Transitory increased blood pressure after upper airway surgery for snoring and sleep apnea correlates with the apnea-hypopnea respiratory disturbance index

A transitory increase in blood pressure (BP) is observed following upper airway surgery for obstructive sleep apnea syndrome but the mechanisms implicated are not yet well understood. The objective of the present study was to evaluate changes in BP and heart rate (HR) and putative factors after uvulopalatopharyngoplasty and septoplasty in normotensive snorers. Patients (N = 10) were instrumented for 24-h ambulatory BP monitoring, nocturnal respiratory monitoring and urinary catecholamine level evaluation one day before surgery and on the day of surgery. The influence of postsurgery pain was prevented by analgesic therapy as confirmed using a visual analog scale of pain. Compared with preoperative values, there was a significant (P < 0.05) increase in nighttime but not daytime systolic BP (119 ± 5 vs 107 ± 3 mmHg), diastolic BP (72 ± 4 vs 67 ± 2 mmHg), HR (67 ± 4 vs 57 ± 2 bpm), respiratory disturbance index (RDI) characterized by apnea-hypopnea (30 ± 10 vs 13 ± 4 events/h of sleep) and norepinephrine levels (22.0 ± 4.7 vs 11.0 ± 1.3 µg l-1 12 h-1) after surgery. A positive correlation was found between individual variations of BP and individual variations of RDI (r = 0.81, P < 0.01) but not between BP or RDI and catecholamines. The visual analog scale of pain showed similar stress levels on the day before and after surgery (6.0 ± 0.8 vs 5.0 ± 0.9 cm, respectively). These data strongly suggest that the cardiovascular changes observed in patients who underwent uvulopalatopharyngoplasty and septoplasty were due to the increased postoperative RDI.

Community-based transconjunctival marginal rotation for cicatricial trachoma in Indians from the Upper Rio Negro basin

The objective of the present study was to describe, for the first time in Brazil, the use by a non-ophthalmologist of a community-based marginal rotation procedure by a posterior approach in the indigenous population from the Upper Rio Negro basin. Seventy-three upper eyelids of 46 Indians (11 males and 35 females) with cicatricial upper eyelid entropion and trichiasis were operated in the Indian communities using a marginal rotational procedure by a posterior approach by a non-ophthalmologist physician who had general surgery experience but only an extremely short period (one week) of ophthalmic training. Subjects were reevaluated 6 months after surgery. Results were classified according to the presence and location of residual trichiasis and symptoms were assessed according to a three-level subjective scale (better, worse or no change). Fifty-six eyelids (76.7%) were free from trichiasis, whereas residual trichiasis was observed in 17 eyelids (23.3%) of 10 subjects. In these cases, trichiasis was either lateral or medial to the central portion of the lid. Of these 10 patients, only 4 reported that the surgery did not improve the irritative symptoms. We conclude that marginal rotation by a posterior approach is an effective and simple procedure with few complications, even when performed by non-specialists. Due to its simplicity the posterior approach is an excellent option for community-based upper eyelid entropion surgery.

Trilobites of the Upper Cambrian (Marjuman) Pika formation of the Southern Canadian Rocky Mountains

The Upper Cambrian Pika Formation in the southern Canadian Rocky Mountains forms a complete lithologic Grand Cycle. The overall pattern of deposition is one of shallowing upwards from a subtidal, muddy, storm-influenced basin to a shallow carbonate bank. The Pika passes gradationally into the overlying inter- to supratidal siliciclastics of the Arctomys Formation. This transition probably reflects a fall in relative sea level. 2 Twenty seven collections from three sections yielded trilobites. The faunas are assigned to two low-diversity biofacies: the Marjumia - Spencella Biofacies and the GZyphaspis - menomoniid Biofacies. In contrast to biofacies of deeper, open-shelf environments, such as the Wheeler and Marjum formations of Utah, the Pika biofacies lack agnostid trilobites. Consequently, agnostid-based zonations defined elsewhere in North America cannot be applied to the Pika and a new sequence of three zones and one informal fauna is proposed for use in inner shelf facies. Eleven species belonging to six genera are described and illustrated. The species Marjumia bagginsi is new. Other genera present are: Bolaspidella, Knechtelia, GZyphaspis and Spencella, in addition to a number of indeterminate forms

Associations between area-level unemployment, body mass index, and risk factors for cardiovascular disease in an urban area

INTRODUCTION: Il existe peu d’évidences sur l’association entre le taux de chômage dans le milieu résidentiel (CR) et le risque de maladies cardiovasculaires parmi les résidents de milieux urbains. De plus, on ne sait pas si ce lien diffère entre les deux sexes. Cette thèse a pour objectif de déterminer la direction et la taille de l’association entre le CR et le risque de maladies cardiovasculaires, et d’examiner si cette association varie en fonction du sexe. MÉTHODES: Un sous-échantillon de 342 participants de l’Étude sur les habitudes de vie et la santé dans les quartiers montréalais a rapporté ses habitudes de vie et sa situation socio-économique. Des mesures biologiques et anthropométriques ont été recueillies par une infirmière. Le CR a été opérationnalisé en fonction d’une zone-tampon d’un rayon de 250 m centrée sur la résidence de chacun des participants à l’aide d’un Système d’Information Géographique (SIG). Des équations d’estimation généralisées ont été utilisées afin d’estimer l’association entre le CR et l’Indice de Masse Corporelle (IMC) et un score cumulatif de Risque Cardio-métabolique (RC) représentant la présence de valeurs élevées de cholestérol total, de triglycérides, de lipoprotéines de haute densité et d’hémoglobine glyquée. RÉSULTATS: Après ajustement pour l’âge, le sexe, le tabagisme, les comportements de santé et le statut socio-économique, le fait de vivre dans un endroit classé dans le 3e ou 4e quartile de CR était associé avec un IMC plus élevé (beta pour Q4 = 2.1 kg/m2, IC 95%: 1.02-3.20; beta pour Q3 = 1.5 kg/m2, IC 95%: 0.55-2.47) et un taux plus élevé de risque cardiovasculaires Risque Relatif [RR pour Q4 = 1.82 (IC 95 %: 1.35-2.44); RR pour Q3 = 1.66 (IC 95%: 1.33-2.06)] par rapport au 1er quartile. L'interaction entre le sexe et le CR révèle une différence absolue d’IMC de 1.99 kg/m2 (IC 95%: 0.00-4.01) et un risque supérieur (RR=1.39; IC 95%: 1.06-1.81) chez les femmes par rapport aux hommes. CONCLUSIONS: Le taux de chômage dans le milieux résidentiel est associé à un plus grand risque de maladies cardiovasculaires, mais cette association est plus prononcée chez les femmes.

Studies on the Vertical Structure of Horizontal Wind Variability in the Surface Boundary Layer Over Sriharikota

The present study on the vertical structure of horizontal wind variability in the surface boundary layer over Sriharikota. Based on clock wind speed and direction measuring meteorological tower facility from seven levels in the 100 m layer. The study on wind variability and elliptical approximation of wind hodographs investigated for this tropical coastal station established that Sriharikota is of meso-scale weather entity. Wind variability ratio increases from lower levels to upper levels. In South West monsoon months the station is of high ratio values and it gets affected with meso-scale weather features like thunderstorms. Average total shears are observed greater values than scalar shears. Scalar shears are high in the lowest shear levels compared to upper levels. Semi diurnal types of oscillation in average total shears are found in south west monsoon months. During cyclonic storm passage it is observed that there can be significant difference in mean wind speed from 10 m to 100 m level, but it is not so for peak wind speeds. The variations in wind variability ratio in different months is clearly depicted its strong link to define meso-scale or synoptic –scale forcing domination for this station. Meso-scale forcing is characterized by diurnal wind variability and synoptic- scale forcing by interdiurnal wind variability.

Low Level Jet stream of Asian Summer Monsoon and its Variability

The main objective of the of present study are to study the intraseasonal variability of LLJ and its relation with convective heating of the atmosphere, to establish whether LLJ splits into two branches over the Arabian sea as widely believed, the role of horizonatal wind shear of LLJ in the episodes of intense rainfall events observed over the west coast of India, to perform atmospheric modeling work to test whether small (meso) scale vortices form during intense rainfall events along the west coast; and to study the relation between LLJ and monsoon depression genesis. The results of a study on the evolution of Low Level Jetstream (LLJ) prior to the formation of monsoon depressions are presented. A synoptic model of the temporal evolution of monsoon depression has been produced. There is a systematic temporal evolution of the field of deep convection strength and position of the LLJ axis leading to the genesis of monsoon depression. One of the significant outcomes of the present thesis is that the LLJ plays an important role in the intraseasonal and the interannual variability of Indian monsoon activity. Convection and rainfall are dependent mainly on the cyclonic vorticity in the boundary layer associated with LLJ. Monsoon depression genesis and the episodes of very heavy rainfall along the west coast of India are closely related to the cyclonic shear of the LLJ in the boundary layer and the associated deep convection. Case studies by a mesoscale numerical model (MM5) have shown that the heavy rainfall episodes along the west coast of India are associated with generation of mesoscale cyclonic vortices in the boundary layer.

A new perspective on Southern hemisphere storm-tracks.

A detailed view of Southern Hemisphere storm tracks is obtained based on the application of filtered variance and modern feature-tracking techniques to a wide range of 45-yr European Centre for Medium-Range Weather Forecasts (ECMWF) Re-Analysis (ERA-40) data. It has been checked that the conclusions drawn in this study are valid even if data from only the satellite era are used. The emphasis of the paper is on the winter season, but results for the four seasons are also discussed. Both upper- and lower-tropospheric fields are used. The tracking analysis focuses on systems that last longer than 2 days and are mobile (move more than 1000 km). Many of the results support previous ideas about the storm tracks, but some new insights are also obtained. In the summer there is a rather circular, strong, deep high-latitude storm track. In winter the high-latitude storm track is more asymmetric with a spiral from the Atlantic and Indian Oceans in toward Antarctica and a subtropical jet–related lower-latitude storm track over the Pacific, again tending to spiral poleward. At all times of the year, maximum storm activity in the higher-latitude storm track is in the Atlantic and Indian Ocean regions. In the winter upper troposphere, the relative importance of, and interplay between, the subtropical and subpolar storm tracks is discussed. The genesis, lysis, and growth rate of lower-tropospheric winter cyclones together lead to a vivid picture of their behavior that is summarized as a set of overlapping plates, each composed of cyclone life cycles. Systems in each plate appear to feed the genesis in the next plate through downstream development in the upper-troposphere spiral storm track. In the lee of the Andes in South America, there is cyclogenesis associated with the subtropical jet and also, poleward of this, cyclogenesis largely associated with system decay on the upslope and regeneration on the downslope. The genesis and lysis of cyclones and anticyclones have a definite spatial relationship with each other and with the Andes. At 500 hPa, their relative longitudinal positions are consistent with vortex-stretching ideas for simple flow over a large-scale mountain. Cyclonic systems near Antarctica have generally spiraled in from lower latitudes. However, cyclogenesis associated with mobile cyclones occurs around the Antarctic coast with an interesting genesis maximum over the sea ice near 150°E. The South Pacific storm track emerges clearly from the tracking as a coherent deep feature spiraling from Australia to southern South America. A feature of the summer season is the genesis of eastward-moving cyclonic systems near the tropic of Capricorn off Brazil, in the central Pacific and, to a lesser extent, off Madagascar, followed by movement along the southwest flanks of the subtropical anticyclones and contribution to the “convergence zone” cloud bands seen in these regions.

New perspectives on the Northern Hemisphere winter storm tracks

The aim of this paper is to explore the use of both an Eulerian and system-centered method of storm track diagnosis applied to a wide range of meteorological fields at multiple levels to provide a range of perspectives on the Northern Hemisphere winter transient motions and to give new insight into the storm track organization and behavior. The data used are primarily from the European Centre for Medium-Range Weather Forecasts reanalyses project extended with operational analyses to the period 1979-2000. This is supplemented by data from the National Centers for Environmental Prediction and Goddard Earth Observing System 1 reanalyses. The range of fields explored include the usual mean sea level pressure and the lower- and upper-tropospheric height, meridional wind, vorticity, and temperature, as well as the potential vorticity (PV) on a 330-K isentropic surface (PV330) and potential temperature on a PV = 2 PVU surface (theta(PV2)). As well as reporting the primary analysis based on feature tracking, the standard Eulerian 2-6-day bandpass filtered variance analysis is also reported and contrasted with the tracking diagnostics. To enable the feature points to be identified as extrema for all the chosen fields, a planetary wave background structure is removed at each data time. The bandpass filtered variance derived from the different fields yield a rich picture of the nature and comparative magnitudes of the North Pacific and Atlantic storm tracks, and of the Siberian and Mediterranean candidates for storm tracks. The feature tracking allows the cyclonic and anticyclonic activities to be considered seperately. The analysis indicates that anticyclonic features are generally much weaker with less coherence than the cyclonic systems. Cyclones and features associated with them are shown to have much greater coherence and give tracking diagnostics that create a vivid storm track picture that includes the aspects highlighted by the variances as well as highlighting aspects that are not readily available from Eulerian studies. In particular, the upper-tropospheric features as shown by negative theta(PV2), for example, occur in a band spiraling around the hemisphere from the subtropical North Atlantic eastward to the high latitudes of the same ocean basin. Lower-troposphere storm tracks occupy more limited longitudinal sectors, with many of the individual storms possibly triggered from the upper-tropospheric disturbances in the spiral band of activity.

A new look at stratospheric sudden warmings. Part III. Polar vortex evolution and vertical structure

The evolution of the Arctic polar vortex during observed major mid-winter stratospheric sudden warmings (SSWs) is investigated for the period 1957-2002, using European Centre for Medium-Range Weather Forecasts (ECMWF) ERA-40 Ertel’s potential vorticity (PV) and temperature fields. Time-lag composites of vertically weighted PV, calculated relative to the SSW onset time, are derived for both vortex displacement SSWs and vortex splitting SSWs, by averaging over the 15 recorded displacement and 13 splitting events. The evolving vertical structure of the polar vortex during a typical SSW of each type is clearly illustrated by plotting an isosurface of the composite PV field, and is shown to be very close to that observed during representative individual events. Results are verified by comparison with an elliptical diagnostic vortex moment technique. For both types of SSW, little variation is found between individual events in the orientation of the developing vortex relative to the underlying topography, i.e. the location of the vortex during SSWs of each type is largely fixed in relation to the Earth’s surface. During each type of SSW, the vortex is found to have a distinctive vertical structure. Vortex splitting events are typically barotropic, with the vortex split occurring near-simultaneously over a large altitude range (20-40 km). In the majority of cases, of the two daughter vortices formed, it is the ‘Siberian’ vortex that dominates over its ‘Canadian’ counterpart. In contrast, displacement events are characterized by a very clear baroclinic structure; the vortex tilts significantly westward with height, so that the top and bottom of the vortex are separated by nearly 180◦ longitude before the upper vortex is sheared away and destroyed.

Analysis of water-level response to rainfall and implications for recharge pathways in the Chalk aquifer, SE England

Water table response to rainfall was investigated at six sites in the Upper, Middle and Lower Chalk of southern England. Daily time series of rainfall and borehole water level were cross-corretated to investigate seasonal variations in groundwater-level response times, based on periods of 3-month duration. The time tags (in days) yielding significant correlations were compared with the average unsaturated zone thickness during each 3-month period. In general, for cases when the unsaturated zone was greater than 18 m thick, the time tag for a significant water-level response increased rapidly once the depth to the water table exceeded a critical value, which varied from site to site. For shallower water tables, a linear relationship between the depth to the water table and the water-level response time was evident. The observed variations in response time can only be partially accounted for using a diffusive model for propagation through the unsaturated matrix, suggesting that some fissure flow was occurring. The majority of rapid responses were observed during the winter/spring recharge period, when the unsaturated zone is thinnest and the unsaturated zone moisture content is highest, and were more likely to occur when the rainfall intensity exceeded 5 mm/day. At some sites, a very rapid response within 24 h of rainfall was observed in addition to the longer term responses even when the unsaturated zone was up to 64 m thick. This response was generally associated with the autumn period. The results of the cross-correlation analysis provide statistical support for the presence of fissure flow and for the contribution of multiple pathways through the unsaturated zone to groundwater recharge. (c) 2006 Elsevier B.V. All rights reserved.

Assimilation of stratospheric ozone from MIPAS into a global general-circulation model: The September 2002 vortex split

Ozone and temperature profiles from the Michelson Interferometer for Passive Atmospheric Sounding (MIPAS) have been assimilated, using three-dimensional variational assimilation, into a stratosphere troposphere version of the Met Office numerical weather-prediction system. Analyses are made for the month of September 2002, when there was an unprecedented split in the southern hemisphere polar vortex. The analyses are validated against independent ozone observations from sondes, limb-occultation and total column ozone satellite instruments. Through most of the stratosphere, precision varies from 5 to 15%, and biases are 15% or less of the analysed field. Problems remain in the vortex and below the 60 hPa. level, especially at the tropopause where the analyses have too much ozone and poor agreement with independent data. Analysis problems are largely a result of the model rather than the data, giving confidence in the MIPAS ozone retrievals, though there may be a small high bias in MIPAS ozone in the lower stratosphere. Model issues include an excessive Brewer-Dobson circulation, which results both from known problems with the tracer transport scheme and from the data assimilation of dynamical variables. The extreme conditions of the vortex split reveal large differences between existing linear ozone photochemistry schemes. Despite these issues, the ozone analyses are able to successfully describe the ozone hole split and compare well to other studies of this event. Recommendations are made for the further development of the ozone assimilation system.

Recorded quadrant incidence of female breast cancer in Great Britain suggests a disproportionate increase in the upper outer quadrant of the breast

Background: The upper outer quadrant (UOQ) of the breast is the most frequent site for incidence of breast cancel; but the reported disproportionate incidence in this quadrant appears to rise with year of publication. Materials and Methods: In order to determine whether this increasing incidence in the UOQ is an artifact of different study populations or is chronological, data have been analysed for annual quadrant incidence of female breast cancer recorded nationally in England and Wales between 1979 and 2000 and in Scotland between 1980 and 2001. Results: In England and Wales, the recorded incidence of female breast cancer in the UOQ rose front 47.9% in 1979 to 53.3% in 2000, and has done so linearly over tune with a con-elation coefficient R of +/- 0.71 +/- SD 0.01 (p < 0.001). Analysis of independent data front Scotland showed a similar trend in that recorded female breast cancer had also increased in the UOQ from 38.3% in 1980 to 54.7% in 2001, with a con-elation coefficient R for the linear annual increase of +0.80 +/- SD 0.03 (p < 0.001). Conclusion: These results are inconsistent with current views that the high level of UOQ breast cancer is due solely to a greater amount of target epithelial tissue in that region. Identification of the reasons for such a disproportionate site-specific increase could provide clues as to causative factors in breast cancer.

