The dependence of minimum-time routes over the North Atlantic on cruise altitude

North Atlantic air traffic is broadly organised into a track system; daily sets of tracks are defined by air traffic control which are vertically stacked, such that the same set of tracks is used for all flight levels, regardless of any vertical variations in wind. This work uses minimum-time routes, previously shown to be a good proxy for the location of the North Atlantic track system, to understand whether vertical variations in wind speed and direction significantly affect minimum-time routes optimised at different altitudes; this is to examine whether (all other factors assumed equal) there is potential for improvements in fuel efficiency. The optimum cruise altitude over the North Atlantic is determined, focusing on the New York – London route. It is found that eastbound routes, which take advantage of the jet stream, are on average faster at 250 hPa (flight level (FL) 340) than at 300 hPa (FL300) or 200 hPa (FL390) by approximately 2 minutes (compared to the annual-mean route time of about 330 minutes, assuming a true air speed of 250 m s-1). For westbound routes, the route time increases with height: aircraft flying at 300 hPa are on average 3 minutes faster than at higher levels (the annual-mean optimum time being about 400 minutes). These estimates are compared with the time penalty which arises from flying a route optimized at 250 hPa at the other two altitudes. The time penalty is generally less than a minute, compared to the minimum-time routes calculated at those altitudes

How do atmospheric rivers form?

Identifying the source of atmospheric rivers: Are they rivers of moisture exported from the subtropics or footprints left behind by poleward travelling storms? The term atmospheric river is used to describe corridors of strong water vapor transport in the troposphere. Filaments of enhanced water vapor, commonly observed in satellite imagery extending from the subtropics to the extratropics, are routinely used as a proxy for identifying these regions of strong water vapor transport. The precipitation associated with these filaments of enhanced water vapor can lead to high impact flooding events. However, there remains some debate as to how these filaments form. In this paper we analyse the transport of water vapor within a climatology of wintertime North Atlantic extratropical cyclones. Results show that atmospheric rivers are formed by the cold front which sweeps up water vapor in the warm sector as it catches up with the warm front. This causes a narrow band of high water vapor content to form ahead of the cold front at the base of the warm conveyor belt airflow. Thus, water vapor in the cyclone's warm sector, and not long-distance transport of water vapor from the subtropics, is responsible for the generation of filaments of high water vapor content. A continuous cycle of evaporation and moisture convergence within the cyclone replenishes water vapor lost via precipitation. Thus, rather than representing a direct and continuous feed of moist air from the subtropics into the centre of a cyclone (as suggested by the term atmospheric river), these filaments are, in-fact, the result of water vapor exported from the cyclone and thus they represent the footprints left behind as cyclones travel polewards from subtropics

Using l‐Carnitine as a Pharmacologic Probe of the Interpatient and Metabolic Variability of Sepsis

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/162752/2/phar2448_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/162752/1/phar2448.pd

The simulation of mineral dust in the United Kingdom Earth System Model UKESM1

Mineral dust plays an important role in Earth system models and is linked to many components, including atmospheric wind speed, precipitation and radiation, surface vegetation cover and soil properties and oceanic biogeochemical systems. In this paper, the dust scheme in the first configuration of the United Kingdom Earth System Model UKESM1 is described, and simulations of dust and its radiative effects are presented and compared with results from the parallel coupled atmosphere–ocean general circulation model (GCM) HadGEM3-GC3.1. Not only changes in the driving model fields but also changes in the dust size distribution are shown to lead to considerable differences to the present-day dust simulations and to projected future changes. UKESM1 simulations produce a present-day, top-of-the-atmosphere (ToA) dust direct radiative effect (DRE – defined as the change in downward net flux directly due to the presence of dust) of 0.086 W m−2 from a dust load of 19.5 Tg. Under climate change pathways these values decrease considerably. In the 2081–2100 mean of the Shared Socioeconomic Pathway SSP5–8.45 ToA DRE reaches 0.048 W m−2 from a load of 15.1 Tg. In contrast, in HadGEM3-GC3.1 the present-day values of −0.296 W m−2 and 15.0 Tg are almost unchanged at −0.289 W m−2 and 14.5 Tg in the 2081–2100 mean. The primary mechanism causing the differences in future dust projections is shown to be the vegetation response, which dominates over the direct effects of warming in our models. Though there are considerable uncertainties associated with any such estimates, the results presented demonstrate both the importance of the size distribution for dust modelling and also the necessity of including Earth system processes such as interactive vegetation in dust simulations for climate change studies

What are the implications of climate change for trans-Atlantic aircraft routing and flight time?

