Subclinical thyroid dysfunction and fracture risk: a meta-analysis.

IMPORTANCE Associations between subclinical thyroid dysfunction and fractures are unclear and clinical trials are lacking. OBJECTIVE To assess the association of subclinical thyroid dysfunction with hip, nonspine, spine, or any fractures. DATA SOURCES AND STUDY SELECTION The databases of MEDLINE and EMBASE (inception to March 26, 2015) were searched without language restrictions for prospective cohort studies with thyroid function data and subsequent fractures. DATA EXTRACTION Individual participant data were obtained from 13 prospective cohorts in the United States, Europe, Australia, and Japan. Levels of thyroid function were defined as euthyroidism (thyroid-stimulating hormone [TSH], 0.45-4.49 mIU/L), subclinical hyperthyroidism (TSH <0.45 mIU/L), and subclinical hypothyroidism (TSH ≥4.50-19.99 mIU/L) with normal thyroxine concentrations. MAIN OUTCOME AND MEASURES The primary outcome was hip fracture. Any fractures, nonspine fractures, and clinical spine fractures were secondary outcomes. RESULTS Among 70,298 participants, 4092 (5.8%) had subclinical hypothyroidism and 2219 (3.2%) had subclinical hyperthyroidism. During 762,401 person-years of follow-up, hip fracture occurred in 2975 participants (4.6%; 12 studies), any fracture in 2528 participants (9.0%; 8 studies), nonspine fracture in 2018 participants (8.4%; 8 studies), and spine fracture in 296 participants (1.3%; 6 studies). In age- and sex-adjusted analyses, the hazard ratio (HR) for subclinical hyperthyroidism vs euthyroidism was 1.36 for hip fracture (95% CI, 1.13-1.64; 146 events in 2082 participants vs 2534 in 56,471); for any fracture, HR was 1.28 (95% CI, 1.06-1.53; 121 events in 888 participants vs 2203 in 25,901); for nonspine fracture, HR was 1.16 (95% CI, 0.95-1.41; 107 events in 946 participants vs 1745 in 21,722); and for spine fracture, HR was 1.51 (95% CI, 0.93-2.45; 17 events in 732 participants vs 255 in 20,328). Lower TSH was associated with higher fracture rates: for TSH of less than 0.10 mIU/L, HR was 1.61 for hip fracture (95% CI, 1.21-2.15; 47 events in 510 participants); for any fracture, HR was 1.98 (95% CI, 1.41-2.78; 44 events in 212 participants); for nonspine fracture, HR was 1.61 (95% CI, 0.96-2.71; 32 events in 185 participants); and for spine fracture, HR was 3.57 (95% CI, 1.88-6.78; 8 events in 162 participants). Risks were similar after adjustment for other fracture risk factors. Endogenous subclinical hyperthyroidism (excluding thyroid medication users) was associated with HRs of 1.52 (95% CI, 1.19-1.93) for hip fracture, 1.42 (95% CI, 1.16-1.74) for any fracture, and 1.74 (95% CI, 1.01-2.99) for spine fracture. No association was found between subclinical hypothyroidism and fracture risk. CONCLUSIONS AND RELEVANCE Subclinical hyperthyroidism was associated with an increased risk of hip and other fractures, particularly among those with TSH levels of less than 0.10 mIU/L and those with endogenous subclinical hyperthyroidism. Further study is needed to determine whether treating subclinical hyperthyroidism can prevent fractures.

Thyroid function within the normal range and risk of coronary heart disease: an individual participant data analysis of 14 cohorts

IMPORTANCE Some experts suggest that serum thyrotropin levels in the upper part of the current reference range should be considered abnormal, an approach that would reclassify many individuals as having mild hypothyroidism. Health hazards associated with such thyrotropin levels are poorly documented, but conflicting evidence suggests that thyrotropin levels in the upper part of the reference range may be associated with an increased risk of coronary heart disease (CHD). OBJECTIVE To assess the association between differences in thyroid function within the reference range and CHD risk. DESIGN, SETTING, AND PARTICIPANTS Individual participant data analysis of 14 cohorts with baseline examinations between July 1972 and April 2002 and with median follow-up ranging from 3.3 to 20.0 years. Participants included 55,412 individuals with serum thyrotropin levels of 0.45 to 4.49 mIU/L and no previously known thyroid or cardiovascular disease at baseline. EXPOSURES Thyroid function as expressed by serum thyrotropin levels at baseline. MAIN OUTCOMES AND MEASURES Hazard ratios (HRs) of CHD mortality and CHD events according to thyrotropin levels after adjustment for age, sex, and smoking status. RESULTS Among 55,412 individuals, 1813 people (3.3%) died of CHD during 643,183 person-years of follow-up. In 10 cohorts with information on both nonfatal and fatal CHD events, 4666 of 48,875 individuals (9.5%) experienced a first-time CHD event during 533,408 person-years of follow-up. For each 1-mIU/L higher thyrotropin level, the HR was 0.97 (95% CI, 0.90-1.04) for CHD mortality and 1.00 (95% CI, 0.97-1.03) for a first-time CHD event. Similarly, in analyses by categories of thyrotropin, the HRs of CHD mortality (0.94 [95% CI, 0.74-1.20]) and CHD events (0.97 [95% CI, 0.83-1.13]) were similar among participants with the highest (3.50-4.49 mIU/L) compared with the lowest (0.45-1.49 mIU/L) thyrotropin levels. Subgroup analyses by sex and age group yielded similar results. CONCLUSIONS AND RELEVANCE Thyrotropin levels within the reference range are not associated with risk of CHD events or CHD mortality. This finding suggests that differences in thyroid function within the population reference range do not influence the risk of CHD. Increased CHD risk does not appear to be a reason for lowering the upper thyrotropin reference limit.

Subclinical Hypothyroidism and the Risk of Stroke Events and Fatal Stroke: An Individual Participant Data Analysis

OBJECTIVE The objective was to determine the risk of stroke associated with subclinical hypothyroidism. DATA SOURCES AND STUDY SELECTION Published prospective cohort studies were identified through a systematic search through November 2013 without restrictions in several databases. Unpublished studies were identified through the Thyroid Studies Collaboration. We collected individual participant data on thyroid function and stroke outcome. Euthyroidism was defined as TSH levels of 0.45-4.49 mIU/L, and subclinical hypothyroidism was defined as TSH levels of 4.5-19.9 mIU/L with normal T4 levels. DATA EXTRACTION AND SYNTHESIS We collected individual participant data on 47 573 adults (3451 subclinical hypothyroidism) from 17 cohorts and followed up from 1972-2014 (489 192 person-years). Age- and sex-adjusted pooled hazard ratios (HRs) for participants with subclinical hypothyroidism compared to euthyroidism were 1.05 (95% confidence interval [CI], 0.91-1.21) for stroke events (combined fatal and nonfatal stroke) and 1.07 (95% CI, 0.80-1.42) for fatal stroke. Stratified by age, the HR for stroke events was 3.32 (95% CI, 1.25-8.80) for individuals aged 18-49 years. There was an increased risk of fatal stroke in the age groups 18-49 and 50-64 years, with a HR of 4.22 (95% CI, 1.08-16.55) and 2.86 (95% CI, 1.31-6.26), respectively (p trend 0.04). We found no increased risk for those 65-79 years old (HR, 1.00; 95% CI, 0.86-1.18) or ≥ 80 years old (HR, 1.31; 95% CI, 0.79-2.18). There was a pattern of increased risk of fatal stroke with higher TSH concentrations. CONCLUSIONS Although no overall effect of subclinical hypothyroidism on stroke could be demonstrated, an increased risk in subjects younger than 65 years and those with higher TSH concentrations was observed.

Thyroid dysfunction and anemia in a large population-based study.

OBJECTIVE AND BACKGROUND Anemia and thyroid dysfunction are common and often co-occur. Current guidelines recommend the assessment of thyroid function in the work-up of anemia, although evidence on this association is scarce. PATIENTS AND METHODS In the "European Prospective Investigation of Cancer" (EPIC)-Norfolk population-based cohort, we aimed to examine the prevalence and type of anemia (defined as hemoglobin <13 g/dl for men and <12 g/dl for women) according to different thyroid function groups. RESULTS The mean age of the 8791 participants was 59.4 (SD 9.1) years and 55.2% were women. Thyroid dysfunction was present in 437 (5.0%) and anemia in 517 (5.9%) participants. After excluding 121 participants with three most common causes of anemia (chronic kidney disease, inflammation, iron deficiency), anemia was found in 4.7% of euthyroid participants. Compared with the euthyroid group, the prevalence of anemia was significantly higher in overt hyperthyroidism (14.6%, P < .01), higher with borderline significance in overt hypothyroidism (7.7%, P = .05) and not increased in subclinical thyroid dysfunction (5.0% in subclinical hypothyroidism, 3.3% in subclinical hyperthyroidism). Anemia associated with thyroid dysfunction was mainly normocytic (94.0%), and rarely macrocytic (6.0%). CONCLUSION The prevalence of anemia was higher in overt hyperthyroidism, but not increased in subclinical thyroid dysfunction. Systematic measurement of thyroid-stimulating hormone in anemic patients is likely to be useful only after excluding common causes of anemia.

Phthalate exposure among US women, NHANES 1999--2002: Relationship to serum gonadotropin levels

Phthalates are industrial chemicals used primarily as plasticizers though they and are found in a myriad of consumer goods such as children's toys, food packaging, dental sealants, cosmetics, pharmaceuticals, perfumes, and building materials. US biomonitoring data show more than 75% of the population have exposure to mono-n-butyl phthalate (MBP), mono-ethyl phthalate (MEP), mono-(2-ethyl) hexyl phthalate (MEHP), and mono-benzyl phthalate (MBZP). Reproductive toxicity from phthalate exposure in animal models has raised concerns about similar effects on fertility in humans. This dissertation research focuses on phthalate exposures in the US population and investigates the plausibility of an exposure-response relationship between phthalates and endocrine hormones essential for ovulation among US women. The objective of this research is to determine the relationship between levels of gonadotropins, follicle stimulating hormone (FSH) and leutinizing hormone (LH), and urinary phthalate monoester metabolites: MBP, MEP, MEHP, MBZP among National Health and Nutrition Examination Survey (NHANES) 1999-2002 women aged 35 to 60 years. Using biomarker data from a one-third sub-sample of NHANES participants, log transformed serum FSH and serum LH, respectively were regressed on phthalates controlling for age, body mass index, smoking, and creatinine taking into consideration the complex survey design (n=385). Models were stratified by reproductive status: reproductive (n=185), menopause transition (n=49) and post-menopausal (n=125). A decrease in FSH associated with increasing MBzP (beta=-0.094, p<0.05) was observed for all participants but no statistical association between log FSH and MBP, MEP, or MEHP was seen. A decrease in LH (beta=-0.125, p<0.05) was also observed with increasing MBzP for all participants though there was no relationship between levels of LH and MBP, MEP, or MEHP. The observed associations between FSH, LH and MBzP did not persist when stratified by reproductive status. Thus, the present study shows a change in endocrine hormones related to ovulation with increasing urinary MBzP among a representative sample of US women from 1999-2002 though this observed exposure-response relationship does not remain after stratification by reproductive status. ^

Adult weight gain and risk of colon cancer in men

Previous research supports the hypothesis that a "rich" diet (i.e., high in fat and low in fiber) increases the risk of colon cancer. Previous research also supports the hypothesis that physical inactivity increases the risk of colon cancer, perhaps because physical inactivity decreases gut motility, thereby increasing tee time that carcinogens are in contact with the intestinal mucosa. Habitual physical inactivity, combined with rich diet, ordinarily results in chronic energy imbalance and gain in weight, except when energy balance is modified by disease or factors such as cigarette smoking. Cigarette smokers typically stay lean because of effects of smoking on the resting metabolic rate as well as on efficiency of caloric intake and storage. Therefore, if physical inactivity and rich diet do increase the risk of colon cancer, then weight gain during young adulthood should be positively associated with incidence of colon cancer during later life, especially in nonsmokers.^ This hypothesis was investigated in a cohort of 2,059 randomly selected middle-aged men who were employed at the Western Electric Company in Chicago and were free of clinically diagnosed cancer at initial examination in 1958. Body mass index (BMI) in middle age was calculated from measured height and weight at the initial examination. BMI at age 20 was estimated from weight at age 20 as recalled at the initial examination and height as measured at the initial examination. Change in BMI between age 20 and middle age was estimated by subtracting the BMI at 20 from the BMI in middle age. Forty-nine incident cases of colon cancer were detected during 25 years (43,326 person-years) at risk. When stratified by level of change in BMI from age 20 to middle age ($\le$1.9, 2.0-3.9, 4.0-5.9, $\ge$6.0 kg/m$\sp2$), age-adjusted relative hazards of colon cancer in never-smokers were 1.00, 1.22, 2.31, and 5.01, respectively (p for trend = 0.008); corresponding values in ever-smokers were 1.00, 0.95, 0.77, and 0.87, These associations did not change appreciably after further adjustment for BMI at age 20, subscapular-triceps skinfold ratio, cigarette smoking, consumption of alcohol, energy, fat, and calcium.^ We also investigated the hypothesis that the risk of colon cancer was higher in men who were lean at age 20 and became fat by middle age (lean-to-fat) than in men who were fat at age 20 and stayed fat in middle-age (fat-to-fat). "Lean" was defined as BMI $<$24 kg/m$\sp2$ at age 20 and as BMI $<$27.0 kg/m$\sp2$ in middle age. Among never-smokers, in comparison to men who were lean at age 20 and in middle age (lean-to-lean), the age-adjusted relative hazard of colon cancer was 1.43 in the fat-to-fat group (95% confidence interval (CI) 0.37-5.52) and 3.36 in the lean-to-fat group (95% CI 1.21-9.37). This investigation provides new results on the magnitude of risk of colon cancer associated with weight gain during adulthood (from age 20 to middle age). This relation was obscured or underestimated in previous studies due to effect-modification by cigarette smoking. Finally, the result supports the idea that a life-style characterized by chronic energy imbalance during young adulthood increases risk of colon cancer. ^

Safety, feasibility, and long-term results of percutaneous closure of atrial septal defects using the Amplatzer septal occluder without periprocedural echocardiography.

OBJECTIVES We sought to assess the safety and efficacy of percutaneous closure of atrial septal defects (ASDs) under fluoroscopic guidance only, without periprocedural echocardiographic guidance. BACKGROUND Percutaneous closure of ASDs is usually performed using simultaneous fluoroscopic and transthoracic, transesophageal (TEE), or intracardiac echocardiographic (ICE) guidance. However, TEE requires deep sedation or general anesthesia, which considerably lengthens the procedure. TEE and ICE increase costs. METHODS Between 1997 and 2008, a total of 217 consecutive patients (age, 38 ± 22 years; 155 females and 62 males), of whom 44 were children ≤16 years, underwent percutaneous ASD closure with an Amplatzer ASD occluder (AASDO). TEE guidance and general anesthesia were restricted to the children, while devices were implanted under fluoroscopic guidance only in the adults. For comparison of technical safety and feasibility of the procedure without echocardiographic guidance, the children served as a control group. RESULTS The implantation procedure was successful in all but 3 patients (1 child and 2 adults; 1.4%). Mean device size was 23 ± 8 mm (range, 4-40 mm). There was 1 postprocedural complication (0.5%; transient perimyocarditis in an adult patient). At last echocardiographic follow-up, 13 ± 23 months after the procedure, 90% of patients had no residual shunt, whereas a minimal, moderate, or large shunt persisted in 7%, 1%, and 2%, respectively. Four adult patients (2%) underwent implantation of a second device for a residual shunt. During a mean follow-up period of 3 ± 2 years, 2 deaths and 1 ischemic stroke occurred. CONCLUSION According to these results, percutaneous ASD closure using the AASDO without periprocedural echocardiographic guidance seems safe and feasible.

