201 resultados para Coronary circulation


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A low resolution coupled ocean-atmosphere general circulation model OAGCM is used to study the characteristics of the large scale ocean circulation and its climatic impacts in a series of global coupled aquaplanet experiments. Three configurations, designed to produce fundamentally different ocean circulation regimes, are considered. The first has no obstruction to zonal flow, the second contains a low barrier that blocks zonal flow in the ocean at all latitudes, creating a single enclosed basin, whilst the third contains a gap in the barrier to allow circumglobal flow at high southern latitudes. Warm greenhouse climates with a global average air surface temperature of around 27C result in all cases. Equator to pole temperature gradients are shallower than that of a current climate simulation. Whilst changes in the land configuration cause regional changes in temperature, winds and rainfall, heat transports within the system are little affected. Inhibition of all ocean transport on the aquaplanet leads to a reduction in global mean surface temperature of 8C, along with a sharpening of the meridional temperature gradient. This results from a reduction in global atmospheric water vapour content and an increase in tropical albedo, both of which act to reduce global surface temperatures. Fitting a simple radiative model to the atmospheric characteristics of the OAGCM solutions suggests that a simpler atmosphere model, with radiative parameters chosen a priori based on the changing surface configuration, would have produced qualitatively different results. This implies that studies with reduced complexity atmospheres need to be guided by more complex OAGCM results on a case by case basis.

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An idealised Pangean configuration is integrated in a coupled ocean atmosphere general circulation model to investigate the form of the ocean circulation and its impacts on the large scale climate system. A vigorous, hemispherically symmetric overturning is found, driven by deep water formation at high latitudes. Whilst the peak mass transport is around 100Sv, a low vertical temperature gradient in the ocean means that the maximum heat transport is only 1.2PW. The geographical change in the coupled model is found to produce a global average warming of 2°C, despite an increase in global surface albedo. This occurs through changes in the atmospheric water vapour and cloud distributions. There is also reduction in the equator-pole temperature gradient, largely attributable to the same causes, avoiding the paradox of low meridional temperature gradients without increased polar heat transport.

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On the time scale of a century, the Atlantic thermohaline circulation (THC) is sensitive to the global surface salinity distribution. The advection of salinity toward the deep convection sites of the North Atlantic is one of the driving mechanisms for the THC. There is both a northward and a southward contributions. The northward salinity advection (Nsa) is related to the evaporation in the subtropics, and contributes to increased salinity in the convection sites. The southward salinity advection (Ssa) is related to the Arctic freshwater forcing and tends on the contrary to diminish salinity in the convection sites. The THC changes results from a delicate balance between these opposing mechanisms. In this study we evaluate these two effects using the IPSL-CM4 ocean-atmosphere-sea-ice coupled model (used for IPCC AR4). Perturbation experiments have been integrated for 100 years under modern insolation and trace gases. River runoff and evaporation minus precipitation are successively set to zero for the ocean during the coupling procedure. This allows the effect of processes Nsa and Ssa to be estimated with their specific time scales. It is shown that the convection sites in the North Atlantic exhibit various sensitivities to these processes. The Labrador Sea exhibits a dominant sensitivity to local forcing and Ssa with a typical time scale of 10 years, whereas the Irminger Sea is mostly sensitive to Nsa with a 15 year time scale. The GIN Seas respond to both effects with a time scale of 10 years for Ssa and 20 years for Nsa. It is concluded that, in the IPSL-CM4, the global freshwater forcing damps the THC on centennial time scales.

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The effect of fluctuating daily surface fluxes on the time-mean oceanic circulation is studied using an empirical flux model. The model produces fluctuating fluxes resulting from atmospheric variability and includes oceanic feedbacks on the fluxes. Numerical experiments were carried out by driving an ocean general circulation model with three different versions of the empirical model. It is found that fluctuating daily fluxes lead to an increase in the meridional overturning circulation (MOC) of the Atlantic of about 1 Sv and a decrease in the Antarctic circumpolar current (ACC) of about 32 Sv. The changes are approximately 7% of the MOC and 16% of the ACC obtained without fluctuating daily fluxes. The fluctuating fluxes change the intensity and the depth of vertical mixing. This, in turn, changes the density field and thus the circulation. Fluctuating buoyancy fluxes change the vertical mixing in a non-linear way: they tend to increase the convective mixing in mostly stable regions and to decrease the convective mixing in mostly unstable regions. The ACC changes are related to the enhanced mixing in the subtropical and the mid-latitude Southern Ocean and reduced mixing in the high-latitude Southern Ocean. The enhanced mixing is related to an increase in the frequency and the depth of convective events. As these events bring more dense water downward, the mixing changes lead to a reduction in meridional gradient of the depth-integrated density in the Southern Ocean and hence the strength of the ACC. The MOC changes are related to more subtle density changes. It is found that the vertical mixing in a latitudinal strip in the northern North Atlantic is more strongly enhanced due to fluctuating fluxes than the mixing in a latitudinal strip in the South Atlantic. This leads to an increase in the density difference between the two strips, which can be responsible for the increase in the Atlantic MOC.

