Validity of SYNTAX score II for risk stratification of percutaneous coronary interventions: A patient-level pooled analysis of 5,433 patients enrolled in contemporary coronary stent trials.

OBJECTIVES To assess the clinical profile and long-term mortality in SYNTAX score II based strata of patients who received percutaneous coronary interventions (PCI) in contemporary randomized trials. BACKGROUND The SYNTAX score II was developed in the randomized, all-comers' SYNTAX trial population and is composed by 2 anatomical and 6 clinical variables. The interaction of these variables with the treatment provides individual long-term mortality predictions if a patient undergoes coronary artery bypass grafting (CABG) or PCI. METHODS Patient-level (n=5433) data from 7 contemporary coronary drug-eluting stent (DES) trials were pooled. The mortality for CABG or PCI was estimated for every patient. The difference in mortality estimates for these two revascularization strategies was used to divide the patients into three groups of theoretical treatment recommendations: PCI, CABG or PCI/CABG (the latter means equipoise between CABG and PCI for long term mortality). RESULTS The three groups had marked differences in their baseline characteristics. According to the predicted risk differences, 5115 patients could be treated either by PCI or CABG, 271 should be treated only by PCI and, rarely, CABG (n=47) was recommended. At 3-year follow-up, according to the SYNTAX score II recommendations, patients recommended for CABG had higher mortality compared to the PCI and PCI/CABG groups (17.4%; 6.1% and 5.3%, respectively; P<0.01). CONCLUSIONS The SYNTAX score II demonstrated capability to help in stratifying PCI procedures.

Mineralogical and geochemical data from five lake sediment cores of Lake Donggi Cona

Sediments of Lake Donggi Cona on the northeastern Tibetan Plateau were studied to infer changes in the lacustrine depositional environment, related to climatic and non-climatic changes during the last 19 kyr. The lake today fills a 30 X 8 km big and 95 m deep tectonic basin, associated with the Kunlun Fault. The study was conducted on a sediment-core transect through the lake basin, in order to gain a complete picture of spatiotemporal environmental change. The recovered sediments are partly finely laminated and are composed of calcareous muds with variable amounts of carbonate micrite, organic matter, detrital silt and clay. On the basis of sedimentological, geochemical, and mineralogical data up to five lithological units (LU) can be distinguished that document distinct stages in the development of the lake system. The onset of the lowermost LU with lacustrine muds above basal sands indicates that lake level was at least 39 m below the present level and started to rise after 19 ka, possibly in response to regional deglaciation. At this time, the lacustrine environment was characterized by detrital sediment influx and the deposition of siliciclastic sediment. In two sediment cores, upward grain-size coarsening documents a lake-level fall after 13 cal ka BP, possibly associated with the late-glacial Younger Dryas stadial. From 11.5 to 4.3 cal ka BP, grainsize fining in sediment cores from the profundal coring sites and the onset of lacustrine deposition at a litoral core site (2m water depth) in a recent marginal bay of Donggi Cona document lake-level rise during the early tomid-Holocene to at least modern level. In addition, high biological productivity and pronounced precipitation of carbonate micrites are consistent with warm and moist climate conditions related to an enhanced influence of summer monsoon. At 4.3 cal ka BP the lake system shifted from an aragonite- to a calcite-dominated system, indicating a change towards a fully open hydrological lake system. The younger clay-rich sediments are moreover non-laminated and lack any diagenetic sulphides, pointing to fully ventilated conditions, and the prevailing absence of lake stratification. This turning point in lake history could imply either a threshold response to insolation-forced climate cooling or a response to a non-climatic trigger, such as an erosional event or a tectonic pulse that induced a strong earthquake, which is difficult to decide from our data base.

Nd isotope data for planktonic foraminifera from within and around sapropels S1 and S5 from ODP Site 160-967

The development of widespread anoxic conditions in the deep oceans is evidenced by the accumulation and preservation of organic-carbon-rich sediments, but its precise cause remains controversial. The two most popular hypotheses involve (1) circulation-induced increased stratification resulting in reduced oxygenation of deep waters or (2) enhanced productivity in the surface ocean, increasing the raining down of organic matter and overwhelming the oxic remineralization potential of the deep ocean. In the periodic development of deep-water anoxia in the Pliocene-Pleistocene Mediterranean Sea, increased riverine runoff has been implicated both as a source for nutrients that fuel enhanced photic-zone productivity and a source of a less dense freshwater cap leading to reduced circulation, basin-wide stagnation, and deep-water oxygen starvation. Monsoon-driven increases in Nile River discharge and increased regional precipitation due to enhanced westerly activity-two mechanisms that represent fundamentally different climatic driving forces-have both been suggested as causes of the altered freshwater balance. Here we present data that confirm a distinctive neodymium (Nd) isotope signature for the Nile River relative to the Eastern Mediterranean-providing a new tracer of enhanced Nile outflow into the Mediterranean in the past. We further present Nd isotope data for planktonic foraminifera that suggest a clear increase in Nile discharge during the central intense period of two recent anoxic events. Our data also suggest, however, that other regional freshwater sources were more important at the beginning and end of the anoxic events. Taken at face value, the data appear to imply a temporal link between peaks in Nile discharge and enhanced westerly activity.

Manganese concentrations and flux data of sediments from Broken and Ninetyeast Ridge

Decomposition of organic matter combined with density stratification generate a pronounced intermediate water oxygen minimum zone (OMZ) in the northwest Indian Ocean. This zone currently lies between water depths of 200 and 2000 m and extends approximately 5000 km southeast from the Arabian coast. Based upon benthic foraminiferal assemblage changes, it has been suggested that this OMZ was even more extensive during the late Miocene-early Pliocene (6.5-3.0 Ma), with a maximum volume and/or intensity at approximately 5.0 Ma. While this inference may contribute to an understanding of the history of northwest Indian Ocean upwelling, corroborating geochemical evidence for this interpretation has heretofore been lacking. Ocean Drilling Program (ODP) sites 752, 754, and 757 on Broken and Ninetyeast ridges are located within central Indian Ocean intermediate water depths (1086-1650 m) but outside the present lateral dimensions of the Indian Ocean OMZ. High-resolution chemical analyses of sediment from these sites indicate significant reductions in the flux of Mn and normalized Mn concentrations between 6.5 and 3.0 Ma that are most pronounced at approximately 5.0 Ma. Because late Miocene-Pliocene paleodepths for these sites were essentially the same as at present and because extremely low sedimentation rates (0.3-1.3 cm/ky) most likely precluded sedimentary metal oxide diagenesis, we suggest that the observed Mn depletions reflect diminished deposition of reducible Mn oxyhydroxide phases within O2 deficient intermediate waters and that this effect was most intense at approximately 5.0 Ma. This interpretation implies that waters with less than 2.0 mL/L O2 extended at least 1500 km beyond their present limits and is consistent with changes in benthic foraminifera assemblages. We further suggest this expanded Indian Ocean OMZ is related to regionally and/or globally increased biological productivity.

Planktonic foraminifera oxygen isotope and trace metal data ODP Hole 172-1056A, 46-54 ka BP

Salinity increase in the subtropical gyre system may have pre-conditioned the North Atlantic Ocean for a rapid return to stronger overturning circulation and high-latitude warming following meltwater events during the Last Glacial period. Here we investigate the Gulf Stream - subtropical gyre system properties over Dansgaard-Oeschger (DO) cycles 14 to 12, including Heinrich ice-rafting event 5. During the Holocene and Last Glacial Maximum a positive gradient in surface dwelling planktonic foraminifera d18O (Globigerinoides ruber) can be observed between the Gulf Stream and subtropical gyre, due to decreasing temperature, increasing salinity, and a change from summer to year-round occurrence of G. ruber. We assess whether this gradient was a common feature during stadial-interstadial climate oscillations of Marine Isotope Stage 3, by comparing existing G. ruber d18O from ODP Site 1060 (subtropical gyre location) and new data from ODP Site 1056 (Gulf Stream location) between 54 and 46 ka. Our results suggest that this gradient was largely absent during the period studied. During the major warm DO interstadials 14 and 12 we infer a more zonal and wider Gulf Stream, influencing both ODP Sites 1056 and 1060. A Gulf Stream presence during these major interstadials is also suggested by the large vertical d18O gradient between shallow dwelling planktonic foraminifera species, especially G. ruber, and the deep dwelling species Globorotalia inflata at site 1056, which we associate with strong summer stratification and Gulf Stream presence. A major reduction in this vertical d18O gradient from 51 ka until the end of Heinrich event 5 at 48.5 ka suggests site 1056 was situated within the subtropical gyre in this mainly cold period, from which we infer a migration of the Gulf Stream to a position nearer to the continental shelf, indicative of a narrower Gulf Stream with possibly reduced transport.