Pressure measurements of the detachment bubble on the Bolund Island

Pressure measurements on the surface of a 1:230 scale model of Bolund Island are presented. The model is smooth and no boundary layer generation has been considered since the experiment is designed as the simplest possible reference case. Measurement have been taken for a range of Reynolds numbers based on the average undisturbed wind speed U∞ and the maximum height of the island, h [1.7×104, 8.5×104], and for a range of wind directions. Four minutes time series of pressure in more than 400 points have been acquired and analysed to obtain the spatial distribution of both the time average and the variance of the pressure signal. The horizontal extension of the detachment bubble for the different Reynolds numbers and wind directions is identified by isobars and curves of constant value of pressure variance. The applicability of this technique for evaluating the horizontal topology of high turbulence regions associated to detachment bubbles after escarpments in potential wind farm sites is analysed. The results obtained shows that the behaviour of the mean pressure coefficient, Cp, the std. pressure coefficient, Cp, and the skewness of the pressure, Sp can be used to study the bubble over the island to a certain extent. This experiment is part of the set of different analysis on the Bolund test case that is being undertaken within WAUDIT project by the different scientific groups.

Pressure measurements of the detachment bubble on the Bolund Island

Pressure measurements on the surface of a 1:230 scale model of Bolund Island are presented. The model is smooth and no boundary layer generation has been considered since the experiment is designed as the simplest possible reference case. Measurement have been taken for a range of Reynolds numbers based on the average undisturbed wind speed U? and the maximum height of the island, h [1.7×104 , 8.5×104], and for a range of wind directions. Four minutes time series of pressure in more than 400 points have been acquired and analysed to obtain the spatial distribution of both the time average and the variance of the pressure signal. The horizontal extension of the detachment bubble for the different Reynolds numbers and wind directions is identified by isobars and curves of constant value of pressure variance. The applicability of this technique for evaluating the horizontal topology of high turbulence regions associated to detachment bubbles after escarpments in potential wind farm sites is analysed. The results obtained shows that the behaviour of the mean pressure coefficient, Cp, the std. pressure coefficient, C?p, and the skewness of the pressure, Sp can be used to study the bubble over the island to a certain extent. This experiment is part of the set of different analysis on the Bolund test case that is being undertaken within WAUDIT project by the different scientific groups.

Reproducing the Bolund experiment in wind tunnel

The Bolund experiment has been reproduced in a neutral boundary layer wind tunnel (WT) at scale 1:115 for two Reynolds numbers. All the results have been obtained for an incoming flow from the 270o wind direction (transect B in the Bolund experiment jargon). Vertical scans of the velocity field are obtained using non-time resolved two components particle image velocimetry. Time-resolved velocity time series with a three component hot-wire probe have been also measured for transects at 2 and 5 m height and in the vertical transects at met masts M6, M3 and M8 locations. Special attention has been devoted to the detailed characterization of the inflow in order to reduce uncertainties in future comparisons with other physical and numerical simulations. Emphasis is placed on the analysis of spectral functions of the undisturbed flow and those of the flow above the island. The result?s reproducibility and trustworthiness have been addressed through redundancy measurements using particle image velocimetry, two and three components hot-wire anemometry. The bias in the prediction of the mean speed is similar to the one reported during the Bolund experiment by the physical modellers. However, certain reduction of the bias in the estimation of the turbulent kinetic energy is achieved. TheWT results of spectra and cosprectra have revealed a behaviour similar to the full-scale measurements in some relevant locations, showing that WT modelling can contribute to provide valid information about these important structural loading factors.

Wind tunnel analysis of the flow topology over complex topographies

El principal objetivo de este trabajo es aportar conocimiento para contestar la pregunta: ¿hasta que punto los ensayos en túnel aerodinámico pueden contribuir a determinar las características que afectan la respuesta dinámica de los aerogeneradores operando en terreno complejo?. Esta pregunta no es nueva, de hecho, el debate en la comunidad científica comenzó en el primer tercio del siglo pasado y aún está intensamente vivo. El método generalmente aceptado para enfrentar el mencionado problema consiste en analizar un caso de estudio determinado en el cual se aplican tanto ensayos a escala real como análisis computacionales y ensayos en túnel aerodinámico. Esto no es ni fácil ni barato. Esta es la razón por la cual desde el experimento de Askervein en 1988, los modelizadores del flujo atmosférico tuvieron que esperar hasta 2007 a que el experimento de Bolund fuese puesto en marcha con un despliegue de medios técnicos equivalentes (teniendo en cuenta la evolución de las tecnologías de sensores y computación). El problema contempla tantos aspectos que ambas experiencias fueron restringidas a condiciones de atmósfera neutra con efectos de Coriolis despreciables con objeto de reducir la complejidad. Este es el contexto en el que se ha desarrollado la presente tesis doctoral. La topología del flujo sobre la isla de Bolund ha sido estudiada mediante la reproducción del experimento de Bolund en los túneles aerodinámicos A9 y ACLA16 del IDR. Dos modelos de la isla de Bolund fueron fabricados a dos escalas, 1:230 y 1:115. El flujo de entrada en el túnel aerodinámico simulando la capa límite sin perturbar correspondía a régimen de transición (transitionally rough regime) y fue usado como situación de referencia. El modelo a escala 1:230 fue ensayado en el túnel A9 para determinar la presión sobre su superficie. La distribución del coeficiente de presión sobre la isla proporcionó una visualización y estimación de una región de desprendimiento sobre el pequeño acantilado situado al frente de la misma. Las medidas de presión instantánea con suficiente grado de resolución temporal pusieron de manifiesto la no estacionariedad en la región de desprendimiento. El modelo a escala 1:115 fue ensayado utilizando hilo caliente de tres componentes y un sistema de velocimetría por imágenes de partículas de dos componentes. El flujo fue caracterizado por el ratio de aceleración, el incremento normalizado de energía cinética turbulenta y los ángulos de inclinación y desviación horizontal. Los resultados a lo largo de la dirección 270°y alturas de 2 m y 5 m presentaron una gran similitud con los resultados a escala real del experimento de Bolund. Los perfiles verticales en las localizaciones de las torres meteorológicas mostraron un acuerdo significativo con los resultados a escala real. El análisis de los esfuerzos de Reynolds y el análisis espectral en las localizaciones de los mástiles meteorológicos presentaron niveles de acuerdo variados en ciertas posiciones, mientras que en otras presentaron claras diferencias. El mapeo horizontal del flujo, para una dirección de viento de 270°, permitió caracterizar el comportamiento de la burbuja intermitente de recirculación sobre el pequeño acantilado existente al frente de la isla así como de la región de relajación y de la capa de cortadura en la región corriente abajo de Bolund. Se realizaron medidas de velocidad con alta resolución espacial en planos perpendiculares a la dirección del flujo sin perturbar. Estas medidas permitieron detectar y caracterizar una estructura de flujo similar a un torbellino longitudinal con regiones con altos gradientes de velocidad y alta intensidad de turbulencia. Esta estructura de flujo es, sin duda, un reto para los modelos computacionales y puede considerarse un factor de riesgo para la operación de los aerogeneradores. Se obtuvieron y analizaron distribuciones espaciales de los esfuerzos de Reynolds mediante 3CHW y PIV. Este tipo de parámetros no constituyen parte de los resultados habituales en los ensayos en túnel sobre topografías y son muy útiles para los modelizadores que utilizan simulación de grades torbellinos (LES). Se proporciona una interpretación de los resultados obtenidos en el túnel aerodinámico en términos de utilidad para los diseñadores de parques eólicos. La evolución y variación de los parámetros del flujo a lo largo de líneas, planos y superficies han permitido identificar como estas