Response of day-to-day home blood pressure variability by antihypertensive drug class after transient ischemic attack or nondisabling stroke.

BACKGROUND AND PURPOSE Visit-to-visit variability in systolic blood pressure (SBP) is associated with an increased risk of stroke and was reduced in randomized trials by calcium channel blockers and diuretics but not by renin-angiotensin system inhibitors. However, time of day effects could not be determined. Day-to-day variability on home BP readings predicts stroke risk and potentially offers a practical method of monitoring response to variability-directed treatment. METHODS SBP mean, maximum, and variability (coefficient of variation=SD/mean) were determined in 500 consecutive transient ischemic attack or minor stroke patients on 1-month home BP monitoring (3 BPs, 3× daily). Hypertension was treated to a standard protocol. Differences in SBP variability from 3 to 10 days before to 8 to 15 days after starting or increasing calcium channel blockers/diuretics versus renin-angiotensin system inhibitors versus both were compared by general linear models, adjusted for risk factors and baseline BP. RESULTS Among 288 eligible interventions, variability in SBP was reduced after increased treatment with calcium channel blockers/diuretics versus both versus renin-angiotensin system inhibitors (-4.0 versus 6.9 versus 7.8%; P=0.015), primarily because of effects on maximum SBP (-4.6 versus -1.0 versus -1.0%; P=0.001), with no differences in effect on mean SBP. Class differences were greatest for early-morning SBP variability (3.6 versus 17.0 versus 38.3; P=0.002) and maximum (-4.8 versus -2.0 versus -0.7; P=0.001), with no effect on midmorning (P=0.29), evening (P=0.65), or diurnal variability (P=0.92). CONCLUSIONS After transient ischemic attack or minor stroke, calcium channel blockers and diuretics reduced variability and maximum home SBP, primarily because of effects on morning readings. Home BP readings enable monitoring of response to SBP variability-directed treatment in patients with recent cerebrovascular events.

The dominant role of semi-arid ecosystems in the trend and variability of the land CO2 sink

The growth rate of atmospheric carbondioxide(CO2) concentrations since industrialization is characterized by large interannual variability, mostly resulting from variability in CO 2 uptake by terrestrial ecosystems (typically termed carbon sink). However, the contributions of regional ecosystems to that variability are not well known. Using an ensemble of ecosystem and land-surface models and an empirical observation-based product of global gross primary production, we show that the mean sink, trend, and interannual variability in CO2 uptake by terrestrial ecosystems are dominated by distinct biogeographic regions. Whereas the mean sink is dominated by highly productive lands (mainly tropical forests), the trend and interannual variability of the sink are dominated by semi-arid ecosystems whose carbon balance is strongly associated with circulation-driven variations in both precipitation and temperature.

A regional climate palaeosimulation for Europe in the period 1500–1990 – Part 2: Shortcomings and strengths of models and reconstructions

This study compares gridded European seasonal series of surface air temperature (SAT) and precipitation (PRE) reconstructions with a regional climate simulation over the period 1500–1990. The area is analysed separately for nine subareas that represent the majority of the climate diversity in the European sector. In their spatial structure, an overall good agreement is found between the reconstructed and simulated climate features across Europe, supporting consistency in both products. Systematic biases between both data sets can be explained by a priori known deficiencies in the simulation. Simulations and reconstructions, however, largely differ in the temporal evolution of past climate for European subregions. In particular, the simulated anomalies during the Maunder and Dalton minima show stronger response to changes in the external forcings than recorded in the reconstructions. Although this disagreement is to some extent expected given the prominent role of internal variability in the evolution of regional temperature and precipitation, a certain degree of agreement is a priori expected in variables directly affected by external forcings. In this sense, the inability of the model to reproduce a warm period similar to that recorded for the winters during the first decades of the 18th century in the reconstructions is indicative of fundamental limitations in the simulation that preclude reproducing exceptionally anomalous conditions. Despite these limitations, the simulated climate is a physically consistent data set, which can be used as a benchmark to analyse the consistency and limitations of gridded reconstructions of different variables. A comparison of the leading modes of SAT and PRE variability indicates that reconstructions are too simplistic, especially for precipitation, which is associated with the linear statistical techniques used to generate the reconstructions. The analysis of the co-variability between sea level pressure (SLP) and SAT and PRE in the simulation yields a result which resembles the canonical co-variability recorded in the observations for the 20th century. However, the same analysis for reconstructions exhibits anomalously low correlations, which points towards a lack of dynamical consistency between independent reconstructions.