Improved predictability of the troposphere using stratospheric final warmings

The final warming of the stratospheric polar vortex at the end of northern hemisphere winter is examined in ECMWF ERA-Interim reanalysis data and an ensemble of chemistry climate models, using 20 years of data from each. In some years the final warming is found to occur first in the mid-stratosphere, and in others to occur first in the upper stratosphere. The strength of the winter stratospheric polar vortex, refraction of planetary waves, and the altitudes at which the planetary waves break in the northern extratropics lead to this difference in the vertical profile of the final warming. Years in which the final warming occurs first in the mid-stratosphere show, on average, a more negative NAO pattern in April mean sea level pressure than years in which the warming occurs first in the upper stratosphere. Thus, in the northern hemisphere, additional predictive skill of tropospheric climate in April can be gained from a knowledge of the vertical profile of the stratospheric final warming.

Observed changes in top-of-the-atmosphere radiation and upper-ocean heating consistent within uncertainty

Global climate change results from a small yet persistent imbalance between the amount of sunlight absorbed by Earth and the thermal radiation emitted back to space. An apparent inconsistency has been diagnosed between interannual variations in the net radiation imbalance inferred from satellite measurements and upper-ocean heating rate from in situ measurements, and this inconsistency has been interpreted as ‘missing energy’ in the system. Here we present a revised analysis of net radiation at the top of the atmosphere from satellite data, and we estimate ocean heat content, based on three independent sources. We find that the difference between the heat balance at the top of the atmosphere and upper-ocean heat content change is not statistically significant when accounting for observational uncertainties in ocean measurements, given transitions in instrumentation and sampling. Furthermore, variability in Earth’s energy imbalance relating to El Niño-Southern Oscillation is found to be consistent within observational uncertainties among the satellite measurements, a reanalysis model simulation and one of the ocean heat content records. We combine satellite data with ocean measurements to depths of 1,800 m, and show that between January 2001 and December 2010, Earth has been steadily accumulating energy at a rate of 0.50±0.43 Wm−2 (uncertainties at the 90% confidence level). We conclude that energy storage is continuing to increase in the sub-surface ocean.

Understanding and projecting sea level change

There is intense scientific and public interest in the Intergovernmental Panel on Climate Change (IPCC) projections of sea level for the twenty-first century and beyond. The Fourth Assessment Report (AR4) projections, obtained by applying standard methods to the results of the World Climate Research Programme Coupled Model Experiment, includes estimates of ocean thermal expansion, the melting of glaciers and ice caps (G&ICs), increased melting of the Greenland Ice Sheet, and increased precipitation over Greenland and Antarctica, partially offsetting other contributions. The AR4 recognized the potential for a rapid dynamic ice sheet response but robust methods for quantifying it were not available. Illustrative scenarios suggested additional sea level rise on the order of 10 to 20 cm or more, giving a wide range in the global averaged projections of about 20 to 80 cm by 2100. Currently, sea level is rising at a rate near the upper end of these projections. Since publication of the AR4 in 2007, biases in historical ocean temperature observations have been identified and significantly reduced, resulting in improved estimates of ocean thermal expansion. Models that include all climate forcings are in good agreement with these improved observations and indicate the importance of stratospheric aerosol loadings from volcanic eruptions. Estimates of the volumes of G&ICs and their contributions to sea level rise have improved. Results from recent (but possibly incomplete) efforts to develop improved ice sheet models should be available for the 2013 IPCC projections. Improved understanding of sea level rise is paving the way for using observations to constrain projections. Understanding of the regional variations in sea level change as a result of changes in ocean properties, wind-stress patterns, and heat and freshwater inputs into the ocean is improving. Recently, estimates of sea level changes resulting from changes in Earth's gravitational field and the solid Earth response to changes in surface loading have been included in regional projections. While potentially valuable, semi-empirical models have important limitations, and their projections should be treated with caution