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Objectives We examined the characteristics and CHD risks of people who accessed the free Healthy Heart Assessment (HHA) service operated by a large UK pharmacy chain from August 2004 to April 2006. Methods Associations between participants’ gender, age, and socioeconomics were explored in relation to calculated 10-year CHD risks by cross-tabulation of the data. Specific associations were tested by forming contingency tables and using Pearson chi-square (χ2). Results Data from 8,287 records were analysable; 5,377 were at low and 2,910 at moderate-to-high CHD risk. The likelihood of moderate-to-high risk for a male versus female participant was significantly higher with a relative risk ratio (RRR) 1.72 (P < 0.001). A higher percentage of those in socioeconomic categories ‘constrained by circumstances’ (RRR 1.15; P < 0.05) and ‘blue collar communities’ (RRR 1.13; P < 0.05) were assessed with moderate-to-high risk compared to those in ‘prospering suburbs’. Conclusions People from ‘hard-to-reach’ sectors of the population, men and people from less advantaged communities, accessed the HHA service and were more likely to return moderate-to-high CHD risk. Pharmacists prioritised provision of lifestyle information above the sale of a product. Our study supports the notion that pharmacies can serve as suitable environments for the delivery of similar screening services.

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Introduction Health promotion (HP) aims to enhance good health while preventing ill-health at three levels of activity; primary (preventative), secondary (diagnostic) and tertiary (management).1 It can range from simple provision of health education to ongoing support, but the effectiveness of HP is ultimately dependent on its ability to influence change. HP as part of the Community Pharmacy Contract (CPC) aims to increase public knowledge and target ‘hard-to-reach’ individuals by focusing mainly on primary and tertiary HP. The CPC does not include screening programmes (secondary HP) as a service. Coronary heart disease (CHD) is a significant cause of morbidity and mortality in the UK. While there is evidence to support the effectiveness of some community pharmacy HP strategies in CHD, there is paucity of research in relation to screening services.2 Against this background, Alliance Pharmacy introduced a free CHD risk screening programme to provide tailored HP advice as part of a participant–pharmacist consultation. The aim of this study is to report on the CHD risk levels of participants and to provide a qualitative indication of consultation outcomes. Methods Case records for 12 733 people who accessed a free CHD risk screening service between August 2004 and April 2006 offered at 217 community pharmacies were obtained. The service involved initial self-completion of the Healthy Heart Assessment (HHA) form and measurement of height, weight, body mass index, blood pressure, total cholesterol and highdensity lipoprotein levels by pharmacists to calculate CHD risk.3 Action taken by pharmacists (lifestyle advice, statin recommendation or general practitioner (GP) referral) and qualitative statements of advice were recorded, and a copy provided to the participants. The service did not include follow-up of participants. All participants consented to taking part in evaluations of the service. Ethical committee scrutiny was not required for this service development evaluation. Results Case records for 10 035 participants (3658 male) were evaluable; 5730 (57%) were at low CHD risk (<15%); 3636 (36%) at moderate-to-high CHD risk (≥15%); and 669 (7%) had existing heart disease. A significantly higher proportion of male (48% versus 30% female) participants were at moderate- to-high risk of CHD (chi-square test; P < 0.005). A range of outcomes resulted from consultations. Lifestyle advice was provided irrespective of participants’ CHD risk or existing disease. In the moderate-to-high-risk group, of which 52% received prescribed medication, lifestyle advice was recorded for 62%, 16% were referred and 34% were advised to have a re-assessment. Statin recommendations were made in 1% of all cases. There was evidence of supportive and motivational statements in the advice recorded. Discussion Pharmacists were able to identify individuals’ level of CHD risk and provide them with bespoke advice. Identification of at-risk participants did not automatically result in referrals or statin recommendation. One-third of those accessing the screening service had moderate-to-high risk of CHD, a significantly higher proportion of whom were men. It is not known whether these individuals had been previously exposed to HP but presumably by accessing this service they may have contemplated change. As effectiveness of HP advice will depend among other factors on ability to influence change, future consultations may need to explore patients’ attitude towards change in relation to the Trans Theoretical Model4 to better tailor HP advice. The high uptake of the service by those at moderate-to-high CHD risk indicates a need for this type of screening programme in community pharmacy, perhaps specifically to reach men who access medical services less.