The effect of wind changes on aircraft routing has been identified as a potential impact of climate change on aviation. This is of particular interest for trans-Atlantic flights, where the pattern of upper-level winds over the north Atlantic, in particular the location and strength of the jet stream, strongly influences both the optimal flight route and the resulting flight time. Eastbound trans-Atlantic flights can often be routed to take advantage of the strong tailwinds in the jet stream, shortening the flight time and reducing fuel consumption. Here we investigate the impact of climate change on upper-level winds over the north Atlantic, using five climate model simulations from the Fifth Coupled Model Intercomparison Project, considering a high greenhouse-gas emissions scenario. The impact on aircraft routing and flight time are quantified using flight routing software. The climate models agree that the jet stream will be on average located 1 degree further north, with a small increase in mean strength, by 2100. However daily variations in both its location and speed are significantly larger than the magnitude of any changes due to climate change. The net effect of climate change on trans-Atlantic aircraft routes is small; in the annual-mean eastbound routes are 1 min shorter and located further north and westbound routes are 1 min longer and more spread out around the great circle. There are, however, seasonal variations; route time changes are larger in winter, while in summer both eastbound and westbound route times increase

Lessons learned during down referral of antiretroviral treatment in Tete, Mozambique

As sub-Saharan African countries continue to scale up antiretroviral treatment, there has been an increasing emphasis on moving provision of services from hospital level to the primary health care clinic level. Delivery of antiretroviral treatment at the clinic level increases the number of entry points to care, while the greater proximity of services encourages retention in care

Effectiveness of Non-nucleoside Reverse-Transcriptase Inhibitor-Based Antiretroviral Therapy in Women Previously Exposed to a Single Intrapartum Dose of Nevirapine: A Multi-country, Prospective Cohort Study

In a comparative cohort study, Jeffrey Stringer and colleagues investigate the risk of ART failure in women who received single-dose nevirapine for PMTCT, and assess the duration of increased risk

Nebulized Recombinant Tissue Plasminogen Activator (rt-PA) for Acute COVID-19-Induced Respiratory Failure : An Exploratory Proof-of-Concept Trial

Acknowledgments We would like to extend our sincerest gratitude to all the colleagues and hospital staff who worked tirelessly throughout the pandemic and without whom this work would not have been possible. Firstly, we would like to thank our colleagues in the intensive care unit (ICU), in particular the matrons, Sean Carroll and Sinead Hanton, and research nurses, Filipe Helder and Amitaa Maharajh for their support, and bedside nurses who bore the responsibility of drug administration. We would also like to extend our thanks to ICU consultants who acted as professional legal consultees on behalf of critical care patients. Equally, we would like to thank colleagues within the respiratory team. Their expertise was instrumental to our role in treating patients on 8N and 8E wards. A special mention to lead Nurse Mary Emerson; we were grateful for her knowledge, support and for facilitating the training for the nebulizer and drug administration on the wards. We would like to thank Aarti Nandani and all the staff in the Royal Free clinical trials pharmacy for their immense support throughout the whole pandemic, especially considering their ever-increasing workload at the time. Thanks also to the HSL coagulation laboratory, the Trust R&D department and all the staff working to cover during a very challenging time. We are also very grateful to the Royal Free charity for funding this study. Finally, we would like to thank all the clinical nurses, physiotherapists, research data managers and healthcare professionals within the Haemophilia department (and wider hospital) for all their many efforts in supporting this study. This trial was overseen by an independent data monitoring committee, chaired by Najib Rahman, Director of the Oxford Respiratory Trials Unit, University of Oxford and comprises the following committee members: Mike Makris, Jonathan Silversides and Henry Watson. Funding Royal Free Charity Trust Fund 35 provided funding for this study. The study drug was provided by Boehringer Ingelheim (BI). BI had no role in the design, analysis, or interpretation of the results. They were given the opportunity to review the manuscript for medical and scientific accuracy since it relates to BI substances and intellectual property considerations.Peer reviewedPublisher PD

