The FReedom from Ischemic Events-New Dimensions for Survival (FRIENDS) registry: design of a prospective cohort study of patients with advanced peripheral artery disease.

BACKGROUND Advanced lower extremity peripheral artery disease (PAD), whether presenting as acute limb ischemia (ALI) or chronic critical limb ischemia (CLI), is associated with high rates of cardiovascular ischemic events, amputation, and death. Past research has focused on strategies of revascularization, but few data are available that prospectively evaluate the impact of key process of care factors (spanning pre-admission, acute hospitalization, and post-discharge) that might contribute to improving short and long-term health outcomes. METHODS/DESIGN The FRIENDS registry is designed to prospectively evaluate a range of patient and health system care delivery factors that might serve as future targets for efforts to improve limb and systemic outcomes for patients with ALI or CLI. This hypothesis-driven registry was designed to evaluate the contributions of: (i) pre-hospital limb ischemia symptom duration, (ii) use of leg revascularization strategies, and (iii) use of risk-reduction pharmacotherapies, as pre-specified factors that may affect amputation-free survival. Sequential patients would be included at an index "vascular specialist-defined" ALI or CLI episode, and patients excluded only for non-vascular etiologies of limb threat. Data including baseline demographics, functional status, co-morbidities, pre-hospital time segments, and use of medical therapies; hospital-based use of revascularization strategies, time segments, and pharmacotherapies; and rates of systemic ischemic events (e.g., myocardial infarction, stroke, hospitalization, and death) and limb ischemic events (e.g., hospitalization for revascularization or amputation) will be recorded during a minimum of one year follow-up. DISCUSSION The FRIENDS registry is designed to evaluate the potential impact of key factors that may contribute to adverse outcomes for patients with ALI or CLI. Definition of new "health system-based" therapeutic targets could then become the focus of future interventional clinical trials for individuals with advanced PAD.

Solar forcing of North Atlantic surface temperature and salinity over the past millennium

There were several centennial-scale fluctuations in the climate and oceanography of the North Atlantic region over the past 1,000 years, including a period of relative cooling from about AD 1450 to 1850 known as the Little Ice Age1. These variations may be linked to changes in solar irradiance, amplified through feedbacks including the Atlantic meridional overturning circulation2. Changes in the return limb of the Atlantic meridional overturning circulation are reflected in water properties at the base of the mixed layer south of Iceland. Here we reconstruct thermocline temperature and salinity in this region from AD 818 to 1780 using paired δ18O and Mg/Ca ratio measurements of foraminifer shells from a subdecadally resolved marine sediment core. The reconstructed centennial-scale variations in hydrography correlate with variability in total solar irradiance. We find a similar correlation in a simulation of climate over the past 1,000 years. We infer that the hydrographic changes probably reflect variability in the strength of the subpolar gyre associated with changes in atmospheric circulation. Specifically, in the simulation, low solar irradiance promotes the development of frequent and persistent atmospheric blocking events, in which a quasi-stationary high-pressure system in the eastern North Atlantic modifies the flow of the westerly winds. We conclude that this process could have contributed to the consecutive cold winters documented in Europe during the Little Ice Age.

Spatial gradients of temperature, accumulation and delta18O-ice in Greenland over a series of Dansgaard-Oeschger events

Air and water stable isotope measurements from four Greenland deep ice cores (GRIP, GISP2, NGRIP and NEEM) are investigated over a series of Dansgaard–Oeschger events (DO 8, 9 and 10), which are representative of glacial millennial scale variability. Combined with firn modeling, air isotope data allow us to quantify abrupt temperature increases for each drill site (1σ = 0.6 °C for NEEM, GRIP and GISP2, 1.5 °C for NGRIP). Our data show that the magnitude of stadial–interstadial temperature increase is up to 2 °C larger in central and North Greenland than in northwest Greenland: i.e., for DO 8, a magnitude of +8.8 °C is inferred, which is significantly smaller than the +11.1 °C inferred at GISP2. The same spatial pattern is seen for accumulation increases. This pattern is coherent with climate simulations in response to reduced sea-ice extent in the Nordic seas. The temporal water isotope (δ18O)–temperature relationship varies between 0.3 and 0.6 (±0.08) ‰ °C−1 and is systematically larger at NEEM, possibly due to limited changes in precipitation seasonality compared to GISP2, GRIP or NGRIP. The gas age−ice age difference of warming events represented in water and air isotopes can only be modeled when assuming a 26% (NGRIP) to 40% (GRIP) lower accumulation than that derived from a Dansgaard–Johnsen ice flow model.

