Tropical and extratropical responses of the North Atlantic atmospheric circulation to a sustained weakening of the MOC

The tropospheric response to a forced shutdown of the North Atlantic Ocean’s meridional overturning circulation (MOC) is investigated in a coupled ocean–atmosphere GCM [the third climate configuration of the Met Office Unified Model (HadCM3)]. The strength of the boreal winter North Atlantic storm track is significantly increased and penetrates much farther into western Europe. The changes in the storm track are shown to be consistent with the changes in near-surface baroclinicity, which can be linked to changes in surface temperature gradients near regions of sea ice formation and in the open ocean. Changes in the SST of the tropical Atlantic are linked to a strengthening of the subtropical jet to the north, which, combined with the enhanced storm track, leads to a pronounced split in the jet structure over Europe. EOF analysis and stationary box indices methods are used to analyze changes to the North Atlantic Oscillation (NAO). There is no consistent signal of a change in the variability of the NAO, and while the changes in the mean flow project onto the positive NAO phase, they are significantly different from it. However, there is a clear eastward shift of the NAO pattern in the shutdown run, and this potentially has implications for ocean circulation and for the interpretation of proxy paleoclimate records.

Health-related quality of life in Huntington's disease: a comparison of two generic instruments, SF-36 and SIP

Whereas several clinical endpoints in monitoring the response to treatment in patients with Huntington's disease (HD) have been explored, there has been a paucity of research in the quality of life in such patients. The aim of this study was to validate the use of two generic health-related quality of life instruments (the Short Form 36 health survey questionnaire [SF-36] and the Sickness Impact Profile [SIP]) and to evaluate their psychometric properties. We found that both instruments demonstrated acceptable convergent validity and reliability for patients and carers. However, there was an advantage in using the SF-36 because of its more robust construct validity and test-retest reliability; furthermore, motor symptoms appeared to influence some strictly nonmotor dimensions of the SIP. On a pragmatic level, the SF-36 is shorter and quicker to administer and, therefore, easier for patients at various stages of the disease to complete. Thus, the SF-36 would appear to be the recommended instrument of choice for patients with HD and their carers, although further work needs to be done to investigate the sensitivity of this instrument longitudinally. (C) 2004 Movement Disorder Society.

A model study of factors influencing projected changes in regional sea level over the 21st century

In addition to projected increases in global mean sea level over the 21st century, model simulations suggest there will also be changes in the regional distribution of sea level relative to the global mean. There is a considerable spread in the projected patterns of these changes by current models, as shown by the recent Intergovernmental Panel on Climate Change (IPCC) Fourth Assessment (AR4). This spread has not reduced from that given by the Third Assessment models. Comparison with projections by ensembles of models based on a single structure supports an earlier suggestion that models of similar formulation give more similar patterns of sea level change. Analysing an AR4 ensemble of model projections under a business-as-usual scenario shows that steric changes (associated with subsurface ocean density changes) largely dominate the sea level pattern changes. The relative importance of subsurface temperature or salinity changes in contributing to this differs from region to region and, to an extent, from model-to-model. In general, thermosteric changes give the spatial variations in the Southern Ocean, halosteric changes dominate in the Arctic and strong compensation between thermosteric and halosteric changes characterises the Atlantic. The magnitude of sea level and component changes in the Atlantic appear to be linked to the amount of Atlantic meridional overturning circulation (MOC) weakening. When the MOC weakening is substantial, the Atlantic thermosteric patterns of change arise from a dominant role of ocean advective heat flux changes.

Modelling of the natural chlorine cycling in a coniferous stand: implications for chlorine-36 behaviour in a contaminated forest environment

Considered as one of the most available radionuclide in soileplant system, 36Cl is of potential concern for long-term management of radioactive wastes, due to its high mobility and its long half-life. To evaluate the risk of dispersion and accumulation of 36Cl in the biosphere as a consequence of a potential contamination, there is a need for an appropriate understanding of the chlorine cycling dynamics in the ecosystems. To date, a small number of studies have investigated the chlorine transfer in the ecosystem including the transformation of chloride to organic chlorine but, to our knowledge, none have modelled this cycle. In this study, a model involving inorganic as well as organic pools in soils has been developed and parameterised to describe the biogeochemical fate of chlorine in a pine forest. The model has been evaluated for stable chlorine by performing a range of sensitivity analyses and by comparing the simulated to the observed values. Finally a range of contamination scenarios, which differ in terms of external supply, exposure time and source, has been simulated to estimate the possible accumulation of 36Cl within the different compartments of the coniferous stand. The sensitivity study supports the relevancy of the model and its compartments, and has highlighted the chlorine transfers affecting the most the residence time of chlorine in the stand. Compared to observations, the model simulates realistic values for the chlorine content within the different forest compartments. For both atmospheric and underground contamination scenarios most of the chlorine can be found in its organic form in the soil. However, in case of an underground source, about two times less chlorine accumulates in the system and proportionally more chlorine leaves the system through drainage than through volatilisation.

