Coupled wind-forced controls of the Bering–Chukchi shelf circulation and the Bering Strait throughflow: Ekman transport, continental shelf waves, and variations of the Pacific–Arctic sea surface height gradient

AbstractWe develop a conceptual model of the closely co-dependent Bering shelf, Bering Strait, and Chukchi shelf circulation fields by evaluating the effects of wind stress over the North Pacific and western Arctic using atmospheric reanalyses, current meter observations, satellite-based sea surface height (SSH) measurements, hydrographic profiles, and numerical model integrations. This conceptual model suggests Bering Strait transport anomalies are primarily set by the longitudinal location of the Aleutian Low, which drives oppositely signed anomalies at synoptic and annual time scales. Synoptic time scale variations in shelf currents result from local wind forcing and remotely generated continental shelf waves, whereas annual variations are driven by basin scale adjustments to wind stress that alter the magnitude of the along-strait (meridional) pressure gradient. In particular, we show that storms centered over the Bering Sea excite continental shelf waves on the eastern Bering shelf that carry northward velocity anomalies northward through Bering Strait and along the Chukchi coast. The integrated effect of these storms tends to decrease the northward Bering Strait transport at annual to decadal time scales by imposing cyclonic wind stress curl over the Aleutian Basin and the Western Subarctic Gyre. Ekman suction then increases the water column density through isopycnal uplift, thereby decreasing the dynamic height, sea surface height, and along-strait pressure gradient. Storms displaced eastward over the Gulf of Alaska generate an opposite set of Bering shelf and Aleutian Basin responses. While Ekman pumping controls Canada Basin dynamic heights (Proshutinsky et al., 2002), we do not find evidence for a strong relation between Beaufort Gyre sea surface height variations and the annually averaged Bering Strait throughflow. Over the western Chukchi and East Siberian seas easterly winds promote coastal divergence, which also increases the along-strait pressure head, as well as generates shelf waves that impinge upon Bering Strait from the northwest

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial

Background: Antiplatelet therapy reduces the risk of major vascular events for people with occlusive vascular disease, although it might increase the risk of intracranial haemorrhage. Patients surviving the commonest subtype of intracranial haemorrhage, intracerebral haemorrhage, are at risk of both haemorrhagic and occlusive vascular events, but whether antiplatelet therapy can be used safely is unclear. We aimed to estimate the relative and absolute effects of antiplatelet therapy on recurrent intracerebral haemorrhage and whether this risk might exceed any reduction of occlusive vascular events. Methods: The REstart or STop Antithrombotics Randomised Trial (RESTART) was a prospective, randomised, open-label, blinded endpoint, parallel-group trial at 122 hospitals in the UK. We recruited adults (≥18 years) who were taking antithrombotic (antiplatelet or anticoagulant) therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage, discontinued antithrombotic therapy, and survived for 24 h. Computerised randomisation incorporating minimisation allocated participants (1:1) to start or avoid antiplatelet therapy. We followed participants for the primary outcome (recurrent symptomatic intracerebral haemorrhage) for up to 5 years. We analysed data from all randomised participants using Cox proportional hazards regression, adjusted for minimisation covariates. This trial is registered with ISRCTN (number ISRCTN71907627). Findings: Between May 22, 2013, and May 31, 2018, 537 participants were recruited a median of 76 days (IQR 29–146) after intracerebral haemorrhage onset: 268 were assigned to start and 269 (one withdrew) to avoid antiplatelet therapy. Participants were followed for a median of 2·0 years (IQR [1·0– 3·0]; completeness 99·3%). 12 (4%) of 268 participants allocated to antiplatelet therapy had recurrence of intracerebral haemorrhage compared with 23 (9%) of 268 participants allocated to avoid antiplatelet therapy (adjusted hazard ratio 0·51 [95% CI 0·25–1·03]; p=0·060). 18 (7%) participants allocated to antiplatelet therapy experienced major haemorrhagic events compared with 25 (9%) participants allocated to avoid antiplatelet therapy (0·71 [0·39–1·30]; p=0·27), and 39 [15%] participants allocated to antiplatelet therapy had major occlusive vascular events compared with 38 [14%] allocated to avoid antiplatelet therapy (1·02 [0·65–1·60]; p=0·92). Interpretation: These results exclude all but a very modest increase in the risk of recurrent intracerebral haemorrhage with antiplatelet therapy for patients on antithrombotic therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage. The risk of recurrent intracerebral haemorrhage is probably too small to exceed the established benefits of antiplatelet therapy for secondary prevention

Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial

Background: Antiplatelet therapy reduces the risk of major vascular events for people with occlusive vascular disease, although it might increase the risk of intracranial haemorrhage. Patients surviving the commonest subtype of intracranial haemorrhage, intracerebral haemorrhage, are at risk of both haemorrhagic and occlusive vascular events, but whether antiplatelet therapy can be used safely is unclear. We aimed to estimate the relative and absolute effects of antiplatelet therapy on recurrent intracerebral haemorrhage and whether this risk might exceed any reduction of occlusive vascular events. Methods: The REstart or STop Antithrombotics Randomised Trial (RESTART) was a prospective, randomised, open-label, blinded endpoint, parallel-group trial at 122 hospitals in the UK. We recruited adults (≥18 years) who were taking antithrombotic (antiplatelet or anticoagulant) therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage, discontinued antithrombotic therapy, and survived for 24 h. Computerised randomisation incorporating minimisation allocated participants (1:1) to start or avoid antiplatelet therapy. We followed participants for the primary outcome (recurrent symptomatic intracerebral haemorrhage) for up to 5 years. We analysed data from all randomised participants using Cox proportional hazards regression, adjusted for minimisation covariates. This trial is registered with ISRCTN (number ISRCTN71907627). Findings: Between May 22, 2013, and May 31, 2018, 537 participants were recruited a median of 76 days (IQR 29–146) after intracerebral haemorrhage onset: 268 were assigned to start and 269 (one withdrew) to avoid antiplatelet therapy. Participants were followed for a median of 2·0 years (IQR [1·0– 3·0]; completeness 99·3%). 12 (4%) of 268 participants allocated to antiplatelet therapy had recurrence of intracerebral haemorrhage compared with 23 (9%) of 268 participants allocated to avoid antiplatelet therapy (adjusted hazard ratio 0·51 [95% CI 0·25–1·03]; p=0·060). 18 (7%) participants allocated to antiplatelet therapy experienced major haemorrhagic events compared with 25 (9%) participants allocated to avoid antiplatelet therapy (0·71 [0·39–1·30]; p=0·27), and 39 [15%] participants allocated to antiplatelet therapy had major occlusive vascular events compared with 38 [14%] allocated to avoid antiplatelet therapy (1·02 [0·65–1·60]; p=0·92). Interpretation: These results exclude all but a very modest increase in the risk of recurrent intracerebral haemorrhage with antiplatelet therapy for patients on antithrombotic therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage. The risk of recurrent intracerebral haemorrhage is probably too small to exceed the established benefits of antiplatelet therapy for secondary prevention

Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial

BACKGROUND: Antiplatelet therapy reduces the risk of major vascular events for people with occlusive vascular disease, although it might increase the risk of intracranial haemorrhage. Patients surviving the commonest subtype of intracranial haemorrhage, intracerebral haemorrhage, are at risk of both haemorrhagic and occlusive vascular events, but whether antiplatelet therapy can be used safely is unclear. We aimed to estimate the relative and absolute effects of antiplatelet therapy on recurrent intracerebral haemorrhage and whether this risk might exceed any reduction of occlusive vascular events. METHODS: The REstart or STop Antithrombotics Randomised Trial (RESTART) was a prospective, randomised, open-label, blinded endpoint, parallel-group trial at 122 hospitals in the UK. We recruited adults (≥18 years) who were taking antithrombotic (antiplatelet or anticoagulant) therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage, discontinued antithrombotic therapy, and survived for 24 h. Computerised randomisation incorporating minimisation allocated participants (1:1) to start or avoid antiplatelet therapy. We followed participants for the primary outcome (recurrent symptomatic intracerebral haemorrhage) for up to 5 years. We analysed data from all randomised participants using Cox proportional hazards regression, adjusted for minimisation covariates. This trial is registered with ISRCTN (number ISRCTN71907627). FINDINGS: Between May 22, 2013, and May 31, 2018, 537 participants were recruited a median of 76 days (IQR 29-146) after intracerebral haemorrhage onset: 268 were assigned to start and 269 (one withdrew) to avoid antiplatelet therapy. Participants were followed for a median of 2·0 years (IQR [1·0- 3·0]; completeness 99·3%). 12 (4%) of 268 participants allocated to antiplatelet therapy had recurrence of intracerebral haemorrhage compared with 23 (9%) of 268 participants allocated to avoid antiplatelet therapy (adjusted hazard ratio 0·51 [95% CI 0·25-1·03]; p=0·060). 18 (7%) participants allocated to antiplatelet therapy experienced major haemorrhagic events compared with 25 (9%) participants allocated to avoid antiplatelet therapy (0·71 [0·39-1·30]; p=0·27), and 39 [15%] participants allocated to antiplatelet therapy had major occlusive vascular events compared with 38 [14%] allocated to avoid antiplatelet therapy (1·02 [0·65-1·60]; p=0·92). INTERPRETATION: These results exclude all but a very modest increase in the risk of recurrent intracerebral haemorrhage with antiplatelet therapy for patients on antithrombotic therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage. The risk of recurrent intracerebral haemorrhage is probably too small to exceed the established benefits of antiplatelet therapy for secondary prevention. FUNDING: British Heart Foundation

