve counting and uranium-thorium methods, we present high-resolution (∼25 years) oxygen (δ18O) and carbon isotope records, supported by carbonate mineralogy data, spanning the late glacial and Holocene. δ18Ocarbonate at Nar Gölü has been shown previously to be a strong proxy for regional water balance. After a dry period (i.e. evaporation far exceeding precipitation) in the Younger Dryas, the data show a transition into the relatively wetter early Holocene. In the early Holocene there are two drier periods that appear to peak at ∼9.3 ka and ∼8.2 ka, coincident with cooling ‘events’ seen in North Atlantic records. After this, and as seen in other records from the Eastern Mediterranean, there is a millennial-scale drying trend through the Mid Holocene Transition. The relatively dry late Holocene is punctuated by centennial-scale drought intervals, at the times of 4.2 ka ‘event’ and Late Bronze Age societal ‘collapse’. Overall, we show that central Turkey is drier when the North Atlantic is cooler, throughout this record and at multiple timescales, thought to be due to a weakening of the westerly storm track resulting from reduced cyclogenesis in the North Atlantic. However, some features, such as the Mid Holocene Transition and the fact the early Holocene dry episodes at Nar Gölü are of a longer duration than the more discrete ‘events’ seen in North Atlantic records, imply there are additional controls on Eastern Mediterranean hydroclimate

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Expanded oxygen minimum zones during the late Paleocene-early Eocene:Hints from multiproxy comparison and ocean modeling

Anthropogenic warming could well drive depletion of oceanic oxygen in the future. Important insight into the relationship between de-oxygenation and warming can be gleaned from the geological record, but evidence is limited because few ocean oxygenation records are available for past greenhouse climate conditions. We use I/Ca in benthic foraminifera to reconstruct late Paleocene through early Eocene bottom and pore-water redox conditions in the South Atlantic and Southern Indian Oceans, and compare our results with those derived from Mn speciation and the Ce anomaly in fish teeth. We conclude that waters with lower oxygen concentrations were widespread at intermediate depths (1.5-2 km), whereas bottom waters were more oxygenated at the deepest site, in the Southeast Atlantic Ocean (>3 km). Epifaunal benthic foraminiferal I/Ca values were higher in the late Paleocene, especially at low oxygen sites, than at well-oxygenated modern sites, indicate higher seawater total iodine concentrations in the late Paleocene than today. The proxy-based bottom water oxygenation pattern agrees with the site-to-site O2 gradient as simulated in a comprehensive climate model (CCSM3), but the simulated absolute dissolved O2 values are low (<~35 µmol/kg), while higher O2 values (~60-100 µmol/kg) were obtained in an Earth system model (cGENIE). Multi-proxy data together with improvements in boundary conditions and model parameterization are necessary if the details of past oceanographic oxygenation are to be resolved

Mortality of emergency abdominal surgery in high-, middle- and low-income countries

Background: Surgical mortality data are collected routinely in high-income countries, yet virtually no low- or middle-income countries have outcome surveillance in place. The aim was prospectively to collect worldwide mortality data following emergency abdominal surgery, comparing findings across countries with a low, middle or high Human Development Index (HDI). Methods: This was a prospective, multicentre, cohort study. Self-selected hospitals performing emergency surgery submitted prespecified data for consecutive patients from at least one 2-week interval during July to December 2014. Postoperative mortality was analysed by hierarchical multivariable logistic regression. Results: Data were obtained for 10 745 patients from 357 centres in 58 countries; 6538 were from high-, 2889 from middle- and 1318 from low-HDI settings. The overall mortality rate was 1⋅6 per cent at 24 h (high 1⋅1 per cent, middle 1⋅9 per cent, low 3⋅4 per cent; P < 0⋅001), increasing to 5⋅4 per cent by 30 days (high 4⋅5 per cent, middle 6⋅0 per cent, low 8⋅6 per cent; P < 0⋅001). Of the 578 patients who died, 404 (69⋅9 per cent) did so between 24 h and 30 days following surgery (high 74⋅2 per cent, middle 68⋅8 per cent, low 60⋅5 per cent). After adjustment, 30-day mortality remained higher in middle-income (odds ratio (OR) 2⋅78, 95 per cent c.i. 1⋅84 to 4⋅20) and low-income (OR 2⋅97, 1⋅84 to 4⋅81) countries. Surgical safety checklist use was less frequent in low- and middle-income countries, but when used was associated with reduced mortality at 30 days. Conclusion: Mortality is three times higher in low- compared with high-HDI countries even when adjusted for prognostic factors. Patient safety factors may have an important role. Registration number: NCT02179112 (http://www.clinicaltrials.gov)

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone