Late Quaternary multi-genetic processes and products on the northern Gulf of Cadiz upper continental slope (SW Iberian Peninsula)

On continental margins, the upper slope to shelf break environment forms a critical region where sediment supply, hydrographic activity and gravitational processes determine how and when sediments are partitioned between the shallow- and deep-marine realm. On the SW Iberian margin, relatively few studies have addressed the dynamics of this region, although it holds key information regarding the link between the sedimentary evolution of the continental shelf and the contourite depositional system on the middle slope. This work therefore presents a high-resolution analysis of the morphological and stratigraphic expressions of late Quaternary (dominantly last glacial and present-day interglacial) sedimentary processes on the upper slope and shelf margin sector between 7° and 7°30’ W. The integration of seismic, bathymetric and hydrographic data reveals the presence of alongslope processes and products (a bottom current-related plastered drift, moat, erosional surface and terrace, an internal wave-/tide-controlled sediment wave field), downslope (gravitational) processes and products (an upper slope – shelf margin valley system, slumps, debrites, gullies), neotectonic elements (diapirs) and fluid flow features (pockmarks, bright spots). The spatial distribution of these features indicates that the study area becomes increasingly alongslope-dominated towards the W, and oppositely, more downslope-dominated towards the E, because sediment supply to the latter area is enhanced under the dominant eastward dispersal of fluvially supplied sediments on the shelf. In addition, glacial-interglacial variations in the amount of sediments supplied to the shelf edge and the intensity of oceanographic processes in the study area also generate a distinct temporal variability, with glacial and interglacial intervals respectively recording principally downslope- and alongslope-controlled morphological elements. Finally, regardless of these overall spatial and temporal patterns, diapirism and fluid flow are inferred to locally destabilize sediments and induce small-scale mass wasting in the study area. These findings are not only relevant to the northern Gulf of Cadiz, but also to the general understanding of sedimentary dynamics and controls in mixed downslope- and alongslope-controlled upper slope to shelf margin settings worldwide.T. Mestdagh is funded through a doctoral scholarship of the Ghent University Special Research Fund (BOF). We would like to thank the captains, crews and scientists involved in research campaigns COMIC 2013 on board of RV Belgica and LASEA 2013 on board of RV Ramón Margalef. Ship time on RV Belgica was provided by BELSPO and RBINS-OD Nature. This research was performed in collaboration with ”The Drifters” Research Group of the Royal Holloway University of London (UK), and is associated to projects CTM 2012-39599-C03 , CGL2016-80445-R ‘SCORE’ ( AEI/FEDER , UE), CTM2016-75129-C3-1-R , CGL2011-30302-C02-02 and CTM2017-88237-P . Editor Michele Rebesco and two anonymous reviewers are kindly acknowledged for providing constructive feedback

Non-invasive ventilation in obesity hypoventilation syndrome without severe obstructive sleep apnoea.

Non-invasive ventilation (NIV) is an effective form of treatment in patients with obesity hypoventilation syndrome (OHS) who have concomitant severe obstructive sleep apnoea (OSA). However, there is a paucity of evidence on the efficacy of NIV in patients with OHS without severe OSA. We performed a multicentre randomised clinical trial to determine the comparative efficacy of NIV versus lifestyle modification (control group) using daytime arterial carbon dioxide tension (PaCO2) as the main outcome measure. Between May 2009 and December 2014 we sequentially screened patients with OHS without severe OSA. Participants were randomised to NIV versus lifestyle modification and were followed for 2 months. Arterial blood gas parameters, clinical symptoms, health-related quality of life assessments, polysomnography, spirometry, 6-min walk distance test, blood pressure measurements and healthcare resource utilisation were evaluated. Statistical analysis was performed using intention-to-treat analysis. A total of 365 patients were screened of whom 58 were excluded. Severe OSA was present in 221 and the remaining 86 patients without severe OSA were randomised. NIV led to a significantly larger improvement in PaCO2 of -6 (95% CI -7.7 to -4.2) mm Hg versus -2.8 (95% CI -4.3 to -1.3) mm Hg, (p NIV is more effective than lifestyle modification in improving daytime PaCO2, sleepiness and polysomnographic parameters. Long-term prospective studies are necessary to determine whether NIV reduces healthcare resource utilisation, cardiovascular events and mortality. NCT01405976; results