Influence of the meridional overturning circulation on tropical Atlantic climate and variability

The influence of the meridional overturning circulation on tropical Atlantic climate and variability has been investigated using the atmosphere-ocean coupled model Speedy-MICOM (Miami Isopycnic Coordinate Ocean Model). In the ocean model MICOM the strength of the meridional overturning cell can be regulated by specifying the lateral boundary conditions. In case of a collapse of the basinwide meridional overturning cell the SST response in the Atlantic is characterized by a dipole with a cooling in the North Atlantic and a warming in the tropical and South Atlantic. The cooling in the North Atlantic is due to the decrease in the strength of the western boundary currents, which reduces the northward advection of heat. The warming in the tropical Atlantic is caused by a reduced ventilation of water originating from the South Atlantic. This effect is most prominent in the eastern tropical Atlantic during boreal summer when the mixed layer attains its minimum depth. As a consequence the seasonal cycle as well as the interannual variability in SST is reduced. The characteristics of the cold tongue mode are changed: the variability in the eastern equatorial region is strongly reduced and the largest variability is now in the Benguela, Angola region. Because of the deepening of the equatorial thermocline, variations in the thermocline depth in the eastern tropical Atlantic no longer significantly affect the mixed layer temperature. The gradient mode remains unaltered. The warming of the tropical Atlantic enhances and shifts the Hadley circulation. Together with the cooling in the North Atlantic, this increases the strength of the subtropical jet and the baroclinicity over the North Atlantic.

Association between education in EOL care and variability in EOL practice: a survey of ICU physicians

This study investigated the association between physician education in EOL and variability in EOL practice, as well as the differences between beliefs and practices regarding EOL in the ICU. Physicians from 11 ICUs at a university hospital completed a survey presenting a patient in a vegetative state with no family or advance directives. Questions addressed approaches to EOL care, as well physicians' personal, professional and EOL educational characteristics. The response rate was 89%, with 105 questionnaires analyzed. Mean age was 38 +/- A 8 years, with a mean of 14 +/- A 7 years since graduation. Physicians who did not apply do-not-resuscitate (DNR) orders were less likely to have attended EOL classes than those who applied written DNR orders [0/7 vs. 31/47, OR = 0.549 (0.356-0.848), P = 0.001]. Physicians who involved nurses in the decision-making process were more likely to be ICU specialists [17/22 vs. 46/83, OR = 4.1959 (1.271-13.845), P = 0.013] than physicians who made such decisions among themselves or referred to ethical or judicial committees. Physicians who would apply "full code" had less often read about EOL [3/22 vs. 11/20, OR = 0.0939 (0.012-0.710), P = 0.012] and had less interest in discussing EOL [17/22 vs. 20/20, OR = 0.210 (0.122-0.361), P < 0.001], than physicians who would withdraw life-sustaining therapies. Forty-four percent of respondents would not do what they believed was best for their patient, with 98% of them believing a less aggressive attitude preferable. Legal concerns were the leading cause for this dichotomy. Physician education about EOL is associated with variability in EOL decisions in the ICU. Moreover, actual practice may differ from what physicians believe is best for the patient.

Mean and Variability of the Tropical Atlantic Ocean in the CCSM4

This study analyzes important aspects of the tropical Atlantic Ocean from simulations of the fourth version of the Community Climate System Model (CCSM4): the mean sea surface temperature (SST) and wind stress, the Atlantic warm pools, the principal modes of SST variability, and the heat budget in the Benguela region. The main goal was to assess the similarities and differences between the CCSM4 simulations and observations. The results indicate that the tropical Atlantic overall is realistic in CCSM4. However, there are still significant biases in the CCSM4 Atlantic SSTs, with a colder tropical North Atlantic and a hotter tropical South Atlantic, that are related to biases in the wind stress. These are also reflected in the Atlantic warm pools in April and September, with its volume greater than in observations in April and smaller than in observations in September. The variability of SSTs in the tropical Atlantic is well represented in CCSM4. However, in the equatorial and tropical South Atlantic regions, CCSM4 has two distinct modes of variability, in contrast to observed behavior. A model heat budget analysis of the Benguela region indicates that the variability of the upper-ocean temperature is dominated by vertical advection, followed by meridional advection.

Flares and variability from Sagittarius A(star): five nights of simultaneous multi-wavelength observations

Aims. We report on simultaneous observations and modeling of mid-infrared (MIR), near-infrared (NIR), and submillimeter (sub-mm) emission of the source Sgr A * associated with the supermassive black hole at the center of our Galaxy. Our goal was to monitor the activity of Sgr A* at different wavelengths in order to constrain the emitting processes and gain insight into the nature of the close environment of Sgr A*. Methods. We used the MIR instrument VISIR in the BURST imaging mode, the adaptive optics assisted NIR camera NACO, and the sub-mm antenna APEX to monitor Sgr A* over several nights in July 2007. Results. The observations reveal remarkable variability in the NIR and sub-mm during the five nights of observation. No source was detected in the MIR, but we derived the lowest upper limit for a flare at 8.59 mu m (22.4 mJy with A(8.59 mu m) = 1.6 +/- 0.5). This observational constraint makes us discard the observed NIR emission as coming from a thermal component emitting at sub-mm frequencies. Moreover, comparison of the sub-mm and NIR variability shows that the highest NIR fluxes (flares) are coincident with the lowest sub-mm levels of our five-night campaign involving three flares. We explain this behavior by a loss of electrons to the system and/or by a decrease in the magnetic field, as might conceivably occur in scenarios involving fast outflows and/or magnetic reconnection.

