Coupling of eastern and western subpolar North Atlantic: salt transport in the Irminger Current

Salt transport in the Irminger Current and thus the coupling between eastern and western subpolar North Atlantic plays an important role for climate variability across a wide range of time scales. High-resolution ocean modeling and observations indicate that 5 salinities in the eastern subpolar North Atlantic decrease with enhanced circulation of the North Atlantic subpolar gyre (SPG). This has led to the perception that a stronger SPG also transports less salt westward. In this study, we analyze a regional ocean model and a comprehensive global coupled climate model, and show that a stronger SPG transports more salt in the Irminger Current irrespective of lower salinities in its 10 source region. The additional salt converges in the Labrador Sea and the Irminger Basin by eddy transports, increases surface salinity in the western SPG, and favors more intense deep convection. This is part of a positive feedback mechanism with potentially large implications for climate variability and predictability

Whole-Genome Sequencing to Detect Numerous Campylobacter jejuni Outbreaks and Match Patient Isolates to Sources, Denmark, 2015-2017

Whole-Genome Sequencing to Detect Numerous Campylobacter jejuni Outbreaks and Match Patient Isolates to Sources, Denmark, 2015–2017 Scientific publication financially supported by ORION/One Health European Joint Programme (grant agreement nos. 773830)

Use of the prognostic biomarker suPAR in the emergency department improves risk stratification but has no effect on mortality:a cluster-randomized clinical trial (TRIAGE III)

Abstract Background Risk stratification of patients in the emergency department can be strengthened using prognostic biomarkers, but the impact on patient prognosis is unknown. The aim of the TRIAGE III trial was to investigate whether the introduction of the prognostic and nonspecific biomarker: soluble urokinase plasminogen activator receptor (suPAR) for risk stratification in the emergency department reduces mortality in acutely admitted patients. Methods The TRIAGE III trial was a cluster-randomized interventional trial conducted at emergency departments in the Capitol Region of Denmark. Eligible hospitals were required to have an emergency department with an intake of acute medical and surgical patients and no previous access to suPAR measurement. Three emergency departments were randomized; one withdrew shortly after the trial began. The inclusion period was from January through June of 2016 consisting of twelve cluster-periods of 3-weeks alternating between intervention and control and a subsequent follow-up of ten months. Patients were allocated to the intervention if they arrived in interventional periods, where suPAR measurement was routinely analysed at arrival. In the control periods suPAR measurement was not performed. The main outcome was all-cause mortality 10 months after arrival of the last patient in the inclusion period. Secondary outcomes included 30-day mortality. Results The trial enrolled a consecutive cohort of 16,801 acutely admitted patients; all were included in the analyses. The intervention group consisted of 6 cluster periods with 8900 patients and the control group consisted of 6 cluster periods with 7901 patients. After a median follow-up of 362 days, death occurred in 1241 patients (13.9%) in the intervention group and in 1126 patients (14.3%) in the control group. The weighted Cox model found a hazard ratio of 0.97 (95% confidence interval, 0.89 to 1.07; p = 0.57). Analysis of all subgroups and of 30-day all-cause mortality showed similar results. Conclusions The TRIAGE III trial found no effect of introducing the nonspecific and prognostic biomarker suPAR in emergency departments on short- or long-term all-cause mortality among acutely admitted patients. Further research is required to evaluate how prognostic biomarkers can be implemented in routine clinical practice. Trial registration clinicaltrials.gov, NCT02643459. Registered 31 December 2015

Transport of salt and freshwater in the Atlantic Subpolar Gyre

Transport of salt in the Irminger Current, the northern branch of the Atlantic Subpolar Gyre coupling the eastern and western subpolar North Atlantic, plays an important role for climate variability across a wide range of time scales. High-resolution ocean modeling and observations indicate that salinities in the eastern subpolar North Atlantic decrease with enhanced circulation of the North Atlantic subpolar gyre (SPG). This has led to the perception that a stronger SPG also transports less salt westward. In this study, we analyze a regional ocean model and a comprehensive global coupled climate model, and show that a stronger SPG transports more salt in the Irminger Current irrespective of lower salinities in its source region. The additional salt converges in the Labrador Sea and the Irminger Basin by eddy transports, increases surface salinity in the western SPG, and favors more intense deep convection. This is part of a positive feedback mechanism with potentially large implications for climate variability and predictability

Introduction of a prognostic biomarker to strengthen risk stratification of acutely admitted patients:rationale and design of the TRIAGE III cluster randomized interventional trial

