10 research outputs found

    The Regional Coupled Suite (RCS-IND1): application of a flexible regional coupled modelling framework to the Indian region at kilometre scale

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    A new regional coupled modelling framework is introduced – the Regional Coupled Suite (RCS). This provides a flexible research capability with which to study the interactions between atmosphere, land, ocean, and wave processes resolved at kilometre scale, and the effect of environmental feedbacks on the evolution and impacts of multi-hazard weather events. A configuration of the RCS focussed on the Indian region, termed RCS-IND1, is introduced. RCS-IND1 includes a regional configuration of the Unified Model (UM) atmosphere, directly coupled to the JULES land surface model, on a grid with horizontal spacing of 4.4 km, enabling convection to be explicitly simulated. These are coupled through OASIS3-MCT libraries to 2.2 km grid NEMO ocean and WAVEWATCH III wave model configurations. To examine a potential approach to reduce computation cost and simplify ocean initialization, the RCS includes an alternative approach to couple the atmosphere to a lower resolution Multi-Column K-Profile Parameterization (KPP) for the ocean. Through development of a flexible modelling framework, a variety of fully and partially coupled experiments can be defined, along with traceable uncoupled simulations and options to use external input forcing in place of missing coupled components. This offers a wide scope to researchers designing sensitivity and case study assessments. Case study results are presented and assessed to demonstrate the application of RCS-IND1 to simulate two tropical cyclone cases which developed in the Bay of Bengal, namely Titli in October 2018 and Fani in April 2019. Results show realistic cyclone simulations, and that coupling can improve the cyclone track and produces more realistic intensification than uncoupled simulations for Titli but prevents sufficient intensification for Fani. Atmosphere-only UM regional simulations omit the influence of frictional heating on the boundary layer to prevent cyclone over-intensification. However, it is shown that this term can improve coupled simulations, enabling a more rigorous treatment of the near-surface energy budget to be represented. For these cases, a 1D mixed layer scheme shows similar first-order SST cooling and feedback on the cyclones to a 3D ocean. Nevertheless, the 3D ocean generally shows stronger localized cooling than the 1D ocean. Coupling with the waves has limited feedback on the atmosphere for these cases. Priorities for future model development are discussed

    Effects of the Mixed Layer Time Variability on Kinematic Subduction Rate Diagnostics

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    International audienceAn eddy-resolving primitive equation general circulation model is used to estimate water-mass subduction rates in the North Atlantic Ocean subtropical gyre. The diagnostics are based on the instantaneous kinematic approach, which allows the calculation of the annual rate of water-mass subduction at a given density range, following isopycnal outcrop positions over the annual cycle. It is shown that water-mass subduction is effected rapidly (∌1–2 months) as the mixed layer depth decreases in spring, consistent with Stommel's hypothesis, and occurs mostly over the area of deep late-winter mixed layers (≄150 m) across the central North Atlantic in the density range 26 ≀ σ ≀ 27.2. Annual subduction rates O(100–200 m yr–1) are found south and east of the Gulf Stream extension in the density range of subtropical mode waters from roughly 26.2 to 26.6. In the northeastern part of the subtropical gyre, annual subduction rates are somewhat larger, O(250 m yr–1), from a density of about 26.9 east of the North Atlantic Current to 27.4 (upper cutoff in this study). The overall basin-integrated subduction rate for subtropical mode waters (26.2 ≀ σ ≀ 26.6) is about 12.2 Sv (Sv ≡ 106 m3 s−1), comparable to the total formation rate inferred from the surface density forcing applied in the model of roughly 11 Sv in this density range. In contrast, basin-integrated rates for denser central water (26.8 ≀ σ ≀ 27.2) provide a vanishingly small net subduction. In this range, eddy correlations (<30 days) between the surface outcrop area and the local subduction rate counteract the net subduction by the mean flow (deduced from monthly averaged model fields). Comparison with estimates of the annual subduction rate based on the annual mean velocity and late-winter mixed layer properties alone, as is usual in climatological and coarse-resolution model analyses, indicates a mismatch of at least 8 Sv in the density range where the model forms subtropical mode water. This mismatch is primarily due to time-varying mixed layer processes rather than small-scale mixing not resolved explicitly by the model. Our diagnostics based on the instantaneous kinematic approach provide a more complete picture of the water-mass formation process than diagnostics based only on air–sea flux or late-winter mixed layer model data. They reveal the crucial importance of both the seasonal mixed layer cycle and mesoscale eddies to the overall formation rate and provide thus a valuable tool for the analysis of water-mass formation rates in eddy-resolving numerical simulations at basin scale

    The Regional Coupled Suite (RCS-IND1): application of a flexible regional coupled modelling framework to the Indian region at kilometre scale

