Impact of ENSO longitudinal position on teleconnections to the NAO

While significant improvements have been made in understanding how the El Niño–Southern Oscillation (ENSO) impacts both North American and Asian climate, its relationship with the North Atlantic Oscillation (NAO) remains less clear. Observations indicate that ENSO exhibits a highly complex relationship with the NAO-associated atmospheric circulation. One critical contribution to this ambiguous ENSO/NAO relationship originates from ENSO’s diversity in its spatial structure. In general, both eastern (EP) and central Pacific (CP) El Niño events tend to be accompanied by a negative NAO-like atmospheric response. However, for two different types of La Niña the NAO response is almost opposite. Thus, the NAO responses for the CP ENSO are mostly linear, while nonlinear NAO responses dominate for the EP ENSO. These contrasting extra-tropical atmospheric responses are mainly attributed to nonlinear air-sea interactions in the tropical eastern Pacific. The local atmospheric response to the CP ENSO sea surface temperature (SST) anomalies is highly linear since the air-sea action center is located within the Pacific warm pool, characterized by relatively high climatological SSTs. In contrast, the EP ENSO SST anomalies are located in an area of relatively low climatological SSTs in the eastern equatorial Pacific. Here only sufficiently high positive SST anomalies during EP El Niño events are able to overcome the SST threshold for deep convection, while hardly any anomalous convection is associated with EP La Niña SSTs that are below this threshold. This ENSO/NAO relationship has important implications for NAO seasonal prediction and places a higher requirement on models in reproducing the full diversity of ENSO

A Prospective Study of Reasons for Prolonged Hospitalizations on a General Medicine Teaching Service

BACKGROUND: Delays in the care of hospitalized patients may lead to increased length of stay, iatrogenic complications, and costs. No study has characterized delays among general medicine inpatients in the current prospective payment era of care. OBJECTIVE: To quantify and characterize delays in care which prolong hospitalizations for general medicine inpatients. DESIGN: Prospective survey of senior residents. SETTING: Urban tertiary care university-affiliated teaching hospital. PARTICIPANTS: Sixteen senior residents were surveyed regarding 2,831 patient-days. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Data were collected on 97.6% (2,762) of patient-days eligible for evaluation. Three hundred seventy-three patient-days (13.5% of all hospital days) were judged unnecessary for acute inpatient care, and occurred because of delays in needed services. Sixty-three percent of these unnecessary days were due to nonmedical service delays and 37% were due to medical service delays. The vast majority of nonmedical service delays (84%) were due to difficulty finding a bed in a skilled nursing facility. Medical service delays were most often due to postponement of procedures (54%) and diagnostic test performance (21%) or interpretation (10%), and were significantly more common on weekend days (relative risk [RR], 1.49; P=.02). Indeed, nearly one fourth of unnecessary patient-days (24% overall, 88 patient-days) involved an inability to access medical services on a weekend day (Saturday or Sunday). CONCLUSIONS: At our institution, a substantial number of hospital days were judged unnecessary for acute inpatient care and were attributable to delays in medical and nonmedical services. Future work is needed to develop and investigate measures to decrease delays

Barrett's esophagus complicating scleroderma

Two patients with scleroderma whose esophageal involvement was associated with longstanding reflux esophagitis were found to also have Barrett's esophagus. Since Barrett's esophagus is a premalignant condition, these patients with scleroderma should be considered at high risk for the development of adenocarcinoma of the esophagus.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/48122/1/261_2005_Article_BF01893122.pd

Interannual extremes in the rate of rise of atmospheric carbon dioxide since 1980

Observations of atmospheric CO2 concentrations at Mauna Loa, Hawaii, and at the South Pole over the past four decades show an approximate proportionality between the rising atmospheric concentrations and industrial CO2 emissions. This proportionality, which is most apparent during the first 20 years of the records, was disturbed in the 1980s by a disproportionately high rate of rise of atmospheric CO2, followed after 1988 by a pronounced slowing down of the growth rate. To probe the causes of these changes, we examine here the changes expected from the variations in the rates of industrial CO2 emissions over this time, and also from influences of climate such as El Niño events. We use the 13C/12C ratio of atmospheric CO2 to distinguish the effects of interannual variations in biospheric and oceanic sources and sinks of carbon. We propose that the recent disproportionate rise and fall in CO2 growth rate were caused mainly by interannual variations in global air temperature (which altered both the terrestrial biospheric and the oceanic carbon sinks), and possibly also by precipitation. We suggest that the anomalous climate-induced rise in CO2 was partially masked by a slowing down in the growth rate of fossil-fuel combustion, and that the latter then exaggerated the subsequent climate-induced fall.