Hydrographic data from Atka Bay taken by Weddell seals during expedition NEU2008 with links to datasets

In order to gain insights into species-level behavioural responses to the physical environment, it is necessary to obtain information from various populations and at all times of year. We analysed the influences of physical environmental parameters on the mid-summer dive behaviour of Weddell seals (Leptonychotes weddellii) from a little-known population at Atka Bay, Antarctica. Dive depth distributions followed a typical bimodal pattern also exhibited by seals from other populations and seals targeted both shallow water layers of <50 m and depths near the seafloor. Increased stratification of temperature layers within the water column resulted in increased forage efforts by the seals through relatively high numbers of dives to the seafloor, as well as forage effort associated with shallow dives. We interpret these behavioural responses to be due to increased water temperature stratification resulting in the concentration of prey species in particular depth layers.

Geochemical data from the USGS #1 Portland core, Canon City, Colorado

During the Cretaceous, widespread black shale deposition occurred during a series of Oceanic Anoxic Events (OAEs). Multiple processes are known to control the deposition of marine black shales, including changes in primary productivity, organic matter preservation, and dilution. OAEs offer an opportunity to evaluate the relative roles of these forcing factors. The youngest of these events-the Coniacian to Santonian OAE 3-resulted in a prolonged organic carbon burial event in shallow and restricted marine environments including the Western Interior Seaway. New high-resolution isotope, organic, and trace metal records from the latest Turonian to early Santonian Niobrara Formation are used to characterize the amount and composition of organic matter preserved, as well as the geochemical conditions under which it accumulated. Redox sensitive metals (Mo, Mn, and Re) indicate a gradual drawdown of oxygen leading into the abrupt onset of organic carbon-rich (up to 8%) deposition. High Hydrogen Indices (HI) and organic carbon to total nitrogen ratios (C:N) demonstrate that the elemental composition of preserved marine organic matter is distinct under different redox conditions. Local changes in d13C indicate that redox-controlled early diagenesis can also significantly alter d13Corg records. These results demonstrate that the development of anoxia is of primary importance in triggering the prolonged carbon burial in the Niobrara Formation. Sea level reconstructions, d18O results, and Mo/total organic carbon ratios suggest that stratification and enhanced bottom water restriction caused the drawdown of bottom water oxygen. Increased nutrients from benthic regeneration and/or continental runoff may have sustained primary productivity.

At surface behaviour, dive depth and dive duration and associated hydrographic data of adult male southern elephant seals from King George Island from expedition JUB2010 with links to datasets

Understanding the distribution and foraging ecology of major consumers within pelagic systems, specifically in relation to physical parameters, can be important for the management of bentho-pelagic systems undergoing rapid change associated with global climate change and other anthropogenic disturbances such as fishing (i.e., the Antarctic Peninsula and Scotia Sea). We tracked 11 adult male southern elephant seals (Mirounga leonina), during their five-month post-moult foraging migrations from King George Island (Isla 25 de Mayo), northern Antarctic Peninsula, using tags capable of recording and transmitting behavioural data and in situ temperature and salinity data. Seals foraged mostly within the Weddell-Scotia Confluence, while a few foraged along the western Antarctic Peninsula shelf of the Bellingshausen Sea. Mixed model outputs suggest that the at-sea behaviour of seals was associated with a number of environmental parameters, especially seafloor depth, sea-ice concentrations and the temperature structure of the water column. Seals increased dive bottom times and travelled at slower speeds in shallower areas and areas with increased sea-ice concentrations. Changes in dive depth and durations, as well as relative amount of time spent during the bottom phases of dives, were observed in relation to differences in overall temperature gradient, likely as a response to vertical changes in prey distribution associated with temperature stratification in the water column. Our results illustrate the likely complex influences of bathymetry, hydrography and sea ice on the behaviour of male southern elephant seals in a changing environment and highlight the need for region-specific approaches to studying environmental influences on behaviour.

