Effect of hypobaric hypoxia, simulating conditions during long-haul air travel, on coagulation, fibrinolysis, platelet function, and endothelial activation

CONTEXT: The link between long-haul air travel and venous thromboembolism is the subject of continuing debate. It remains unclear whether the reduced cabin pressure and oxygen tension in the airplane cabin create an increased risk compared with seated immobility at ground level. OBJECTIVE: To determine whether hypobaric hypoxia, which may be encountered during air travel, activates hemostasis. DESIGN, SETTING, AND PARTICIPANTS: A single-blind, crossover study, performed in a hypobaric chamber, to assess the effect of an 8-hour seated exposure to hypobaric hypoxia on hemostasis in 73 healthy volunteers, which was conducted in the United Kingdom from September 2003 to November 2005. Participants were screened for factor V Leiden G1691A and prothrombin G20210A mutation and were excluded if they tested positive. Blood was drawn before and after exposure to assess activation of hemostasis. INTERVENTIONS: Individuals were exposed alternately (> or =1 week apart) to hypobaric hypoxia, similar to the conditions of reduced cabin pressure during commercial air travel (equivalent to atmospheric pressure at an altitude of 2438 m), and normobaric normoxia (control condition; equivalent to atmospheric conditions at ground level, circa 70 m above sea level). MAIN OUTCOME MEASURES: Comparative changes in markers of coagulation activation, fibrinolysis, platelet activation, and endothelial cell activation. RESULTS: Changes were observed in some hemostatic markers during the normobaric exposure, attributed to prolonged sitting and circadian variation. However, there were no significant differences between the changes in the hypobaric and the normobaric exposures. For example, the median difference in change between the hypobaric and normobaric exposure was 0 ng/mL for thrombin-antithrombin complex (95% CI, -0.30 to 0.30 ng/mL); -0.02 [corrected] nmol/L for prothrombin fragment 1 + 2 (95% CI, -0.03 to 0.01 nmol/L); 1.38 ng/mL for D-dimer (95% CI, -3.63 to 9.72 ng/mL); and -2.00% for endogenous thrombin potential (95% CI, -4.00% to 1.00%). CONCLUSION: Our findings do not support the hypothesis that hypobaric hypoxia, of the degree that might be encountered during long-haul air travel, is associated with prothrombotic alterations in the hemostatic system in healthy individuals at low risk of venous thromboembolism.

An event-based approach to understanding decadal fluctuations in the Atlantic meridional overturning circulation

Many previous studies have shown that unforced climate model simulations exhibit decadal-scale fluctuations in the Atlantic meridional overturning circulation (AMOC), and that this variability can have impacts on surface climate fields. However, the robustness of these surface fingerprints across different models is less clear. Furthermore, with the potential for coupled feedbacks that may amplify or damp the response, it is not known whether the associated climate signals are linearly related to the strength of the AMOC changes, or if the fluctuation events exhibit nonlinear behaviour with respect to their strength or polarity. To explore these questions, we introduce an objective and flexible method for identifying the largest natural AMOC fluctuation events in multicentennial/multimillennial simulations of a variety of coupled climate models. The characteristics of the events are explored, including their magnitude, meridional coherence and spatial structure, as well as links with ocean heat transport and the horizontal circulation. The surface fingerprints in ocean temperature and salinity are examined, and compared with the results of linear regression analysis. It is found that the regressions generally provide a good indication of the surface changes associated with the largest AMOC events. However, there are some exceptions, including a nonlinear change in the atmospheric pressure signal, particularly at high latitudes, in HadCM3. Some asymmetries are also found between the changes associated with positive and negative AMOC events in the same model. Composite analysis suggests that there are signals that are robust across the largest AMOC events in each model, which provides reassurance that the surface changes associated with one particular event will be similar to those expected from regression analysis. However, large differences are found between the AMOC fingerprints in different models, which may hinder the prediction and attribution of such events in reality.

Spatial and temporal variations of the seasonal sea level cycle in the northwest Pacific

The seasonal sea level variations observed from tide gauges over 1900-2013 and gridded satellite altimeter product AVISO over 1993-2013 in the northwest Pacific have been explored. The seasonal cycle is able to explain 60-90% of monthly sea level variance in the marginal seas, while it explains less than 20% of variance in the eddy-rich regions. The maximum annual and semi-annual sea level cycles (30cm and 6cm) are observed in the north of the East China Sea and the west of the South China Sea respectively. AVISO was found to underestimate the annual amplitude by 25% compared to tide gauge estimates along the coasts of China and Russia. The forcing for the seasonal sea level cycle was identified. The atmospheric pressure and the steric height produce 8-12cm of the annual cycle in the middle continental shelf and in the Kuroshio Current regions separately. The removal of the two attributors from total sea level permits to identify the sea level residuals that still show significant seasonality in the marginal seas. Both nearby wind stress and surface currents can explain well the long-term variability of the seasonal sea level cycle in the marginal seas and the tropics because of their influence on the sea level residuals. Interestingly, the surface currents are a better descriptor in the areas where the ocean currents are known to be strong. Here, they explain 50-90% of inter-annual variability due to the strong links between the steric height and the large-scale ocean currents.