CATALISE: A multinational and multidisciplinary Delphi consensus study. Identifying language impairments in children

Delayed or impaired language development is a common developmental concern, yet thereis little agreement about the criteria used to identify and classify language impairments inchildren. Children's language difficulties are at the interface between education, medicineand the allied professions, who may all adopt different approaches to conceptualising them.Our goal in this study was to use an online Delphi technique to see whether it was possibleto achieve consensus among professionals on appropriate criteria for identifying childrenwho might benefit from specialist services. We recruited a panel of 59 experts representingten disciplines (including education, psychology, speech-language therapy/pathology, paediatricsand child psychiatry) from English-speaking countries (Australia, Canada, Ireland,New Zealand, United Kingdom and USA). The starting point for round 1 was a set of 46statements based on articles and commentaries in a special issue of a journal focusing onthis topic. Panel members rated each statement for both relevance and validity on a sevenpointscale, and added free text comments. These responses were synthesised by the firsttwo authors, who then removed, combined or modified items with a view to improving consensus.The resulting set of statements was returned to the panel for a second evaluation(round 2). Consensus (percentage reporting 'agree' or 'strongly agree') was at least 80 percentfor 24 of 27 round 2 statements, though many respondents qualified their responsewith written comments. These were again synthesised by the first two authors. The resultingconsensus statement is reported here, with additional summary of relevant evidence, and aconcluding commentary on residual disagreements and gaps in the evidence base.</p

Description and evaluation of aerosol in UKESM1 and HadGEM3-GC3.1 CMIP6 historical simulations

We document and evaluate the aerosol schemes as implemented in the physical and Earth system models, HadGEM3-GC3.1 (GC3.1) and UKESM1, which are contributing to the 6th Coupled Model Intercomparison Project (CMIP6). The simulation of aerosols in the present-day period of the historical ensemble of these models is evaluated against a range of observations. Updates to the aerosol microphysics scheme are documented as well as differences in the aerosol representation between the physical and Earth system configurations. The additional Earth-system interactions included in UKESM1 leads to differences in the emissions of natural aerosol sources such as dimethyl sulfide, mineral dust and organic aerosol and subsequent evolution of these species in the model. UKESM1 also includes a stratospheric-tropospheric chemistry scheme which is fully coupled to the aerosol scheme, while GC3.1 employs a simplified aerosol chemistry mechanism driven by prescribed monthly climatologies of the relevant oxidants. Overall, the simulated speciated aerosol mass concentrations compare reasonably well with observations. Both models capture the negative trend in sulfate aerosol concentrations over Europe and the eastern United States of America (US) although the models tend to underestimate the sulfate concentrations in both regions. Interactive emissions of biogenic volatile organic compounds in UKESM1 lead to an improved agreement of organic aerosol over the US. Simulated dust burdens are similar in both models despite a 2-fold difference in dust emissions. Aerosol optical depth is biased low in dust source and outflow regions but performs well in other regions compared to a number of satellite and ground-based retrievals of aerosol optical depth. Simulated aerosol number concentrations are generally within a factor of 2 of the observations with both models tending to overestimate number concentrations over remote ocean regions, apart from at high latitudes, and underestimate over Northern Hemisphere continents. Finally, a new primary marine organic aerosol source is implemented in UKESM1 for the first time. The impact of this new aerosol source is evaluated. Over the pristine Southern Ocean, it is found to improve the seasonal cycle of organic aerosol mass and cloud droplet number concentrations relative to GC3.1 although underestimations in cloud droplet number concentrations remain. This paper provides a useful characterization of the aerosol climatology in both models facilitating the understanding of the numerous aerosol-climate interaction studies that will be conducted as part of CMIP6 and beyond