Reconciling two alternative mechanisms behind bi-decadal variability in the North Atlantic

Understanding the preferential timescales of variability in the North Atlantic, usually associated with the Atlantic meridional overturning circulation (AMOC), is essential for the prospects for decadal prediction. However, the wide variety of mechanisms proposed from the analysis of climate simulations, potentially dependent on the models themselves, has stimulated the debate of which processes take place in reality. One mechanism receiving increasing attention, identified both in idealized models and observations, is a westward propagation of subsurface buoyancy anomalies that impact the AMOC through a basin-scale intensification of the zonal density gradient, enhancing the northward transport via thermal wind balance. In this study, we revisit a control simulation from the Institut Pierre-Simon Laplace Coupled Model 5A (IPSL-CM5A), characterized by a strong AMOC periodicity at 20 years, previously explained by an upper ocean–atmosphere–sea ice coupled mode driving convection activity south of Iceland. Our study shows that this mechanism interacts constructively with the basin-wide propagation in the subsurface. This constructive feedback may explain why bi-decadal variability is so intense in this coupled model as compared to others.

Comparison of co-located independent ground-based middle atmospheric wind and temperature measurements with numerical weather prediction models

High-resolution, ground-based and independent observations including co-located wind radiometer, lidar stations, and infrasound instruments are used to evaluate the accuracy of general circulation models and data-constrained assimilation systems in the middle atmosphere at northern hemisphere midlatitudes. Systematic comparisons between observations, the European Centre for Medium-Range Weather Forecasts (ECMWF) operational analyses including the recent Integrated Forecast System cycles 38r1 and 38r2, the NASA’s Modern-Era Retrospective Analysis for Research and Applications (MERRA) reanalyses, and the free-running climate Max Planck Institute–Earth System Model–Low Resolution (MPI-ESM-LR) are carried out in both temporal and spectral dom ains. We find that ECMWF and MERRA are broadly consistent with lidar and wind radiometer measurements up to ~40 km. For both temperature and horizontal wind components, deviations increase with altitude as the assimilated observations become sparser. Between 40 and 60 km altitude, the standard deviation of the mean difference exceeds 5 K for the temperature and 20 m/s for the zonal wind. The largest deviations are observed in winter when the variability from large-scale planetary waves dominates. Between lidar data and MPI-ESM-LR, there is an overall agreement in spectral amplitude down to 15–20 days. At shorter time scales, the variability is lacking in the model by ~10 dB. Infrasound observations indicate a general good agreement with ECWMF wind and temperature products. As such, this study demonstrates the potential of the infrastructure of the Atmospheric Dynamics Research Infrastructure in Europe project that integrates various measurements and provides a quantitative understanding of stratosphere-troposphere dynamical coupling for numerical weather prediction applications.

Variability of daily winter wind speed distribution over Northern Europe during the past millennium in regional and global climate simulations

We analyse the variability of the probability distribution of daily wind speed in wintertime over Northern and Central Europe in a series of global and regional climate simulations covering the last centuries, and in reanalysis products covering approximately the last 60 years. The focus of the study lies on identifying the link of the variations in the wind speed distribution to the regional near-surface temperature, to the meridional temperature gradient and to the North Atlantic Oscillation. Our main result is that the link between the daily wind distribution and the regional climate drivers is strongly model dependent. The global models tend to behave similarly, although they show some discrepancies. The two regional models also tend to behave similarly to each other, but surprisingly the results derived from each regional model strongly deviates from the results derived from its driving global model. In addition, considering multi-centennial timescales, we find in two global simulations a long-term tendency for the probability distribution of daily wind speed to widen through the last centuries. The cause for this widening is likely the effect of the deforestation prescribed in these simulations. We conclude that no clear systematic relationship between the mean temperature, the temperature gradient and/or the North Atlantic Oscillation, with the daily wind speed statistics can be inferred from these simulations. The understand- ing of past and future changes in the distribution of wind speeds, and thus of wind speed extremes, will require a detailed analysis of the representation of the interaction between large-scale and small-scale dynamics.