Assessment and management of oral health in liver transplant candidates

Liver transplantation has become a standard treatment for end-stage liver disease and the number of recipients has grown rapidly in the last few years. Dental care during pre-transplant workup is important to reduce potential sources of infection in the drug-induced immunosuppression phase of liver transplantation. Objectives: The objectives of this study were to document the prevalence of oral abnormalities in patients on a liver transplant waiting list presenting to an urban dental school clinic, discuss the appropriate dental treatment according their systemic conditions and compare their oral manifestations with those of healthy individuals. Material and Methods: A pilot study was conducted involving 16 end-stage liver disease individuals (study group- SG) attending the Special Care Dentistry Center of the University of So Paulo and 16 control individuals (control group- CG) with no liver diseases, receiving dental care at the Dental School of the University of So Paulo. These individuals were assessed for their dental status (presence of oral disease or abnormalities), coagulation status, and dental treatment indications. Results: The patients from SG exhibited a greater incidence of oral manifestations compared with CG (p=0.0327) and were diagnosed with at least one oral disease or condition that required treatment. Coagulation abnormalities reflecting an increased risk of bleeding were found in 93.75% of the patients. However, no bleeding complications occurred after dental treatment. Conclusions: The patients with chronic liver diseases evaluated in this study exhibited a higher incidence of oral manifestations compared with the control group and had at least one oral disease or abnormality which required dental treatment prior to liver transplantation. Careful oral examination and evaluation of the patient, including laboratory tests, will ensure correct oral preparation and control of oral disease prior to liver transplantation.

Pediatric pain: prevalence, assessment, and management in a teaching hospital

The goal of this study was to examine the prevalence, assessment and management of pediatric pain in a public teaching hospital. The study sample consisted of 121 inpatients (70 infants, 36 children, and 15 adolescents), their families, 40 physicians, and 43 nurses. All participants were interviewed except infants and children who could not communicate due to their clinical status. The interview included open-ended questions concerning the inpatients’ pain symptoms during the 24 h preceding data collection, as well as pain assessment and pharmacological/non-pharmacological management of pain. The data were obtained from 100% of the eligible inpatients. Thirty-four children/adolescents (28%) answered the questionnaire and for the other 72% (unable to communicate), the family/health professional caregivers reported pain. Among these 34 persons, 20 children/adolescents reported pain, 68% of whom reported that they received pharmacological intervention for pain relief. Eighty-two family caregivers were available on the day of data collection. Of these, 40 family caregivers (49%) had observed their child’s pain response. In addition, 74% reported that the inpatients received pharmacological management. Physicians reported that only 38% of the inpatients exhibited pain signs, which were predominantly acute pain detected during clinical procedures. They reported that 66% of patients received pharmacological intervention. The nurses reported pain signs in 50% of the inpatients, which were detected during clinical procedures. The nurses reported that pain was managed in 78% of inpatients by using pharmacological and/or non-pharmacological interventions. The findings provide evidence of the high prevalence of pain in pediatric inpatients and the under-recognition of pain by health professionals.

RegCM3 nested in HadAM3 scenarios A2 and B2: projected changes in extratropical cyclogenesis, temperature and precipitation over the South Atlantic Ocean

The RegCM3 (Regional Climate Model-version 3) was nested in HadAM3 model to simulate present (1975-1989, referred hereafter as RegHad) and two future climate scenarios (A2 and B2 from 2071 to 2085, referred as RegA2 and RegB2) over the South America (SA) and South Atlantic Ocean (SAO). Projected changes in the air temperature, precipitation, low level circulation and cyclogenesis climatology were investigated. The cyclogenesis were identified using an automatic scheme for tracking based on the minimum of relative vorticity (zeta) from 10-m height wind. During summer, a general decrease (increase) in the precipitation is projected by RegA2 and RegB2 over the northeastern SA (center-west and south Brazil, north Argentina and Uruguay). For winter, an anomalous low level anticyclonic circulation is associated with the reduction in the rainfall over the central part of southern Brazil in RegA2 and RegB2 scenarios. Similar to HadAM3, RegCM3 projects larger warming in A2 scenario. For the present climate, when compared to HadAM3, RegHad defines better both the location of the main cyclogenetic areas and its annual cycle near southwestern SAO. The projections indicate a reduction in the total number of cyclones of -7.2% and -4.7% for RegA2 and RegB2, respectively, while HadAM3 reduction is -4.5% for both scenarios. The decrease is larger for initially intense cyclones (zeta <=-<= 2.5 x 10(-5) s-(1)): -20.9% (RegA2) and -11.3% (RegB2). For the lifetime, distance traveled and mean velocity of the cyclones, the A2 and B2 scenarios present mean values close to the present climate ( 3 days, 1900 km, and 9 m s(-1), respectively). Regarding the initial mean vorticity of the systems, RegB2 simulates values similar to the present climate, but they are initially weaker in RegA2. In general, RegA2 and RegB2 show a large decrease in the number of cyclones over the southern SAO due to an anticyclonic anomaly covering SAO between 30-55A degrees S. The reduction is larger in the scenario with higher concentrations of greenhouse gases (RegA2).