Measurements of wind-wave growth and swell decay during the joint North Sea wave project (JONSWAP).

Wavo spectra were measured along a profile extending 160 km into the North Sea westward from Sylt for a period of ten weeks in 1969. Currents, tides, air-sea temperature differences and turbulence in the atmospheric boundary layer were also measured. the goal of the experiment (described in Part 1) was to determine the structure of the source function governing the energy balance of the wave spectrum, with particular emphasis on wave growth under stationary offshore wind conditions (Part 2) and the attention of swell in water of finito depth (Part 3). The source functions of wave spectra generated by offshore winds exhibit a characteristic plus-minus signature associated with the shift of the sharp spectral peak towards lower frequencies. The two-lobed distribution of the source function can be explained quantitively by the nonlinear transfer due to resonant wave-wave interactions (second order Bragg scattering). The evolution of a pronounced peak and its shift towards lower frequencies can also be understood as a self-stabilizing feature of this process. The decay rates determined for incoming swell varied considerably, but energy attenuation factors of two along the length of the profile were typical. This is in order of magnitude agreement with expected damping rates due to bottom friction. However, the strong tidal modulation predicted by theory for the case of a quadratic bottom friction law was not observed. Adverse winds did not affect the decay rate. Computations also rule out wave-wave interactions or dissipation due to turbulence outside the bottom boundary layer as effective mechanisms of swell attenuation. We conclude that either the generally accepted friction law needs to be significantly modified or that some other mechanism, such as scattering by bottom irregularities, is the cause of the attenuation. The dispersion characteristics of thw swells indicated rather nearby origins, for which the classical DELTA-event model was generally inapplicable. A strong Doppler modulation by tidal currents was also observed. (A

Can medical therapy mimic the clinical efficacy or physiological effects of bariatric surgery?

The number of bariatric surgical procedures performed has increased dramatically. This review discusses the clinical and physiological changes, and in particular, the mechanisms behind weight loss and glycaemic improvements, observed following the gastric bypass, sleeve gastrectomy and gastric banding bariatric procedures. The review then examines how close we are to mimicking the clinical or physiological effects of surgery through less invasive and safer modern interventions that are currently available for clinical use. These include dietary interventions, orlistat, lorcaserin, phentermine/topiramate, glucagon-like peptide-1 receptor agonists, dipeptidyl peptidase-4 inhibitors, pramlintide, dapagliflozin, the duodenal–jejunal bypass liner, gastric pacemakers and gastric balloons. We conclude that, based on the most recent trials, we cannot fully mimic the clinical or physiological effects of surgery; however, we are getting closer. A ‘medical bypass' may not be as far in the future as we previously thought, as the physician's armamentarium against obesity and type 2 diabetes has recently got stronger through the use of specific dietary modifications, novel medical devices and pharmacotherapy. Novel therapeutic targets include not only appetite but also taste/food preferences, energy expenditure, gut microbiota, bile acid signalling, inflammation, preservation of β-cell function and hepatic glucose output, among others. Although there are no magic bullets, an integrated multimodal approach may yield success. Non-surgical interventions that mimic the metabolic benefits of bariatric surgery, with a reduced morbidity and mortality burden, remain tenable alternatives for patients and health-care professionals

Increased postprandial energy expenditure may explain superior long term weight loss after Roux-en-Y gastric bypass compared to vertical banded gastroplasty