North Pacific Carbon Cycle Response to Climate Variability on Seasonal to Decadal Timescales

Climate variability drives significant changes in the physical state of the North Pacific, and there may be important impacts of this variability on the upper ocean carbon balance across the basin. We address this issue by considering the response of seven biogeochemical ocean models to climate variability in the North Pacific. The models' upper ocean pCO(2) and air-sea CO(2) flux respond similarly to climate variability on seasonal to decadal timescales. Modeled seasonal cycles of pCO(2) and its temperature- and non-temperature-driven components at three contrasting oceanographic sites capture the basic features found in observations (Takahashi et al., 2002, 2006; Keeling et al., 2004; Brix et al., 2004). However, particularly in the Western Subarctic Gyre, the models have difficulty representing the temporal structure of the total pCO(2) seasonal cycle because it results from the difference of these two large and opposing components. In all but one model, the air-sea CO(2) flux interannual variability (1 sigma) in the North Pacific is smaller ( ranges across models from 0.03 to 0.11 PgC/yr) than in the Tropical Pacific ( ranges across models from 0.08 to 0.19 PgC/yr), and the time series of the first or second EOF of the air-sea CO(2) flux has a significant correlation with the Pacific Decadal Oscillation (PDO). Though air-sea CO(2) flux anomalies are correlated with the PDO, their magnitudes are small ( up to +/- 0.025 PgC/yr ( 1 sigma)). Flux anomalies are damped because anomalies in the key drivers of pCO(2) ( temperature, dissolved inorganic carbon (DIC), and alkalinity) are all of similar magnitude and have strongly opposing effects that damp total pCO(2) anomalies.

Tracking of plasma lipids and lipoproteins, within-person and year-to-year variability in plasma cholesterol levels among participants from age 8 to 18 in Project HeartBeat!

Coronary heart disease remains the leading cause of death in the United States and increased blood cholesterol level has been found to be a major risk factor with roots in childhood. Tracking of cholesterol, i.e., the tendency to maintain a particular cholesterol level relative to the rest of the population, and variability in blood lipid levels with increase in age have implications for cholesterol screening and assessment of lipid levels in children for possible prevention of further rise to prevent adulthood heart disease. In this study the pattern of change in plasma lipids, over time, and their tracking were investigated. Also, within-person variance and retest reliability defined as the square root of within-person variance for plasma total cholesterol, HDL-cholesterol, LDL-cholesterol, and triglycerides and their relation to age, sex and body mass index among participants from age 8 to 18 years were investigated. ^ In Project HeartBeat!, 678 healthy children aged 8, 11 and 14 years at baseline were enrolled and examined at 4-monthly intervals for up to 4 years. We examined the relationship between repeated observations by Pearson's correlations. Age- and sex-specific quintiles were calculated and the probability of participants to remain in the uppermost quintile of their respective distribution was evaluated with life table methods. Plasma total cholesterol, HDL-C and LDL-C at baseline were strongly and significantly correlated with measurements at subsequent visits across the sex and age groups. Plasma triglyceride at baseline was also significantly correlated with subsequent measurements but less strongly than was the case for other plasma lipids. The probability to remain in the upper quintile was also high (60 to 70%) for plasma total cholesterol, HDL-C and LDL-C. ^ We used a mixed longitudinal, or synthetic cohort design with continuous observations from age 8 to 18 years to estimate within person variance of plasma total cholesterol, HDL-C, LDL-C and triglycerides. A total of 5809 measurements were available for both cholesterol and triglycerides. A multilevel linear model was used. Within-person variance among repeated measures over up to four years of follow-up was estimated for total cholesterol, HDL-C, LDL-C and triglycerides separately. The relationship of within-person and inter-individual variance with age, sex, and body mass index was evaluated. Likelihood ratio tests were conducted by calculating the deviation of −2log (likelihood) within the basic model and alternative models. The square root of within-person variance provided the retest reliability (within person standard deviation) for plasma total cholesterol, HDL-C, LDL-C and triglycerides. We found 13.6 percent retest reliability for plasma cholesterol, 6.1 percent for HDL-cholesterol, 11.9 percent for LDL-cholesterol and 32.4 percent for triglycerides. Retest reliability of plasma lipids was significantly related with age and body mass index. It increased with increase in body mass index and age. These findings have implications for screening guidelines, as participants in the uppermost quintile tended to maintain their status in each of the age groups during a four-year follow-up. The magnitude of within-person variability of plasma lipids influences the ability to classify children into risk categories recommended by the National Cholesterol Education Program. ^

