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

Oceanic Routing of Wind-Sourced Energy Along the Arctic Continental Shelves

Data from coastal tide gauges, oceanographic moorings, and a numerical model show that Arctic storm surges force continental shelf waves (CSWs) that dynamically link the circumpolar Arctic continental shelf system. These trains of barotropic disturbances result from coastal convergences driven by cross-shelf Ekman transport. Observed propagation speeds of 600−3000 km day–1, periods of 2−6 days, wavelengths of 2000−7000 km, and elevation maxima near the coast but velocity maxima near the upper slope are all consistent with theoretical CSW characteristics. Other, more isolated events are tied to local responses to propagating storm systems. Energy and phase propagation is from west to east: ocean elevation anomalies in the Laptev Sea follow Kara Sea anomalies by one day and precede Chukchi and Beaufort Sea anomalies by 4−6 days. Some leakage and dissipation occurs. About half of the eastward-propagating energy in the Kara Sea passes Severnaya Zemlya into the Laptev Sea. About half of the eastward-propagating energy from the East Siberian Sea passes southward through Bering Strait, while one quarter is dissipated locally in the Chukchi Sea and another quarter passes eastward into the Beaufort Sea. Likewise, CSW generation in the Bering Sea can trigger elevation and current speed anomalies downstream in the Northeast Chukchi Sea of 25 cm and 20 cm s–1, respectively. Although each event is ephemeral, the large number of CSWs generated annually suggest that they represent a non-negligible source of time-averaged energy transport and bottom stress-induced dissipative mixing, particularly near the outer shelf and upper slope. Coastal water level and landfast ice breakout event forecasts should include CSW effects and associated lag times from distant upstream winds

Global, regional, and national burden of traumatic brain injury and spinal cord injury, 1990-2016 : a systematic analysis for the Global Burden of Disease Study 2016

Background Traumatic brain injury (TBI) and spinal cord injury (SCI) are increasingly recognised as global health priorities in view of the preventability of most injuries and the complex and expensive medical care they necessitate. We aimed to measure the incidence, prevalence, and years of life lived with disability (YLDs) for TBI and SCI from all causes of injury in every country, to describe how these measures have changed between 1990 and 2016, and to estimate the proportion of TBI and SCI cases caused by different types of injury. Methods We used results from the Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study 2016 to measure the global, regional, and national burden of TBI and SCI by age and sex. We measured the incidence and prevalence of all causes of injury requiring medical care in inpatient and outpatient records, literature studies, and survey data. By use of clinical record data, we estimated the proportion of each cause of injury that required medical care that would result in TBI or SCI being considered as the nature of injury. We used literature studies to establish standardised mortality ratios and applied differential equations to convert incidence to prevalence of long-term disability. Finally, we applied GBD disability weights to calculate YLDs. We used a Bayesian meta-regression tool for epidemiological modelling, used cause-specific mortality rates for non-fatal estimation, and adjusted our results for disability experienced with comorbid conditions. We also analysed results on the basis of the Socio-demographic Index, a compound measure of income per capita, education, and fertility. Findings In 2016, there were 27.08 million (95% uncertainty interval [UI] 24.30-30.30 million) new cases of TBI and 0.93 million (0.78-1.16 million) new cases of SCI, with age-standardised incidence rates of 369 (331-412) per 100 000 population for TBI and 13 (11-16) per 100 000 for SCI. In 2016, the number of prevalent cases of TBI was 55.50 million (53.40-57.62 million) and of SCI was 27.04 million (24 .98-30 .15 million). From 1990 to 2016, the age-standardised prevalence of TBI increased by 8.4% (95% UI 7.7 to 9.2), whereas that of SCI did not change significantly (-0.2% [-2.1 to 2.7]). Age-standardised incidence rates increased by 3.6% (1.8 to 5.5) for TBI, but did not change significantly for SCI (-3.6% [-7.4 to 4.0]). TBI caused 8.1 million (95% UI 6. 0-10. 4 million) YLDs and SCI caused 9.5 million (6.7-12.4 million) YLDs in 2016, corresponding to age-standardised rates of 111 (82-141) per 100 000 for TBI and 130 (90-170) per 100 000 for SCI. Falls and road injuries were the leading causes of new cases of TBI and SCI in most regions. Interpretation TBI and SCI constitute a considerable portion of the global injury burden and are caused primarily by falls and road injuries. The increase in incidence of TBI over time might continue in view of increases in population density, population ageing, and increasing use of motor vehicles, motorcycles, and bicycles. The number of individuals living with SCI is expected to increase in view of population growth, which is concerning because of the specialised care that people with SCI can require. Our study was limited by data sparsity in some regions, and it will be important to invest greater resources in collection of data for TBI and SCI to improve the accuracy of future assessments. Copyright (C) 2018 The Author(s). Published by Elsevier Ltd.Peer reviewe

Symptoms and concerns among children and young people with life limiting and life-threatening conditions: A systematic review highlighting meaningful health outcomes

Background: The design and provision of quality pediatric palliative care should prioritize issues that matter to children and their families for optimal outcomes. Objective: This review aims to identify symptoms, concerns and outcomes that matter to children and young people (“young people”) with terminal illnesses and their families. Findings from the systematic review will inform the development of a relevant framework of health outcomes. Method: This is a systematic literature review across multiple databases for identification of eligible primary evidence. Data sources included PsycINFO, MEDLINE, Embase, CINAHL, OpenGrey, and Science Direct Journals, searched from 1 August 2016 to 30 July 2017. The study also incorporates consultations with experts in the field, citation searches via Scopus, and a hand search of reference lists of included studies. Results: Of the 13,567 articles that were evaluated, 81 studies were included. Most of these studies (n = 68) were from high-income countries and foused on young people with cancer (n = 58). A total of 3236 young people, 2103 family carers, 108 families, and 901 healthcare providers were included in the studies. Young people did not contribute to data in 30% of studies. Themes on priority concerns are presented by the following domains and health outcomes: (1) physical (n = 62 studies), e.g., physical symptoms; (2) psychological (n = 65), e.g., worry; (3) psychosocial (n = 31), e.g., relationships; (4) existential (n = 37), e.g., existential loss; and (5) “other” (n = 39), e.g., information access. Conclusion: Burdensome symptoms and concerns affect young people with malignant and nonmalignant conditions and occur across the disease trajectory; pediatric palliative care should not be limited to the end-of-life phase. A child–family-centered framework of health outcomes, spanning the patient, family, and quality of service levels is proposed to inform service development. Future research should address gaps identified across the literature (i.e., the involvement of young people in research, evidence for developing countries, and a focus on nonmalignant conditions