Significant internal waves and internal tides measured northeast of Taiwan

Author Posting. © The Author(s), 2013. This article is posted here by permission of Sears Foundation for Marine Research for personal use, not for redistribution. The definitive version was published in Journal of Marine Research 71 (2013): 47-81, doi:10.1357/002224013807343416.Internal gravity waves in an area northeast of Taiwan are characterized using data from multiple sensor types. The data set includes intermittent information collected from a ship and short time series from moorings. Modeled nonlinear waves are fitted to observed nonlinear waves to provide self-consistent estimates of multiple wave parameters. A nonlinear internal wave of over 50 m amplitude, observed in deep water, is examined in detail. This wave was moving northward from the southern Okinawa Trough toward the continental shelf, and presumably formed from internal tides propagating northward from the Ilan Ridge area. A possible scenario for the formation of this wave from the internal tide is compared to related behavior south of Taiwan. On the outer continental shelf, a few large internal waves with maximum displacement greater than one-quarter of the water depth were measured with moorings. Sensors aboard ship and satellite recorded waves in this area traveling in many directions. Two possible causes (not mutually exclusive) for the multiple wave directions are scattering of nonlinear internal waves arriving from the south, and variable local generation of nonlinear gravity waves by the strong tidal and internal tidal currents. Internal tides on the shelf are relatively strong, among the strongest measured, having about 10 times greater kinetic energy density than numerous low-energy sites, which is consistent with the strong barotropic tides of the area. The ratio of diurnal baroclinic to barotropic kinetic energy found in this area is unusually high.Funding for the use of RV OR1 was provided by the National Science Council of Taiwan. TFD was supported by the Office of Naval Research (ONR) Ocean Acoustics Program under grants N00014-05-1-0482 and N00014-11-1-0194. AEN was supported under ONR grant N00014- 08-1-0763, and GG under ONR grant N00014-07-01-0482. HCG and MJC were supported by ONR grants N00014-09-1-0392 and N00014-07-1-0650

Circulation and intrusions northeast of Taiwan : chasing and predicting uncertainty in the cold dome

Author Posting. © The Oceanography Society, 2011. This article is posted here by permission of The Oceanography Society for personal use, not for redistribution. The definitive version was published in Oceanography 24 no. 4 (2011): 110–121, doi:10.5670/oceanog.2011.99.An important element of present oceanographic research is the assessment and quantification of uncertainty. These studies are challenging in the coastal ocean due to the wide variety of physical processes occurring on a broad range of spatial and temporal scales. In order to assess new methods for quantifying and predicting uncertainty, a joint Taiwan-US field program was undertaken in August/September 2009 to compare model forecasts of uncertainties in ocean circulation and acoustic propagation, with high-resolution in situ observations. The geographical setting was the continental shelf and slope northeast of Taiwan, where a feature called the "cold dome" frequently forms. Even though it is hypothesized that Kuroshio subsurface intrusions are the water sources for the cold dome, the dome's dynamics are highly uncertain, involving multiple scales and many interacting ocean features. During the experiment, a combination of near-surface and profiling drifters, broad-scale and high-resolution hydrography, mooring arrays, remote sensing, and regional ocean model forecasts of fields and uncertainties were used to assess mean fields and uncertainties in the region. River runoff from Typhoon Morakot, which hit Taiwan August 7–8, 2009, strongly affected shelf stratification. In addition to the river runoff, a cold cyclonic eddy advected into the region north of the Kuroshio, resulting in a cold dome formation event. Uncertainty forecasts were successfully employed to guide the hydrographic sampling plans. Measurements and forecasts also shed light on the evolution of cold dome waters, including the frequency of eddy shedding to the north-northeast, and interactions with the Kuroshio and tides. For the first time in such a complex region, comparisons between uncertainty forecasts and the model skill at measurement locations validated uncertainty forecasts. To complement the real-time model simulations, historical simulations with another model show that large Kuroshio intrusions were associated with low sea surface height anomalies east of Taiwan, suggesting that there may be some degree of predictability for Kuroshio intrusions.We thank the National Science Council of Taiwan as well as the Office of Naval Research for generous support of this effort

Acoustics and oceanographic observations collected during the QPE Experiment by Research Vessels OR1, OR2 and OR3 in the East China Sea in the Summer of 2009