BACKGROUND AND AIMS: Gastric bypass results in greater weight loss than Vertical banded gastroplasty (VBG), but the underlying mechanisms remain unclear. In addition to effects on energy intake the two bariatric techniques may differentially influence energy expenditure (EE). Gastric bypass in rats increases postprandial EE enough to result in elevated EE over 24 hours. This study aimed to investigate alterations in postprandial EE after gastric bypass and VBG in humans. METHODS: Fourteen women from a randomized clinical trial between gastric bypass (n = 7) and VBG (n = 7) were included. Nine years postoperatively and at weight stability patients were assessed for body composition and calorie intake. EE was measured using indirect calorimetry in a respiratory chamber over 24 hours and focused on the periods surrounding meals and sleep. Blood samples were analysed for postprandial gut hormone responses. RESULTS: Groups did not differ regarding body composition or food intake either preoperatively or at study visit. Gastric bypass patients had higher EE postprandially (p = 0.018) and over 24 hours (p = 0.048) compared to VBG patients. Postprandial peptide YY (PYY) and glucagon like peptide 1 (GLP-1) levels were higher after gastric bypass (both p<0.001). CONCLUSIONS: Gastric bypass patients have greater meal induced EE and total 24 hours EE compared to VBG patients when assessed 9 years postoperatively. Postprandial satiety gut hormone responses were exaggerated after gastric bypass compared to VBG. Long-term weight loss maintenance may require significant changes in several physiological mechanisms which will be important to understand if non-surgical approaches are to mimic the effects of bariatric surgery

Bone mineral density and expression of vitamin D receptor-dependent calcium uptake mechanisms in the proximal small intestine after bariatric surgery

BACKGROUND Roux-en-Y gastric bypass may lead to impaired calcium uptake. Therefore, operation-specific effects of gastric bypass and vertical banded gastroplasty on bone mineral density (BMD) were examined in a randomized clinical trial. Bone resorption markers and mechanisms of decreased calcium uptake after gastric bypass were investigated using blood and endoscopic samples from two additional patient cohorts. METHODS Total BMD and non-weight-bearing skull BMD were measured by dual-energy X-ray absorptiometry at baseline, and 1 and 6 years after gastric bypass or vertical banded gastroplasty in patients who were not receiving calcium supplements. Bone resorption markers in serum and calcium uptake mechanisms in jejunal mucosa biopsies were analysed after gastric bypass by proteomics including radioimmunoassay, gel electrophoresis and mass spectrometry. RESULTS One year after surgery, weight loss was similar after gastric bypass and vertical banded gastroplasty. There was a moderate decrease in skull BMD after gastric bypass, but not after vertical banded gastroplasty (P < 0•001). Between 1 and 6 years after gastric bypass, skull BMD and total BMD continued to decrease (P = 0•001). C-terminal telopeptide levels in serum had increased twofold by 18 months after gastric bypass. Proteomic analysis of the jejunal mucosa revealed decreased levels of heat-shock protein 90β, a co-activator of the vitamin D receptor, after gastric bypass. Despite increased vitamin D receptor levels, expression of the vitamin D receptor-regulated calcium transporter protein TRPV6 decreased. CONCLUSION BMD decreases independently of weight after gastric bypass. Bone loss might be attributed to impaired calcium absorption caused by decreased activation of vitamin D-dependent calcium absorption mechanisms mediated by heat-shock protein 90β and TRPV6

The leaky funnel model revisited

A former publication proposed an idealised view of the global ocean ventilation consisting in a flow through a porous pipe with decreasing section (a leaky funnel). The agreement between the domain-averaged ages as obtained with a coarse-grid 3-D ocean general circulation model (OGCM) and the leaky funnel is excellent. Further, the latter allows to infer characteristic scales, which are consistent with the current knowledge of the ocean ventilation. However, the method, based on numerical experiments in which the circulation fields of the OGCM were artificially modified, is questionable. Here, we revisit the leaky funnel and base our study on the global water age distribution &#x3C6;(&#x3C4;), where &#x3C6;(&#x3C4;)&#x394;&#x3C4; is the ocean volume fraction with age in the interval [&#x3C4;,&#x3C4;+&#x394;&#x3C4;]. The steady-state analytical solution for this distribution is shown to be in excellent agreement with numerical results from two coarse grid OGCMs: an outcome that helps strengthening the leaky funnel representation. The asymptotic analysis of &#x3C6;(&#x3C4;) suggests that, for large ages, water parcels have the same life expectancy, whatever their age. Further, the leaky funnel provides bulk characteristics of the circulation in OGCMs, which may serve as metrics in model intercomparison studies