Self-reported symptoms and motor tests via telemetry in a 36-month levodopa-carbidopa intestinal gel infusion trial

Objective To investigate if a home environment test battery can be used to measure effects of Parkinson’s disease (PD) treatment intervention and disease progression. Background Seventy-seven patients diagnosed with advanced PD were recruited in an open longitudinal 36-month study at 10 clinics in Sweden and Norway; 40 of them were treated with levodopa-carbidopa intestinal gel (LCIG) and 37 patients were candidates for switching from oral PD treatment to LCIG. They utilized a mobile device test battery, consisting of self-assessments of symptoms and objective measures of motor function through a set of fine motor tests (tapping and spiral drawings), in their homes. Both the LCIG-naïve and LCIG-non-naïve patients used the test battery four times per day during week-long test periods. Methods Assessments The LCIG-naïve patients used the test battery at baseline (before LCIG), month 0 (first visit; at least 3 months after intraduodenal LCIG), and thereafter quarterly for the first year and biannually for the second and third years. The LCIG-non-naïve patients used the test battery from the first visit, i.e. month 0. Out of the 77 patients, only 65 utilized the test battery; 35 were LCIG-non-naïve and 30 LCIG-naïve. In 20 of the LCIG-naïve patients, assessments with the test battery were available during oral treatment and at least one test period after having started infusion treatment. Three LCIG-naïve patients did not use the test battery at baseline but had at least one test period of assessments thereafter. Hence, n=23 in the LCIG-naïve group. In total, symptom assessments in the full sample (including both patient groups) were collected during 379 test periods and 10079 test occasions. For 369 of these test periods, clinical assessments including UPDRS and PDQ-39 were performed in afternoons at the start of the test periods. The repeated measurements of the test battery were processed and summarized into scores representing patients’ symptom severities over a test period, using statistical methods. Six conceptual dimensions were defined; four subjectively-reported: ‘walking’, ‘satisfied’, ‘dyskinesia’, and ‘off’ and two objectively-measured: ‘tapping’ and ‘spiral’. In addition, an ‘overall test score’ (OTS) was defined to represent the global health condition of the patient during a test period. Statistical methods Change in the test battery scores over time, that is at baseline and follow-up test periods, was assessed with linear mixed-effects models with patient ID as a random effect and test period as a fixed effect of interest. The within-patient variability of OTS was assessed using intra-class correlation coefficient (ICC), for the two patient groups. Correlations between clinical rating scores and test battery scores were assessed using Spearman’s rank correlations (rho). Results In LCIG-naïve patients, mean OTS compared to baseline was significantly improved from the first test period on LCIG treatment until month 24. However, there were no significant changes in mean OTS scores of LCIG-non-naïve patients, except for worse mean OTS at month 36 (p<0.01, n=16). The mean scores of all subjectively-reported dimensions improved significantly throughout the course of the study, except ‘walking’ at month 36 (p=0.41, n=4). However, there were no significant differences in mean scores of objectively-measured dimensions between baseline and other test periods, except improved ‘tapping’ at month 6 and month 36, and ‘spiral’ at month 3 (p<0.05). The LCIG-naïve patients had a higher within-subject variability in their OTS scores (ICC=0.67) compared to LCIG-non-naïve patients (ICC=0.71). The OTS correlated adequately with total UPDRS (rho=0.59) and total PDQ-39 (rho=0.59). Conclusions In this 3-year follow-up study of advanced PD patients treated with LCIG we found that it is possible to monitor PD progression over time using a home environment test battery. The significant improvements in the mean OTS scores indicate that the test battery is able to measure functional improvement with LCIG sustained over at least 24 months.