This document describes data, sensors, and other useful information pertaining to the ONR sponsored QPE field program to quantify, predict and exploit uncertainty in observations and prediction of sound propagation. This experiment was a joint operation between Taiwanese and U.S. researchers to measure and assess uncertainty of predictions of acoustic transmission loss and ambient noise, and to observe the physical oceanography and geology that are necessary to improve their predictability. This work was performed over the continental shelf and slope northeast of Taiwan at two sites: one that was a relatively flat, homogeneous shelf region and a more complex geological site just shoreward of the shelfbreak that was influenced by the proximity of the Kuroshio Current. Environmental moorings and ADCP moorings were deployed and a shipboard SeaSoar vehicle was used to measure environmental spatial structure. In addition, multiple bottom moored receivers and a horizontal hydrophone array were deployed to sample transmission loss from a mobile source and ambient noise. The acoustic sensors, environmental sensors, shipboard resources, and experiment design, and their data, are presented and described in this technical report.Funding was provided by the Office of Naval Research under Contract No. N00014-08-1-076

Utilization patterns of Chinese medicine and Western medicine under the National Health Insurance Program in Taiwan, a population-based study from 1997 to 2003

<p>Abstract</p> <p>Background</p> <p>In 1995, Taiwan has launched a national health-care system (the National Health Insurance Program, NHI) covering the use of both Western medicine (WM) and Chinese medicine (CM). This population-based study was conducted to understand the role of CM in this dual medical system by determining the utilization patterns of CM and WM and to analyze the demographic characteristics and primary indications influencing the choice of the medical services for the development of strategies to enhance the appropriate use and reduce unnecessary use of CM.</p> <p>Methods</p> <p>This study used the NHI sample files from 1997 to 2003 consisting of comprehensive utilization and enrolment information for a random sample of 200,432 NHI beneficiaries of the total enrolees from 1995 to 2000. A total of 136,720 subjects with valid and complete enrolment and utilization data were included in this study. The logistic regression method was employed to estimate the odds ratios (ORs) for utilization of CM and WM. The usage, frequency of services, and primary indications for CM and WM were evaluated. A significance level of α = 0.05 was selected.</p> <p>Results</p> <p>Compared with WM, the odds of CM increased from 1997 to 2003. The odds of using CM (OR = 1.48; 95% CI: 1.45–1.50; p < 0.001) and WM (OR = 1.74; 95% CI: 1.72–1.77; p < 0.001) were higher in females and that of CM increased with age to a peak in the 45–54-year-group (OR = 1.75; 95% CI: 1.68–1.82; p < 0.001) and WM (OR = 1.09; 95% CI: 1.05–1.13; p < 0.001) in the elderly subjects (≥ 65 years). The odds of CM and WM were similar in all income groups. However, those of CM were higher in Central (OR = 1.65; 95% CI: 1.56–1.74; p < 0.001) and Southern Taiwan (OR = 1.18; 95% CI: 1.12–1.25; p < 0.001) and lower in the remote areas (OR = 0.57; 95% CI: 0.52–0.63; p < 0.001). Most of the patients had one ambulatory visit of both medical services annually. However, the utilization of WM predominated over CM. Over 90% of CM service was provided by clinics, whereas over 60% of WM service by hospitals. Diseases of the respiratory system was the most frequent primary indication in CM and WM. Herbal medication was the most commonly used form of CM (68.4–72.7%).</p> <p>Conclusion</p> <p>In recent years, there is an increasing trend in the utilization of CM in Taiwan. This increasing trend may be due to the covering of CM in the national health insurance system.</p

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

The formation and fate of internal waves in the South China Sea

Author Posting. © The Author(s), 2015. This is the author's version of the work. It is posted here by permission of Nature Publishing Group for personal use, not for redistribution. The definitive version was published in Nature 521 (2015): 65-69, doi:10.1038/nature14399.Internal gravity waves, the subsurface analogue of the familiar surface gravity waves that break on beaches, are ubiquitous in the ocean. Because of their strong vertical and horizontal currents, and the turbulent mixing caused by their breaking, they impact a panoply of ocean processes, such as the supply of nutrients for photosynthesis1, sediment and pollutant transport2 and acoustic transmission3; they also pose hazards for manmade structures in the ocean4. Generated primarily by the wind and the tides, internal waves can travel thousands of kilometres from their sources before breaking5, posing severe challenges for their observation and their inclusion in numerical climate models, which are sensitive to their effects6-7. Over a decade of studies8-11 have targeted the South China Sea, where the oceans’ most powerful internal waves are generated in the Luzon Strait and steepen dramatically as they propagate west. Confusion has persisted regarding their generation mechanism, variability and energy budget, however, due to the lack of in-situ data from the Luzon Strait, where extreme flow conditions make measurements challenging. Here we employ new observations and numerical models to (i) show that the waves begin as sinusoidal disturbances rather than from sharp hydraulic phenomena, (ii) reveal the existence of >200-m-high breaking internal waves in the generation region that give rise to turbulence levels >10,000 times that in the open ocean, (iii) determine that the Kuroshio western boundary current significantly refracts the internal wave field emanating from the Luzon Strait, and (iv) demonstrate a factor-of-two agreement between modelled and observed energy fluxes that enables the first observationally-supported energy budget of the region. Together, these findings give a cradle-to-grave picture of internal waves on a basin scale, which will support further improvements of their representation in numerical climate predictions.Our work was supported by the U.S. Office of Naval Research and the Taiwan National Science Council.2015-10-2