Bayesian generalized linear models for meta-analysis of diagnostic tests

With the recognition of the importance of evidence-based medicine, there is an emerging need for methods to systematically synthesize available data. Specifically, methods to provide accurate estimates of test characteristics for diagnostic tests are needed to help physicians make better clinical decisions. To provide more flexible approaches for meta-analysis of diagnostic tests, we developed three Bayesian generalized linear models. Two of these models, a bivariate normal and a binomial model, analyzed pairs of sensitivity and specificity values while incorporating the correlation between these two outcome variables. Noninformative independent uniform priors were used for the variance of sensitivity, specificity and correlation. We also applied an inverse Wishart prior to check the sensitivity of the results. The third model was a multinomial model where the test results were modeled as multinomial random variables. All three models can include specific imaging techniques as covariates in order to compare performance. Vague normal priors were assigned to the coefficients of the covariates. The computations were carried out using the 'Bayesian inference using Gibbs sampling' implementation of Markov chain Monte Carlo techniques. We investigated the properties of the three proposed models through extensive simulation studies. We also applied these models to a previously published meta-analysis dataset on cervical cancer as well as to an unpublished melanoma dataset. In general, our findings show that the point estimates of sensitivity and specificity were consistent among Bayesian and frequentist bivariate normal and binomial models. However, in the simulation studies, the estimates of the correlation coefficient from Bayesian bivariate models are not as good as those obtained from frequentist estimation regardless of which prior distribution was used for the covariance matrix. The Bayesian multinomial model consistently underestimated the sensitivity and specificity regardless of the sample size and correlation coefficient. In conclusion, the Bayesian bivariate binomial model provides the most flexible framework for future applications because of its following strengths: (1) it facilitates direct comparison between different tests; (2) it captures the variability in both sensitivity and specificity simultaneously as well as the intercorrelation between the two; and (3) it can be directly applied to sparse data without ad hoc correction. ^

Age models, color measurements, and calculated sea surface temperatures of sediment cores from the Bering Sea and the Sea of Okhotsk

Past changes in North Pacific sea surface temperatures and sea-ice conditions are proposed to play a crucial role in deglacial climate development and ocean circulation but are less well known than from the North Atlantic. Here, we present new alkenone-based sea surface temperature records from the subarctic northwest Pacific and its marginal seas (Bering Sea and Sea of Okhotsk) for the time interval of the last 15 kyr, indicating millennial-scale sea surface temperature fluctuations similar to short-term deglacial climate oscillations known from Greenland ice-core records. Past changes in sea-ice distribution are derived from relative percentage of specific diatom groups and qualitative assessment of the IP25 biomarker related to sea-ice diatoms. The deglacial variability in sea-ice extent matches the sea surface temperature fluctuations. These fluctuations suggest a linkage to deglacial variations in Atlantic meridional overturning circulation and a close atmospheric coupling between the North Pacific and North Atlantic. During the Holocene the subarctic North Pacific is marked by complex sea surface temperature trends, which do not support the hypothesis of a Holocene seesaw in temperature development between the North Atlantic and the North Pacific.

Revised age models and foraminiferal records obtained for the Last Interglacial period in six marine sediment cores

The dataset contains the revised age models and foraminiferal records obtained for the Last Interglacial period in six marine sediment cores: - the Southern Ocean core MD02-2488 (age model, sea surface temperatures, benthic d18O and d13C for the period 136-108 ka), - the North Atlantic core MD95-2042 (age model, planktic d18O, benthic d18O and d13C for the period 135-110 ka), - the North Atlantic core ODP 980 (age model, planktic d18O, sea surface temperatures, seawater d18O, benthic d18O and d13C, ice-rafted detritus for the period 135-110 ka), - the North Atlantic core CH69-K09 (age model, planktic d18O, sea surface temperatures, seawater d18O, benthic d18O and d13C, ice-rafted detritus for the period 135-110 ka), - the Norwegian Sea core MD95-2010 (age model, percentage of Neogloboquadrina pachyderma sinistral, sea surface temperatures, benthic d18O, ice-rafted detritus for the period 134-110 ka), - the Labrador Sea core EW9302-JPC2 (age model, percentage of Neogloboquadrina pachyderma sinistral, sea surface temperatures, benthic d18O for the period 134-110 ka).

Age models of five ice cores from the Dronning Maud Land, Antarctica

For the first time, annually resolved accumulation rates have been determined in central Antarctica by means of counting seasonal signals of ammonium, calcium, and sodium. All records, obtained from three intermediate depth ice cores from Dronning Maud Land, East Antarctica, show rather constant accumulation rates throughout the last 9 centuries with mean values of 63, 61, and 44 mm H2O yr**-1 and a typical year-to-year variation of about 30%. For the last few decades, no trend was detected accounting for the high natural variability of all records. A significant weak intersite correlation is apparent only between two cores when the high-frequency part with periods less than 30 years is removed. By analyzing the records in the frequency domain, no persistent periods were found. This suggests that the snow accumulation in this area is mainly influenced by local deposition patterns and may be additionally masked by redistribution of snow due to wind. By comparing accumulation rates over the last 2 millennia a distinct change in the layer thickness in one of the three cores was found, which might be attributed either to an area upstream of the drilling site with lower accumulation rates, or to deposition processes influenced by surface undulations. The missing of a clear correlation between the accumulation rate histories at the three locations is also important for the interpretation of small, short time variations of past precipitation records obtained from deep ice cores.