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    Abstract. A new regional coupled modelling framework is introduced – the Regional Coupled Suite (RCS). This provides a flexible research capability with which to study the interactions between atmosphere, land, ocean, and wave processes resolved at kilometre scale, and the effect of environmental feedbacks on the evolution and impacts of multi-hazard weather events. A configuration of the RCS focussed on the Indian region, termed RCS-IND1, is introduced. RCS-IND1 includes a regional configuration of the Unified Model (UM) atmosphere, directly coupled to the JULES land surface model, on a grid with horizontal spacing of 4.4 km, enabling convection to be explicitly simulated. These are coupled through OASIS3-MCT libraries to 2.2 km grid NEMO ocean and WAVEWATCH III wave model configurations. To examine a potential approach to reduce computation cost and simplify ocean initialization, the RCS includes an alternative approach to couple the atmosphere to a lower resolution Multi-Column K-Profile Parameterization (KPP) for the ocean. Through development of a flexible modelling framework, a variety of fully and partially coupled experiments can be defined, along with traceable uncoupled simulations and options to use external input forcing in place of missing coupled components. This offers a wide scope to researchers designing sensitivity and case study assessments. Case study results are presented and assessed to demonstrate the application of RCS-IND1 to simulate two tropical cyclone cases which developed in the Bay of Bengal, namely Titli in October 2018 and Fani in April 2019. Results show realistic cyclone simulations, and that coupling can improve the cyclone track and produces more realistic intensification than uncoupled simulations for Titli but prevents sufficient intensification for Fani. Atmosphere-only UM regional simulations omit the influence of frictional heating on the boundary layer to prevent cyclone over-intensification. However, it is shown that this term can improve coupled simulations, enabling a more rigorous treatment of the near-surface energy budget to be represented. For these cases, a 1D mixed layer scheme shows similar first-order SST cooling and feedback on the cyclones to a 3D ocean. Nevertheless, the 3D ocean generally shows stronger localized cooling than the 1D ocean. Coupling with the waves has limited feedback on the atmosphere for these cases. Priorities for future model development are discussed. </jats:p

    Effect of lung recruitment and titrated Positive End-Expiratory Pressure (PEEP) vs low PEEP on mortality in patients with acute respiratory distress syndrome - A randomized clinical trial

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    IMPORTANCE: The effects of recruitment maneuvers and positive end-expiratory pressure (PEEP) titration on clinical outcomes in patients with acute respiratory distress syndrome (ARDS) remain uncertain. OBJECTIVE: To determine if lung recruitment associated with PEEP titration according to the best respiratory-system compliance decreases 28-day mortality of patients with moderate to severe ARDS compared with a conventional low-PEEP strategy. DESIGN, SETTING, AND PARTICIPANTS: Multicenter, randomized trial conducted at 120 intensive care units (ICUs) from 9 countries from November 17, 2011, through April 25, 2017, enrolling adults with moderate to severe ARDS. INTERVENTIONS: An experimental strategy with a lung recruitment maneuver and PEEP titration according to the best respiratory-system compliance (n = 501; experimental group) or a control strategy of low PEEP (n = 509). All patients received volume-assist control mode until weaning. MAIN OUTCOMES AND MEASURES: The primary outcome was all-cause mortality until 28 days. Secondary outcomes were length of ICU and hospital stay; ventilator-free days through day 28; pneumothorax requiring drainage within 7 days; barotrauma within 7 days; and ICU, in-hospital, and 6-month mortality. RESULTS: A total of 1010 patients (37.5% female; mean [SD] age, 50.9 [17.4] years) were enrolled and followed up. At 28 days, 277 of 501 patients (55.3%) in the experimental group and 251 of 509 patients (49.3%) in the control group had died (hazard ratio [HR], 1.20; 95% CI, 1.01 to 1.42; P = .041). Compared with the control group, the experimental group strategy increased 6-month mortality (65.3% vs 59.9%; HR, 1.18; 95% CI, 1.01 to 1.38; P = .04), decreased the number of mean ventilator-free days (5.3 vs 6.4; difference, −1.1; 95% CI, −2.1 to −0.1; P = .03), increased the risk of pneumothorax requiring drainage (3.2% vs 1.2%; difference, 2.0%; 95% CI, 0.0% to 4.0%; P = .03), and the risk of barotrauma (5.6% vs 1.6%; difference, 4.0%; 95% CI, 1.5% to 6.5%; P = .001). There were no significant differences in the length of ICU stay, length of hospital stay, ICU mortality, and in-hospital mortality. CONCLUSIONS AND RELEVANCE: In patients with moderate to severe ARDS, a strategy with lung recruitment and titrated PEEP compared with low PEEP increased 28-day all-cause mortality. These findings do not support the routine use of lung recruitment maneuver and PEEP titration in these patients. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01374022

    Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

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    Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P &lt; 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)

    Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

    No full text
    Background: Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods: The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results: A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion: Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)
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