More Than Marine Heatwaves: A New Regime of Heat, Acidity, and Low Oxygen Compound Extreme Events in the Gulf of Alaska

Abstract Recent marine heatwaves in the Gulf of Alaska have had devastating impacts on species from various trophic levels. Due to climate change, total heat exposure in the upper ocean has become longer, more intense, more frequent, and more likely to happen at the same time as other environmental extremes. The combination of multiple environmental extremes can exacerbate the response of sensitive marine organisms. Our hindcast simulation provides the first indication that more than 20% of the bottom water of the Gulf of Alaska continental shelf was exposed to quadruple heat, positive hydrogen ion concentration [H+], negative aragonite saturation state (Ωarag), and negative oxygen concentration [O2] compound extreme events during the 2018–2020 marine heat wave. Natural intrusion of deep and acidified water combined with the marine heat wave triggered the first occurrence of these events in 2019. During the 2013–2016 marine heat wave, surface waters were already exposed to widespread marine heat and positive [H+] compound extreme events due to the temperature effect on the [H+]. We introduce a new Gulf of Alaska Downwelling Index (GOADI) with short‐term predictive skill, which can serve as indicator of past and near‐future positive [H+], negative Ωarag, and negative [O2] compound extreme events near the shelf seafloor. Our results suggest that the marine heat waves may have not been the sole environmental stressor that led to the observed ecosystem impacts and warrant a closer look at existing in situ inorganic carbon and other environmental data in combination with biological observations and model output

Modelled connectivity between Walleye Pollock (Gadus chalcogrammus) spawning and age-0 nursery areas in warm and cold years with implications for juvenile survival

Abstract Adult and early life stage distributions of the commercially important demersal fish Walleye Pollock (Gadus chalcogrammus) have varied in relation to the warm and cold environmental conditions on the eastern Bering Sea (EBS) shelf. Previous modelling studies indicate that transport alone does not account for the disparate juvenile distributions in warm and cold years, but that spawning locations are important. Our objective was to determine the potential connectivity of EBS pollock spawning areas with juvenile nursery areas between warm and cold years from an 18-year hindcast (1995–2012). We calculated the connectivity between larval sources and juvenile positions that were produced by a coupled biological-physical individual-based model that simulated transport, growth, and vertical behavior of pollock from the egg until the juvenile stage. Three connectivity patterns were seen in most simulations: along-isobaths to the northwest, self-retention, and transport around the Pribilof Islands. The major differences in connectivity between warm and cold years, more northwards in warm years and more off-shelf in cold years, mimicked wind-driven flow characteristics of those years that were related to winter mean zonal position of the Aleutian Low. Connectivity relationships were more sensitive to spatial alterations in the spawning areas in cold years, while they were more responsive to spawn timing shifts in warm years. The strongest connectivity to advantageous juvenile habitats originated in the well-known spawning areas, but also in a less well-studied region on the Outer Shelf. This northern Outer Shelf region emerged as a very large sink of pollock reaching the juvenile transition from all spawning sources, suggesting more thorough sampling across multiple trophic levels of this potentially important juvenile pollock nursery is needed