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

The formation and fate of internal waves in the South China Sea

Internal gravity waves, the subsurface analogue of the familiar surface gravity waves that break on beaches, are ubiquitous in the ocean. Because of their strong vertical and horizontal currents, and the turbulent mixing caused by their breaking, they affect a panoply of ocean processes, such as the supply of nutrients for photosynthesis¹, sediment and pollutant transport² and acoustic transmission³; they also pose hazards for man-made structures in the ocean⁴. Generated primarily by the wind and the tides, internal waves can travel thousands of kilometres from their sources before breaking⁵, making it challenging to observe them and to include them in numerical climate models, which are sensitive to their effects[superscript 6,7]. For over a decade, studies[superscript 8–11] have targeted the South China Sea, where the oceans’ most powerful known internal waves are generated in the Luzon Strait and steepen dramatically as they propagate west. Confusion has persisted regarding their mechanism of generation, variability and energy budget, however, owing to the lack of in situ data from the Luzon Strait, where extreme flow conditions make measurements difficult. Here we use new observations and numerical models to (1) show that the waves begin as sinusoidal disturbances rather than arising from sharp hydraulic phenomena, (2) reveal the existence of >200-metre-high breaking internal waves in the region of generation that give rise to turbulence levels >10,000 times that in the open ocean, (3) determine that the Kuroshio western boundary current noticeably refracts the internal wave field emanating from the Luzon Strait, and (4) demonstrate a factor-of-two agreement between modelled and observed energy fluxes, which allows us to produce an observationally supported energy budget of the region. Together, these findings give a cradle-to-grave picture of internal waves on a basin scale, which will support further improvements of their representation in numerical climate predictions

Coupled Ocean-Acoustic Prediction of Transmission Loss in a Continental Shelfbreak Region: Predictive Skill, Uncertainty Quantification and Dynamical Sensitivities

In this paper, we quantify the dynamical causes and uncertainties of striking differences in acoustic transmission data collected on the shelf and shelfbreak in the northeastern Taiwan region within the context of the 2008 Quantifying, Predicting, and Exploiting Uncertainty (QPE 2008) pilot experiment. To do so, we employ our coupled oceanographic (4-D) and acoustic (Nx2-D) modeling systems with ocean data assimilation and a best-fit depth-dependent geoacoustic model. Predictions are compared to the measured acoustic data, showing skill. Using an ensemble approach, we study the sensitivity of our results to uncertainties in several factors, including geoacoustic parameters, bottom layer thickness, bathymetry, and ocean conditions. We find that the lack of signal received on the shelfbreak is due to a 20-dB increase in transmission loss (TL) caused by bottom trapping of sound energy during up-slope transmissions over the complex and deeper bathymetry. Sensitivity studies on sediment properties show larger but isotropic TL variations on the shelf and smaller but more anisotropic TL variations over the shelfbreak. Sediment sound-speed uncertainties affect the shape of the probability density functions of the TLs more than uncertainties in sediment densities and attenuations. Diverse thicknesses of sediments lead to only limited effects on the TL. The small bathymetric data uncertainty is modeled and also leads to small TL variations. We discover that the initial transport conditions in the Taiwan Strait can affect acoustic transmissions downstream more than 100 km away, especially above the shelfbreak. Simulations also reveal internal tides and we quantify their spatial and temporal effects on the ocean and acoustic fields. One type of predicted waves are semidiurnal shelfbreak internal tides propagating up-slope with wavelengths around 40–80 km, horizontal phase speeds of 0.5–1 m/s, and vertical peak-to-peak displacements of isotherms of 20–60 m. These waves lead to variations of broadband TL estimates over 5–6-km range that are more isotropic and on bearing average larger (up to 5–8-dB amplitudes) on the shelf than on the complex shelfbreak where the TL varies rapidly with bearing angles