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Here we make an initial step toward the development of an ocean assimilation system that can constrain the modelled Atlantic Meridional Overturning Circulation (AMOC) to support climate predictions. A detailed comparison is presented of 1° and 1/4° resolution global model simulations with and without sequential data assimilation, to the observations and transport estimates from the RAPID mooring array across 26.5° N in the Atlantic. Comparisons of modelled water properties with the observations from the merged RAPID boundary arrays demonstrate the ability of in situ data assimilation to accurately constrain the east-west density gradient between these mooring arrays. However, the presence of an unconstrained "western boundary wedge" between Abaco Island and the RAPID mooring site WB2 (16 km offshore) leads to the intensification of an erroneous southwards flow in this region when in situ data are assimilated. The result is an overly intense southward upper mid-ocean transport (0–1100 m) as compared to the estimates derived from the RAPID array. Correction of upper layer zonal density gradients is found to compensate mostly for a weak subtropical gyre circulation in the free model run (i.e. with no assimilation). Despite the important changes to the density structure and transports in the upper layer imposed by the assimilation, very little change is found in the amplitude and sub-seasonal variability of the AMOC. This shows that assimilation of upper layer density information projects mainly on the gyre circulation with little effect on the AMOC at 26° N due to the absence of corrections to density gradients below 2000 m (the maximum depth of Argo). The sensitivity to initial conditions was explored through two additional experiments using a climatological initial condition. These experiments showed that the weak bias in gyre intensity in the control simulation (without data assimilation) develops over a period of about 6 months, but does so independently from the overturning, with no change to the AMOC. However, differences in the properties and volume transport of North Atlantic Deep Water (NADW) persisted throughout the 3 year simulations resulting in a difference of 3 Sv in AMOC intensity. The persistence of these dense water anomalies and their influence on the AMOC is promising for the development of decadal forecasting capabilities. The results suggest that the deeper waters must be accurately reproduced in order to constrain the AMOC.

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Measurements of anthropogenic tracers such as chlorofluorocarbons and tritium must be quantitatively combined with ocean general circulation models as a component of systematic model development. The authors have developed and tested an inverse method, using a Green's function, to constrain general circulation models with transient tracer data. Using this method chlorofluorocarbon-11 and -12 (CFC-11 and -12) observations are combined with a North Atlantic configuration of the Miami Isopycnic Coordinate Ocean Model with 4/3 degrees resolution. Systematic differences can be seen between the observed CFC concentrations and prior CFC fields simulated by the model. These differences are reduced by the inversion, which determines the optimal gas transfer across the air-sea interface, accounting for uncertainties in the tracer observations. After including the effects of unresolved variability in the CFC fields, the model is found to be inconsistent with the observations because the model/data misfit slightly exceeds the error estimates. By excluding observations in waters ventilated north of the Greenland-Scotland ridge (sigma (0) < 27.82 kg m(-3); shallower than about 2000 m), the fit is improved, indicating that the Nordic overflows are poorly represented in the model. Some systematic differences in the model/data residuals remain and are related, in part, to excessively deep model ventilation near Rockall and deficient ventilation in the main thermocline of the eastern subtropical gyre. Nevertheless, there do not appear to be gross errors in the basin-scale model circulation. Analysis of the CFC inventory using the constrained model suggests that the North Atlantic Ocean shallower than about 2000 m was near 20% saturated in the mid-1990s. Overall, this basin is a sink to 22% of the total atmosphere-to-ocean CFC-11 flux-twice the global average value. The average water mass formation rates over the CFC transient are 7.0 and 6.0 Sv (Sv = 10(6) m(3) s(-1)) for subtropical mode water and subpolar mode water, respectively.

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The multidecadal variability of El Niño–Southern Oscillation (ENSO)–South Asian monsoon relationship is elucidated in a 1000 year control simulation of a coupled general circulation model. The results indicate that the Atlantic Multidecadal Oscillation (AMO), resulting from the natural fluctuation of the Atlantic Meridional Overturning Circulation (AMOC), plays an important role in modulating the multidecadal variation of the ENSO-monsoon relationship. The sea surface temperature anomalies associated with the AMO induce not only significant climate impact in the Atlantic but also the coupled feedbacks in the tropical Pacific regions. The remote responses in the Pacific Ocean to a positive phase of the AMO which is resulted from enhanced AMOC in the model simulation and are characterized by statistically significant warming in the North Pacific and in the western tropical Pacific, a relaxation of tropical easterly trades in the central and eastern tropical Pacific, and a deeper thermocline in the eastern tropical Pacific. These changes in mean states lead to a reduction of ENSO variability and therefore a weakening of the ENSO-monsoon relationship. This study suggests a nonlocal mechanism for the low-frequency fluctuation of the ENSO-monsoon relationship, although the AMO explains only a fraction of the ENSO–South Asian monsoon variation on decadal-multidecadal timescale. Given the multidecadal variation of the AMOC and therefore of the AMO exhibit decadal predictability, this study highlights the possibility that a part of the change of climate variability in the Pacific Ocean and its teleconnection may be predictable.