Structure and inferred dynamics of a large grove of Microberlinia bisulcata trees in central African rain forest: the possible role of periods of multiple disturbance events

A 272-ha grove of dominant Microberlinia bisulcata (Caesalpinioideae) adult trees greater than or equal to 50 cm stem diameter was mapped in its entirety in the southern part of Korup National Park, Cameroon. The approach used an earlier-established 82.5-ha permanent plot with a new surrounding 50-m grid of transect lines. Tree diameters were available from the plot but trees on the grid were recorded as being greater than or equal to 50 cm. The grove consisted of 1028 trees in 2000. Other species occurred within the grove. including the associated subdominants Tetraberlinia bifoliolata and T. korupensis. Microberlinia bisulcata becomes adult at a stein diameter of c. 50 cm and at an estimated age of 50 y. Three oval-shaped subgroves with dimensions c. 8 50 in x 13 50 in (90 ha) were defined. For two of them (within the plot) tree diameters were available. Subgroves differed in their scales and intensities of spatial tree patterns, and in their size frequency distributions, these suggesting differing past dynamics. The modal scale of clumping was 40-50 m. Seed dispersal by pod ejection (to c. 50 in) was evident from the semi-circles of trees at the grove's edge and from the many internal circles (100-200 m diameter). The grove has the capacity. therefore, to increase at c. 100 m per century. To form its present extent and structure. it is inferred that it expanded and infilled from a possibly smaller area of lower adult-tree density. This possibly happened in three waves of recruitment, each one determined by a period of several intense disturbances. Climate records for Africa show that 1740-50 and 1820-30 were periods of drought, and that 1870-1895 was also regionally very dry. Canopy openings allow the light-demanding and fast-growing ectomycorrhizal M. bisulcata to establish, but successive releases are thought to be required to achieve effective recruitment. Nevertheless, in the last 50 y there were no major events and recruitment in the grove was very poor. This present study leads to a new hypothesis of the role of periods of multiple extreme events being the driving factor for the population dynamics of many large African tree species such as M. bisulcata.

The effect of cumulating exposure to abacavir on the risk of cardiovascular disease events in patients from the Swiss HIV Cohort Study.

BACKGROUND Patients with HIV exposed to the antiretroviral drug abacavir may have an increased risk of cardiovascular disease (CVD). There is concern that this association arises because of a channelling bias. Even if exposure is a risk, it is not clear how that risk changes as exposure cumulates. METHODS We assess the effect of exposure to abacavir on the risk of CVD events in the Swiss HIV Cohort Study. We use a new marginal structural Cox model to estimate the effect of abacavir as a flexible function of past exposures while accounting for risk factors that potentially lie on a causal pathway between exposure to abacavir and CVD. RESULTS 11,856 patients were followed for a median of 6.6 years; 365 patients had a CVD event (4.6 events per 1000 patient years). In a conventional Cox model, recent - but not cumulative - exposure to abacavir increased the risk of a CVD event. In the new marginal structural Cox model, continued exposure to abacavir during the past four years increased the risk of a CVD event (hazard ratio 2.06, 95% confidence interval 1.43-2.98). The estimated function for the effect of past exposures suggests that exposure during the past 6 to 36 months caused the greatest increase in risk. CONCLUSIONS Abacavir increases the risk of a CVD event: the effect of exposure is not immediate, rather the risk increases as exposure cumulates over the past few years. This gradual increase in risk is not consistent with a rapidly acting mechanism, such as acute inflammation.