propiedades del flujo podrían afectar la localización de los aerogeneradores y a la clasificación de emplazamientos. Los resultados presentados sugieren, bajo ciertas condiciones, la robustez de los ensayos en túnel para estudiar la topología sobre terreno complejo y su comparabilidad con otras técnicas de simulación, especialmente considerando el nivel de acuerdo del conjunto de resultados presentados con los resultados a escala real. De forma adicional, algunos de los parámetros del flujo obtenidos de las medidas en túnel son difícilmente determinables en ensayos a escala real o por medios computacionales, considerado el estado del arte. Este trabajo fue realizado como parte de las actividades subvencionadas por la Comisión Europea como dentro del proyecto FP7-PEOPLE-ITN-2008WAUDIT (Wind Resource Assessment Audit and Standardization) dentro de la FP7 Marie-Curie Initial Training Network y por el Ministerio Español de Economía y Competitividad dentro del proyecto ENE2012-36473, TURCO (Determinación en túnel aerodinámico de la distribución espacial de parámetros estadísticos de la turbulencia atmosférica sobre topografías complejas) del Plan Nacional de Investigación (Subprograma de investigación fundamental no orientada 2012). El informe se ha organizado en siete capítulos y un conjunto de anexos. En el primer capítulo se introduce el problema. En el capítulo dos se describen los medios experimentales utilizados. Seguidamente, en el capítulo tres, se analizan en detalle las condiciones de referencia del principal túnel aerodinámico utilizado en esta investigación. En el capítulo tres se presentan resultados de ensayos de presión superficial sobre un modelo de la isla. Los principales resultados del experimento de Bolund se reproducen en el capítulo cinco. En el capítulo seis se identifican diferentes estructuras del flujo sobre la isla y, finalmente, en el capitulo siete, se recogen las conclusiones y una propuesta de lineas de trabajo futuras. ABSTRACT The main objective of this work is to contribute to answer the question: to which extend can the wind tunnel testing contribute to determine the flow characteristics that affect the dynamic response of wind turbines operating in highly complex terrains?. This question is not new, indeed, the debate in the scientific community was opened in the first third of the past century and it is still intensely alive. The accepted approach to face this problem consists in analysing a given case study where full-scale tests, computational modelling and wind tunnel testing are applied to the same topography. This is neither easy nor cheap. This is is the reason why since the Askervein experience in 1988, the atmospheric flow modellers community had to wait till 2007 when the Bolund experiment was setup with a deployment of technical means equivalent (considering the evolution of the sensor and computing techniques). The problem is so manifold that both experiences were restricted to neutral conditions without Coriolis effects in order to reduce the complexity. This is the framework in which this PhD has been carried out. The flow topology over the Bolund Island has been studied by replicating the Bolund experiment in the IDR A9 and ACLA16 wind tunnels. Two mock-ups of the Bolund island were manufactured at two scales of 1:230 and 1:115. The in-flow in the empty wind tunnel simulating the incoming atmospheric boundary layer was in the transitionally rough regime and used as a reference case. The 1:230 model was tested in the A9 wind tunnel to measure surface pressure. The mapping of the pressure coefficient across the island gave a visualisation and estimation of a detachment region on the top of the escarpment in front of the island. Time resolved instantaneous pressure measurements illustrated the non-steadiness in the detachment region. The 1:115 model was tested using 3C hot-wires(HW) and 2C Particle Image Velocimetry(PIV). Measurements at met masts M3, M6, M7 and M8 and along Line 270°were taken to replicate the result of the Bolund experiment. The flow was characterised by the speed-up ratio, normalised increment of the turbulent kinetic energy, inclination angle and turning angle. Results along line 270°at heights of 2 m and 5 m compared very well with the full-scale results of the Bolund experiment. Vertical profiles at the met masts showed a significant agreement with the full-scale results. The analysis of the Reynolds stresses and the spectral analysis at the met mast locations gave a varied