Strontium and oxygen isotope data for DSDP Hole 44-390A and ODP Leg 171 holes

Differences in regional responses to climate fluctuations are well documented on short time scales (e.g., El Niño-Southern Oscillation), but with the exception of latitudinal temperature gradients, regional patterns are seldom considered in discussions of ancient greenhouse climates. Contrary to the expectation of global warming or global cooling implicit in most treatments of climate evolution over millions of years, this paper shows that the North Atlantic warmed by as much as 6°C (1.5% decrease in d18O values of planktic foraminifera) during the Maastrichtian global cooling interval. We suggest that warming was the result of the importation of heat from the South Atlantic. Decreasing North Atlantic d18O values are also associated with increasing gradients in planktic d13C values, suggesting increasing surface-water stratification and a correlated strengthening of the North Atlantic Polar Front. If correct, this conclusion predicts arctic cooling during the late Maastrichtian. Beyond implications for the Maastrichtian, these data demonstrate that climate does not behave as if there is a simple global thermostat, even on geologic time scales.

Part of the global DOC versus AOU (dissolved organic carbon/apparent oxygen utilization) data compilation, Azores-I

Temperate, transitional and subtropical waters of the remote Azores Front region east of Azores (24-40°N, 22-32°W) were sampled during three cruises conducted under increasing stratification conditions (April 1999, May 1997 and August 1998). Despite the temporal increase of surface temperature (by 5 °C) and stratification (by 2.1 1/min**2), as well as the thermocline shoaling (by ~15 m), dissolved organic carbon (DOC) and nitrogen (DON) in the surface layer were not significantly different for the early spring, late spring and summer periods, with average concentrations of 69±2 µM-C and 5.2±0.4 µM-N, respectively. The surface excess of semi-labile DOC, compared with the baseline DOC concentration in the deep ocean (47±2 µM-C), represents 33% of the bulk DOC concentration and as much as 85% of the TOC (=POC+DOC) excess. When compared with the winter baseline (56±2 µM-C), the seasonal surface DOC excess is 20% of the bulk DOC concentration and 87% of the seasonal TOC excess. These results confirm the major role played by DOC in the carbon cycle of surface waters of the Azores Front region. The total amount of bioreactive DOC transported from the temperate to the subtropical North Atlantic by the Ekman flux between March and December represents only ~15% of the average annual primary production, and ~15% and ~30% of the measured sinking POC flux+vertical DOC eddy diffusion during early spring and summer, respectively. Vertical eddy diffusion is 35% and 2% of the spring and summer sinking POC flux, respectively. On the other hand, DOC only contributes 13% to the local oxidation of organic matter in subsurface waters (between the pycnocline and 500 m) of the study region.

Stable isotopes, core logging data, relative paleointensity, dry bulk density, biogenic opal, CN-data (TC, TOC, CaCO3, TN), element concentrations, and coarse fraction of three sediment cores from the western Bering Sea