Depositional modes and lake-level variability at Lake Towuti, Indonesia, during the past ~29 kyr BP

Lake Towuti (2.5°S, 121.5°E) is a long-lived, tectonic lake located on the Island of Sulawesi, Indonesia, and in the center of the Indo-Pacific warm pool (IPWP). Lake Towuti is connected with upstream lakes Matano and Mahalona through the Mahalona River, which constitutes the largest inlet to the lake. The Mahalona River Delta is prograding into Lake Towuti’s deep northern basin thus exerting significant control on depositional processes in the basin. We combine high-resolution seismic reflection and sedimentological datasets from a 19.8-m-long sediment piston core from the distal edge of this delta to characterize fluctuations in deltaic sedimentation during the past ~29 kyr BP and their relation to climatic change. Our datasets reveal that, in the present, sedimentation is strongly influenced by deposition of laterally transported sediments sourced from the Mahalona River Delta. Variations in the amount of laterally transported sediments, as expressed by coarse fraction amounts in pelagic muds and turbidite recurrence rates and cumulative thicknesses, are primarily a function of lake-level induced delta slope instability and delta progradation into the basin. We infer lowest lake-levels between ~29 and 16, a gradual lake level rise between ~16 and 11, and high lake-levels between ~11 and 0 kyr BP. Periods of highest turbidite deposition, ~26 to 24 and ~18 to 16 kyr BP coincide with Heinrich events 2 and 1, respectively. Our lake-level reconstruction therefore supports previous observations based on geochemical hydroclimate proxies of a very dry last glacial and a wet Holocene in the region, and provides new evidence of millennial-scale variations in moisture balance in the IPWP.

Adolescent Meaning Making of Past Experience

This study examined the meaning making processes of self-defining memories in adolescents, as well as how they co-construct the narratives of these events with their parents. The sample consisted of 53 students, aged 12-14, who came in for recorded laboratory sessions to discuss self-defining memories with their parents. These sessions were later coded on levels of meaning making and co-construction. These codes were, then, analyzed with the adolescents’ questionnaire scores regarding friendship quality, internalizing, and externalizing behaviors. The data revealed that adolescents and parents were both rated higher for more complex levels of meaning making and that those rated higher for more complex meaning making abilities had better friendship qualities. The implications of these findings were discussed in terms of their importance for parents supporting their children’s emotional expressivity, narrative abilities, and meaning making strategies.

The effect of life events on blood pressure and body mass index in children

In Conroe, Texas, 492 students ages 5 to 15 participated in a screening examination for cardiovascular risk factor study. Among 492 students, 141 elementary and junior high students participated in the present sub-study to investigate the effect of the number of recent life events on blood pressure and on body mass index. Using the elementary and junior high school Coddington scales, life events occurring in the past 12 months were measured for students ages 9 to 14 years, no significant differences in life events were observed by age and sex. The number of life events was not related to blood pressure but was positively correlated to body mass index in children and adolescents. ^

Age determination and Heinrich Events in sediment cores SU90-08 and KET80-03

The Mediterranean Sea hydrology at the time of the Heinrich formation in the North Atlantic Ocean was analyzed by comparing sea surface temperatures (SSTs) and oxygen isotope composition of seawater (dw) changes during the past 75 kyr in two marine cores. These were compared to the palynological variations derived in the Mediterranean Sea core. During the last glacial the two oceanic SST records show similar and synchronous patterns, with several long-term cooling periods, ending by abrupt SST increases. At the time of the Heinrich events, cold SSTs and low salinity prevailed in the Mediterranean Sea. The freshwater budget was similar to the modern one, permitting the presence of a mixed forest on the Mediterranean borderlands. The post-Heinrich periods are marked by a freshwater budget decrease, limiting oak and fir tree growth in the Mediterranean region. Increase of precipitation or reduction of evaporation is observed before the Heinrich episode, and is associated with a well-developed mixed Mediterranean forest.