level of agreement at some locations while clear mismatch at others. The horizontal mapping of the flow field, for a 270°wind direction, allowed to characterise the behaviour of the intermittent recirculation bubble on top of the front escarpment followed by a relaxation region and the presence of a shear layer in the lee side of the island. Further detailed velocity measurements were taken at cross-flow planes over the island to study the flow structures on the island. A longitudinal vortex-like structure with high mean velocity gradients and high turbulent kinetic energy was characterised on the escarpment and evolving downstream. This flow structure is a challenge to the numerical models while posing a threat to wind farm designers when siting wind turbines. Spatial distribution of Reynold stresses were presented from 3C HW and PIV measurements. These values are not common results from usual wind tunnel measurements and very useful for modellers using large eddy simulation (LES). An interpretation of the wind tunnel results in terms of usefulness to wind farm designers is given. Evolution and variation of the flow parameters along measurement lines, planes and surfaces indicated how the flow field could affect wind turbine siting. Different flow properties were presented so compare the level of agreement to full-scale results and how this affected when characterising the site wind classes. The results presented suggest, under certain conditions, the robustness of the wind tunnel testing for studying flow topology over complex terrain and its capability to compare to other modelling techniques especially from the level of agreement between the different data sets presented. Additionally, some flow parameters obtained from wind tunnel measurements would have been quite difficult to be measured at full-scale or by computational means considering the state of the art. This work was carried out as a part of the activities supported by the EC as part of the FP7- PEOPLE-ITN-2008 WAUDIT project (Wind Resource Assessment Audit and Standardization) within the FP7 Marie-Curie Initial Training Network and by the Spanish Ministerio de Economía y Competitividad, within the framework of the ENE2012-36473, TURCO project (Determination of the Spatial Distribution of Statistic Parameters of Flow Turbulence over Complex Topographies in Wind Tunnel) belonging to the Spanish National Program of Research (Subprograma de investigación fundamental no orientada 2012). The report is organised in seven chapters and a collection of annexes. In chapter one, the problem is introduced. In chapter two the experimental setup is described. Following, in chapter three, the inflow conditions of the main wind tunnel used in this piece of research are analysed in detail. In chapter three, preliminary pressure tests results on a model of the island are presented. The main results from the Bolund experiment are replicated in chapter five. In chapter six, an identification of specific flow strutures over the island is presented and, finally, in chapter seven, conclusions and lines for future works related to the presented one are included.

Effects of the water level on the flow topology over the Bolund island.

We have analyzed the influence of the actual height of Bolund island above water level on different full-scale statistics of the velocity field over the peninsula. Our analysis is focused on the database of 10-minute statistics provided by Risø-DTU for the Bolund Blind Experiment. We have considered 10-minut.e periods with near-neutral atmospheric conditions, mean wind speed values in the interval [5,20] m/s, and westerly wind directions. As expected, statistics such as speed-up, normalized increase of turbulent kinetic energy and probability of recirculating flow show a large dependence on the emerged height of the island for the locations close to the escarpment. For the published ensemble mean values of speed-up and normalized increase of turbulent kinetic energy in these locations, we propose that some ammount of uncertainty could be explained as a deterministic dependence of the flow field statistics upon the actual height of the Bolund island above the sea level.

Bone mineral density and incidence of stroke: European Prospective Investigation into Caner-Norfolk population-based study, systematic review and meta-analysis : European Prospective Investigation into Cancer - Norfolk population–based study, systematic review, and meta-analysis

Peer reviewed