Age models of ODP Site 184-1143

Here we present an improved astronomical timescale since 5 Ma as recorded in the ODP Site 1143 in the southern South China Sea, using a recently published Asian summer monsoon record (hematite to goethite content ratio, Hm/Gt) and a parallel benthic d18O record. Correlation of the benthic d18O record to the stack of 57 globally distributed benthic d18O records (LR04 stack) and the Hm/Gt curve to the 65°N summer insolation curve is a particularly useful approach to obtain refined timescales. Hence, it constitutes the basis for our effort. Our proposed modifications result in a more accurate and robust chronology than the existing astronomical timescale for the ODP Site 1143. This updated timescale further enables a detailed study of the orbital variability of low-latitude Asian summer monsoon throughout the Plio-Pleistocene. Comparison of the Hm/Gt record with the d18O record from the same core reveals that the oscillations of low-latitude Asian summer monsoon over orbital scales differed considerably from the glacial-interglacial climate cycles. The popular view that summer monsoon intensifies during interglacial stages and weakens during glacial stages appears to be too simplistic for low-latitude Asia. In low-latitude Asia, some strong summer monsoon intervals appear to have also occurred during glacial stages in addition to their increased occurrence during interglacial stages. Vice versa, some notably weak summer monsoon intervals have also occurred during interglacial stages next to their anticipated occurrence during glacial stages. The well-known mid-Pleistocene transition (MPT) is only identified in the benthic d18O record but not in the Hm/Gt record from the same core. This suggests that the MPT may be a feature of high- and middle-latitude climates, possibly determined by high-latitude ice sheet dynamics. For low-latitude monsoonal climate, its orbital-scale variations respond more directly to insolation and are little influenced by high-latitude processes, thus the MPT is likely not recorded. In addition, the Hm/Gt record suggests that low-latitude Asian summer monsoon intensity has a long-term decreasing trend since 2.8 Ma with increased oscillation amplitude. This long-term variability is presumably linked to the Northern Hemisphere glaciation since then.

Age models of sediment cores from the continental margin of northwest Africa

Diatom abundance and species composition were quantitatively studied in two latest Quaternary (~130 ka to the Present) sequences from the continental margin of northwest Africa. Off this region, coastal upwelling is well developed under the influence of the NE trade winds. Variations in diatom abundance in these cores are inferred to represent changes caused by varying degrees of the upwelling fertility. Times of high productivity are marked by high relative frequencies of Chaetoceros, while low productivity is marked by the dominance of Aulacoseira granulata. Upwelling increased during glacial episodes (isotopic stages 2-4 and 6) relative to isotopic stages 1 and 5. During the late Holocene, primary productivity levels are similar to those for Stage 5, but in the early Holocene upwelling intensities seem to have been weaker than today. The paleoproductivity reconstruction based on the diatom record is supported by paleoproductivity estimations based on the organic carbon content of the sediments (Sarnthein et al., 1987).

Age models of ODP Leg 175 holes

A multiproxy approach including the use of stable isotopes, magnetic characterization analyses, and organic geochemistry has been adopted to consider factors such as productivity and terrigenous input over the past 1.5 m.y. at two areas off the western coast of Africa. These factors can, in turn, be used to consider variability in ocean circulation and upwelling in addition to changes in climate on the African continent. In particular, studies focused on the influence of glacial-interglacial cycles and evidence for the mid-Pleistocene revolution (MPR), a complex change in climate that occurred at ~1 Ma. A comparison of the records from the two areas drilled during Ocean Drilling Program Leg 175, the Congo Basin, at a latitude of 5°S (Holes 1076A and 1077A), and the Walvis Ridge, at 17°S (Hole 1081A), demonstrates that these sites are affected by different localized factors. The sites in the Congo Basin are strongly influenced by freshwater and sediment from the Congo River, whereas the site at the Walvis Ridge is located in the center of oceanic upwelling and contains a more marine signal. Evidence also suggests that the two sites responded differently to both long- and short-term climatic variations. In particular, the response at the Walvis Ridge to the MPR occurred over an extended period, from 1.1 to 0.8 Ma, and was associated with a change in the dominant source of terrigenous input to the site in conjunction with a change in the productivity signal. In the Congo Basin, the response to the MPR was more rapid, occurring between 0.9 and 0.8 Ma. During this period, the influence of the Congo River became significant. However, productivity records only began to respond toward the end of this interval, at 0.8 Ma.