Planktic foraminiferal Mg/Ca and oxygen isotopes, plus estimated d18Oseawater and ice volume corrected d18Oseawater for the past 35000 years of sediment core GeoB10069-3

Evidence from geologic archives suggests that there were large changes in the tropical hydrologic cycle associated with the two prominent northern hemisphere deglacial cooling events, Heinrich Stadial 1 (HS1; ~19 to 15 kyr BP; kyr BP = 1000 yr before present) and the Younger Dryas (~12.9 to 11.7 kyr BP). These hydrologic shifts have been alternatively attributed to high and low latitude origin. Here, we present a new record of hydrologic variability based on planktic foraminifera-derived d18O of seawater (d18Osw) estimates from a sediment core from the tropical Eastern Indian Ocean, and using 12 additional d18Osw records, construct a single record of the dominant mode of tropical Eastern Equatorial Pacific and Indo-Pacific Warm Pool (IPWP) hydrologic variability. We show that deglacial hydrologic shifts parallel variations in the reconstructed interhemispheric temperature gradient, suggesting a strong response to variations in the Atlantic Meridional Overturning Circulation and the attendant heat redistribution. A transient model simulation of the last deglaciation suggests that hydrologic changes, including a southward shift in the Intertropical Convergence Zone (ITCZ) which likely occurred during these northern hemisphere cold events, coupled with oceanic advection and mixing, resulted in increased salinity in the Indonesian region of the IPWP and the eastern tropical Pacific, which is recorded by the d18Osw proxy. Based on our observations and modeling results we suggest the interhemispheric temperature gradient directly controls the tropical hydrologic cycle on these time scales, which in turn mediates poleward atmospheric heat transport.

Radiolarian events in the eastern Equatorial Pacific

The development of an orbitally tuned time scale for the ODP leg 138 sites provides biostratigraphers a very high resolution chronostratigraphic framework. With this framework we are better able to define which of the first and last appearances of species appear to be synchronous. In addition, the geographic distribution of sites provides the means with which the detailed spatial patterns of invasion of new species and the extinction of older species can be mapped. These maps not only provide information on the process of evolution, migration, and extinction, they can also be related to water mass distributions and near-surface circulation of the ocean. Of 39 radiolarian events studied at 11 sites in the eastern equatorial Pacific, 28 were found to have a minimum range in their estimated age that exceeded 0.15 m.y. The temporal pattern of first and last appearances of these diachronous events have coherent spatial patterns that indicate shifts in the areas of high oceanographic gradients over the past 10 Ma. These changes in the locations of high gradient regions suggest that the South Equatorial Current (SEC) was north of its present position prior to approximately 7 Ma. There was a southward shift in the northern boundary of this current between approximately 6 and 7 Ma, and the development of a relatively strong gradient between the northeastern and northwestern sites. Between approximately 3.7 and 3.4 Ma, there was a very slight northward shift in the northern boundary of the SEC and the steep gradients between the northeastern and northwestern sites may have disappeared. This change is thought to be associated with the closing of the Isthmus of Panama. The temporal-spatial patterns of diachronous events younger than 3.4 Ma are consistent with patterns of circulation in the modern ocean.

Core characteristics and events detected in ice cores from Svalbard

Ice coring and snow cover observations have been carried out at 3 sites in Nordaustlandet, Svalbard since 1995. The results of stratigraphic analyses, and chemical and d18O analyses from Vestfonna and Austfonna cores are presented here. The results from these sites show that most of the chemical constituents contained in the initial snow cover still remained in the ice cores, although re-distribution of them by melt water percolation had occurred. Anthropogenic increases in trace metals, sulfate and nitrate since about 1950 are detected. This suggests that ice-core chemistry records from Nordaustlandet, Svalbard, can be useful to reconstruct past atmospheric conditions. In addition to chemical records, records, that correlate well with the temperature records in Svalbard, can be used to reconstruct past temperature changes.

Holocene DBD and Ti/LOI timeseries from Lake Hajeren on Svalbard, indicators of past glacier activity

