Revisiting the 26.5°C Sea Surface Temperature Threshold for Tropical Cyclone Development

Abstract A high sea surface temperature is generally accepted to be one of the necessary ingredients for tropical cyclone development, indicative of the potential for surface heat and moisture fluxes capable of fueling a self-sustaining circulation. Although the minimum 26.5°C threshold for tropical cyclogenesis has become a mainstay in research and education, the fact that a nonnegligible fraction of storm formation events (about 5%) occur over cooler waters casts some doubt on the robustness of this estimate. Tropical cyclogenesis over subthreshold sea surface temperatures is associated with low tropopause heights, indicative of the presence of a cold trough aloft. To focus on this type of development environment, the applicability of the 26.5°C threshold is investigated for tropical transitions from baroclinic precursor disturbances in all basins between 1989 and 2013. Although the threshold performs well in the majority of cases without appreciable environmental baroclinicity, the potential for development is underestimated by up to 27% for systems undergoing tropical transition. An alternative criterion of a maximum 22.5°C difference between the tropopause-level and 850-hPa equivalent potential temperatures (defined as the coupling index) is proposed for this class of development. When combined with the standard 26.5°C sea surface temperature threshold for precursor-free environments, error rates are reduced to 3%–6% for all development types. The addition of this physically relevant representation of the deep-tropospheric state to the ingredients-based conceptual model for tropical cyclogenesis improves the representation of the important tropical transition-based subset of development events.</jats:p

A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). CAPRIE Steering Committee

Many clinical trials have evaluated the benefit of long-term use of antiplatelet drugs in reducing the risk of clinical thrombotic events. Aspirin and ticlopidine have been shown to be effective, but both have potentially serious adverse effects. Clopidogrel, a new thienopyridine derivative similar to ticlopidine, is an inhibitor of platelet aggregation induced by adenosine diphosphate. METHODS: CAPRIE was a randomised, blinded, international trial designed to assess the relative efficacy of clopidogrel (75 mg once daily) and aspirin (325 mg once daily) in reducing the risk of a composite outcome cluster of ischaemic stroke, myocardial infarction, or vascular death; their relative safety was also assessed. The population studied comprised subgroups of patients with atherosclerotic vascular disease manifested as either recent ischaemic stroke, recent myocardial infarction, or symptomatic peripheral arterial disease. Patients were followed for 1 to 3 years. FINDINGS: 19,185 patients, with more than 6300 in each of the clinical subgroups, were recruited over 3 years, with a mean follow-up of 1.91 years. There were 1960 first events included in the outcome cluster on which an intention-to-treat analysis showed that patients treated with clopidogrel had an annual 5.32% risk of ischaemic stroke, myocardial infarction, or vascular death compared with 5.83% with aspirin. These rates reflect a statistically significant (p = 0.043) relative-risk reduction of 8.7% in favour of clopidogrel (95% Cl 0.3-16.5). Corresponding on-treatment analysis yielded a relative-risk reduction of 9.4%. There were no major differences in terms of safety. Reported adverse experiences in the clopidogrel and aspirin groups judged to be severe included rash (0.26% vs 0.10%), diarrhoea (0.23% vs 0.11%), upper gastrointestinal discomfort (0.97% vs 1.22%), intracranial haemorrhage (0.33% vs 0.47%), and gastrointestinal haemorrhage (0.52% vs 0.72%), respectively. There were ten (0.10%) patients in the clopidogrel group with significant reductions in neutrophils (< 1.2 x 10(9)/L) and 16 (0.17%) in the aspirin group. INTERPRETATION: Long-term administration of clopidogrel to patients with atherosclerotic vascular disease is more effective than aspirin in reducing the combined risk of ischaemic stroke, myocardial infarction, or vascular death. The overall safety profile of clopidogrel is at least as good as that of medium-dose aspirin