BACKGROUND: Several biomarkers have shown to carry prognostic value beyond current triage algorithms and may aid in initial risk stratification of patients in the emergency department (ED). It has yet to be established if information provided by biomarkers can be used to prevent serious complications or deaths. Our aim is to determine whether measurement of the blood level of the biomarker soluble urokinase plasminogen activator receptor (suPAR) can enhance early risk stratification leading to reduced mortality, lower rate of complications, and improved patient flow in acutely admitted adult patients at the ED. The main hypothesis is that the availability of suPAR can reduce all-cause mortality, assessed at least 10 months after admission, by drawing attention towards patients with an unrecognized high risk, leading to improved diagnostics and treatment. METHODS: The study is designed as a cross-over cluster randomized interventional trial. SuPAR is measured within 2 h after admission and immediately reported to the treating physicians in the ED. All ED physicians are educated in the prognostic capabilities of suPAR prior to the inclusion period. The inclusion period began January 11(th) 2016 and ends June 6(th) 2016. The study aims to include 10.000 patients in both the interventional and control arm. The results will be presented in 2017. DISCUSSION: The present article aims to describe the design and rationale of the TRIAGE III study that will investigate whether the availability of prognostic information can improve outcome in acutely admitted patients. This might have an impact on health care organization and decision-making. TRIAL REGISTRATION: The trial is registered at clinicaltrials.gov (ID NCT02643459, November 13, 2015) and at the Danish Data Protection agency (ID HGH-2015-042 I-Suite no. 04087)

Buoyancy forcing: A key driver for northern North Atlantic SST variability across multiple time scales

Analyses of observational data (from year 1870 AD) show that sea surface temperature (SST) anomalies along the pathway of Atlantic Water transport in the North Atlantic, the Norwegian Sea and the Iceland Sea are spatially coherent at multidecadal timescales. Spatially coherent SST anomalies are also observed over hundreds of thousands of years during parts of the Pliocene (5.23–5.03, 4.63–4.43, and 4.33–4.03 Ma). However, when investigating CMIP6 (Coupled Model Intercomparison Project 6) SSP126 (Shared Socioeconomic Pathway) future scenario runs (next century) and other Pliocene time intervals, the following three additional SST relations emerge: (1) the Norwegian Sea SST anomaly is dissimilar to the North Atlantic and the Iceland Sea SST anomalies (Pliocene; 4.93–4.73 and 3.93–3.63 Ma), (2) the Iceland Sea SST anomaly is dissimilar to the North Atlantic and the Norwegian Sea SST anomalies (Pliocene; 3.43–3.23 Ma), and (3) the North Atlantic SST anomaly is dissimilar to the SST anomalies of the Norwegian and Iceland seas (future trend). Hence, spatially non-coherent SST anomalies may occur in equilibrium climates (Pliocene), as well as in response to transient forcing (CMIP6 SSP126 low-emission future scenario). Since buoyancy is a key forcing for the inflow of Atlantic Water to the Norwegian Sea, we investigate the impacts of buoyancy forcing on spatial relations between SST anomalies seen in the North Atlantic and the Norwegian and Iceland seas. This is done by performing a range of idealized experiments using the Massachusetts Institute of Technology general circulation model (MITgcm). Through these idealized experiments we can reproduce three out of four of the documented SST anomaly relations: being spatially coherent under weak to intermediate freshwater forcing over the Nordic Seas, the Iceland Sea being dissimilar to the North Atlantic and the Norwegian Sea under weak atmospheric warming over the Nordic Seas, and the North Atlantic being dissimilar to the Norwegian and Iceland seas under strong atmospheric warming over the Nordic Seas. We suggest that the unexplained SST anomaly relation, when the Norwegian Sea is dissimilar to the North Atlantic and the Iceland Sea, may reflect a response to a weakened Norwegian Atlantic Current compensated for by a strong Irminger Current or an expanded East Greenland Current

Marine Resources, Climate Change and International Management Regimes

This volume examines how international institutions set up to manage marine living resources are adapting to the effects of climate change on the geographic distribution of these resources. In the Barents Sea, the world’s biggest cod stock is expanding north-eastwards, while in the Nordic Seas significant changes in abundance, distribution and migration patterns can be observed in the world’s largest stocks for mackerel and herring. In the Antarctic, increasing temperatures and the associated declines in sea ice, ocean acidification and changes in circulation is likely to affect the geographical distribution of krill, the keystone species of Southern Ocean ecosystems. These developments put established international management regimes under pressure. In this interdisciplinary research volume, world-leading marine biologists, international lawyers and political scientists join efforts to study the resilience of Arctic and Antarctic marine resource management institutions to large-scale shifts of major marine stocks