The Arctic is warming faster than anywhere else on Earth. Holocene proxy time-series are increasingly used to put this amplified response in perspective by understanding Arctic climate processes beyond the instrumental period. However, available datasets are scarce, unevenly distributed and often of coarse resolution. Glaciers are sensitive recorders of climate shifts and variations in rock-flour production transfer this signal to the lacustrine sediment archives of downstream lakes. Here, we present the first full Holocene record of continuous glacier variability on Svalbard from glacier-fed Lake Hajeren. This reconstruction is based on an undisturbed lake sediment core that covers the entire Holocene and resolves variability on centennial scales owing to 26 dating points. A toolbox of physical, geochemical (XRF) and magnetic proxies in combination with multivariate statistics has allowed us to fingerprint glacier activity in addition to other processes affecting the sediment record. Evidence from variations in sediment density, validated by changes in Ti concentrations, reveal glaciers remained present in the catchment following deglaciation prior to 11,300 cal BP, culminating in a Holocene maximum between 9.6 and 9.5 ka cal BP. Correspondence with freshwater pulses from Hudson Strait suggests that Early Holocene glacier advances were driven by the melting Laurentide Ice Sheet (LIS). We find that glaciers disappeared from the catchment between 7.4 and 6.7 ka cal BP, following a late Hypsithermal. Glacier reformation around 4250 cal BP marks the onset of the Neoglacial, supporting previous findings. Between 3380 and 3230 cal BP, we find evidence for a previously unreported centennial-scale glacier advance. Both events are concurrent with well-documented episodes of North Atlantic cooling. We argue that this brief forcing created suitable conditions for glaciers to reform in the catchment against a background of gradual orbital cooling. These findings highlight the climate-sensitivity of the small glaciers studied, which rapidly responded to climate shifts. The start of prolonged Neoglacial glacier activity commenced during the Little Ice Age (LIA) around 700 cal BP, in agreement with reported advances from other glaciers on Svalbard. In conclusion, this study proposes a three-stage Holocene climate history of Svalbard, successively driven by LIS meltwater pulses, episodic Atlantic cooling and declining summer insolation.

Records of past mid-depth ventilation: Cretaceous ocean anoxic event 2 vs. recent oxygen minimum zones

Present day oceans are well ventilated, with the exception of mid-depth oxygen minimum zones (OMZs) under high surface water productivity, regions of sluggish circulation, and restricted marginal basins. In the Mesozoic, however, entire oceanic basins transiently became dysoxic or anoxic. The Cretaceous ocean anoxic events (OAEs) were characterised by laminated organic-carbon rich shales and low-oxygen indicating trace fossils preserved in the sedimentary record. Yet assessments of the intensity and extent of Cretaceous near-bottom water oxygenation have been hampered by deep or long-term diagenesis and the evolution of marine biota serving as oxygen indicators in today's ocean. Sedimentary features similar to those found in Cretaceous strata were observed in deposits underlying Recent OMZs, where bottom-water oxygen levels, the flux of organic matter, and benthic life have been studied thoroughly. Their implications for constraining past bottom-water oxygenation are addressed in this review. We compared OMZ sediments from the Peruvian upwelling with deposits of the late Cenomanian OAE 2 from the north-west African shelf. Holocene laminated sediments are encountered at bottom-water oxygen levels of < 7 µmol/kg under the Peruvian upwelling and < 5 µmol/kg in California Borderland basins and the Pakistan Margin. Seasonal to decadal changes of sediment input are necessary to create laminae of different composition. However, bottom currents may shape similar textures that are difficult to discern from primary seasonal laminae. The millimetre-sized trace fossil Chondrites was commonly found in Cretaceous strata and Recent oxygen-depleted environments where its diameter increased with oxygen levels from 5 to 45 µmol/kg. Chondrites has not been reported in Peruvian sediments but centimetre-sized crab burrows appeared around 10 µmol/kg, which may indicate a minimum oxygen value for bioturbated Cretaceous strata. Organic carbon accumulation rates ranged from 0.7 and 2.8 g C /cm2 /kyr in laminated OAE 2 sections in Tarfaya Basin, Morocco, matching late Holocene accumulation rates of laminated Peruvian sediments under Recent oxygen levels below 5 µmol/kg. Sediments deposited at > 10 µmol/kg showed an inverse exponential relationship of bottom-water oxygen levels and organic carbon accumulation depicting enhanced bioirrigation and decomposition of organic matter with increased oxygen supply. In the absence of seasonal laminations and under conditions of low burial diagenesis, this relationship may facilitate quantitative estimates of palaeo-oxygenation. Similarities and differences between Cretaceous OAEs and late Quaternary OMZs have to be further explored to improve our understanding of sedimentary systems under hypoxic conditions.