Avaliação da qualidade de vida dos funcionários do cartório do 1º Ofício da cidade de Diamantino-MT através do questionário SF-36

O objetivo desta pesquisa foi analisar a qualidade de vida dos funcionários do Cartório de 1º Ofício da cidade de Diamantino, em Mato Grosso. Foi utilizada a versão brasileira do Short Form-36 (SF-36) em dez funcionários do Cartório de 1º Ofício, que colaboraram voluntariamente para a coleta da análise dos dados do questionário. O estudo obteve a análise dos oito domínios do escore do SF-36, onde pôde ser observado que o primeiro domínio, relativo à capacidade funcional, foi aquele que apresentou o maior escore, enquanto os demais domínios (D2, D3, D4, D5, D6, D7 e D8), respectivamente relacionados à saúde mental, também estão acima da metade do valor máximo esperado no escore do SF-36. O questionário SF-36 foi um instrumento adequado, de aplicação relativamente rápida e de fácil uso para a avaliação da qualidade de vida dos funcionários do Cartório de 1º Ofício, pois, na amostra estudada, os oito domínios apresentaram resultado médio entre 51,9 (menor escore = domínio 4) e 71,8 (maior escore = domínio 1).

Manifestações mucocutâneas de histoplasmose na AIDS : avaliação de 36 pacientes

Introdução: A histoplasmose é uma infecção geralmente subclínica e autolimitada em pacientes imunocompetentes. A maioria dos pacientes com HIV apresenta a forma disseminada da doença, considerada definidora de aids. As manifestações cutâneo-mucosas da histoplasmose são variadas, dificultando o diagnóstico. Métodos: Estudo retrospectivo de 24 pacientes com diagnóstico de histoplasmose, avaliados no serviço de Dermatologia do Hospital de Clínicas de Porto Alegre, de 2000 a 2003 e, prospectivamente, mais 12 pacientes, atendidos em 2004 e 2005. A análise considerou dados epidemiológicos e demográficos, bem como os parâmetros clínicos, distribuição e morfologia das lesões, contagem de células CD4+, terapia da micose e antirretroviral e se a doença foi a definidora de aids. Resultados: Vinte e seis (72%) doentes eram homens. A idade média foi 34 anos (17-58) e 16 pacientes (49%) tiveram seus diagnósticos realizados de dezembro a março, no verão. A histoplasmose foi confirmada por biópsia cutânea em 33 casos e por cultura em 23 deles. Onze pacientes recebiam antirretrovirais no momento do diagnóstico e a sua contagem de células CD4+ variou de 2 a 103 (média 29 células/mm³). Não houve diferenças significativas em relação a sexo, idade, método diagnóstico e uso de antirretrovirais entre a amostra retrospectiva e prospectiva. O número médio de lesões foi 2,7, variando de 1 a 7 tipos diferentes em um mesmo paciente. Pápulas com crosta e erosão/úlcera de mucosa foram as mais frequentes, em 64% e 58% dos pacientes, respectivamente. Uma distribuição difusa foi a mais comum, em mais de 58% dos casos. Houve uma associação significativa entre a contagem de células CD4+ e a variabilidade morfológica de lesões por paciente, sendo que um menor polimorfismo de lesões está associado a contagens mais baixas de células CD4+. Conclusão: A familiaridade com as manifestações dermatológicas da histoplasmose é importante para uma maior suspeição tanto da doença, quanto do próprio HIV. Pápulas com crostas difusas e erosão/úlcera de mucosa, no verão, em pacientes com aids e contagem de células CD4+ menor do que 50 células/ mm³ são achados muito sugestivos de histoplasmose. Porém, é de suma importância a realização de exames complementares para a exclusão dos outros diagnósticos diferenciais. A maior variabilidade morfológica das lesões nos pacientes com menor comprometimento imunológico (CD4 maior) poderia ser devido à necessidade de um certo grau de imunidade na gênese das lesões cutâneas.

Osteocondrite dissecante da cabeça do úmero em cães: Estudo retrospectivo de 36 casos (1991-1996)

A osteocondrite dissecante da cabeça do úmero (OCD) é uma condição patológica da cartilagem articular, decorrente de distúrbio da ossificação endocondral. Foram analisados 36 casos de OCD em cães com idades compreendidas entre 5 e 24 meses, observando-se maior representação entre machos comparados com fêmeas (3,5:1). A maioria destes animais (80,6%) tinha recebido suplementação alimentar. Oito cães foram tratados conservativamente através de repouso e restrição alimentar, enquanto os demais foram submetidos a intervenção cirúrgica por meio de artrotomia e remoção do retalho de superfície articular da cabeça do úmero. Concluiu-se que a predisposição de algumas raças, associada ao desequilíbrio nutricional durante os primeiros meses de vida, são as causas determinantes da OCD, e que a cirurgia é a melhor terapia a ser empregada.