We used piston cores recovered in the western Bering Sea to reconstruct millennial-scale changes in marine productivity and terrigenous matter supply over the past ~180 kyr. Based on a geochemical multi-proxy approach, our results indicate closely interacting processes controlling marine productivity and terrigenous matter supply comparable to the situation in the Okhotsk Sea. Overall, terrigenous inputs were high, whereas export production was low. Minor increases in marine productivity occurred during intervals of Marine Isotope Stage 5 and interstadials, but pronounced maxima were recorded during interglacials and Termination I. The terrigenous material is suggested to be derived from continental sources on the eastern Bering Sea shelf and to be subsequently transported via sea ice, which is likely to drive changes in surface productivity, terrigenous inputs, and upper-ocean stratification. From our results we propose glacial, deglacial, and interglacial scenarios for environmental change in the Bering Sea. These changes seem to be primarily controlled by insolation and sea-level forcing which affect the strength of atmospheric pressure systems and sea-ice growth. The opening history of the Bering Strait is considered to have had an additional impact. High-resolution core logging data (color b*, XRF scans) strongly correspond to the Dansgaard-Oeschger climate variability registered in the NGRIP ice core and support an atmospheric coupling mechanism of Northern Hemisphere climates.

Chemical composition of sediment core GeoB12309-5 from the northern Arabian Sea, its pore water profile and age depth relationship as well as CTD data obtained during cruise M74/3

The Arabian Sea off the Pakistan continental margin is characterized by one of the world's largest oxygen minimum zones (OMZ). The lithology and geochemistry of a 5.3 m long gravity core retrieved from the lower boundary of the modern OMZ (956 m water depth) were used to identify late Holocene changes in oceanographic conditions and the vertical extent of the OMZ. While the lower part of the core (535 - 465 cm, 5.04 - 4.45 cal kyr BP, Unit 3) is strongly bioturbated indicating oxic bottom water conditions, the upper part of the core (284 - 0 cm, 2.87 cal kyr BP to present, Unit 1) shows distinct and well-preserved lamination, suggesting anoxic bottom waters. The transitional interval from 465 to 284 cm (4.45 - 2.87 cal kyr BP, Unit 2) contains relicts of lamination which are in part intensely bioturbated. These fluctuations in bioturbation intensity suggest repetitive changes between anoxic and oxic/suboxic bottom-water conditions between 4.45 - 2.87 cal kyr BP. Barium excess (Baex) and total organic carbon (TOC) contents do not explain whether the increased TOC contents found in Unit 1 are the result of better preservation due to low BWO concentrations or if the decreased BWO concentration is a result of increased productivity. Changes in salinity and temperature of the outflowing water from the Red Sea during the Holocene influenced the water column stratification and probably affected the depth of the lower boundary of the OMZ in the northern Arabian Sea. Even if we cannot prove certain scenarios, we propose that the observed downward shift of the lower boundary of the OMZ was also impacted by a weakened Somali Current and a reduced transport of oxygen-rich Indian Central Water into the Arabian Sea, both as a response to decreased summer insolation and the continuous southward shift of the Intertropical Convergence Zone during the late Holocene.

Upper-ocean microstructure data from the tropical Atlantic

SST variability within the Atlantic cold tongue (ACT) region is of climatic relevance for the surrounding continents. A multi cruise data set of microstructure observations is used to infer regional as well as seasonal variability of upper ocean mixing and diapycnal heat flux within the ACT region. The variability in mixing intensity is related to the variability in large scale background conditions, which were additionally observed during the cruises. The observations indicate fundamental differences in background conditions in terms of shear and stratification below the mixed layer (ML) for the western and eastern equatorial ACT region causing critical Froude numbers (Fr) to be more frequently observed in the western equatorial ACT. The distribution of critical Fr occurrence below the ML reflects the regional and seasonal variability of mixing intensity. Turbulent dissipation rates (?) at the equator (2°N-2°S) are strongly increased in the upper thermocline compared to off-equatorial locations. In addition, ? is elevated in the western equatorial ACT compared to the east from May to November, whereas boreal summer appears as the season of highest mixing intensities throughout the equatorial ACT region, coinciding with ACT development. Diapycnal heat fluxes at the base of the ML in the western equatorial ACT region inferred from ? and stratification range from a maximum of 90 Wm-2 in boreal summer to 55 Wm-2 in September and 40 Wm-2 in November. In the eastern equatorial ACT region maximum values of about 25 Wm-2 were estimated during boreal summer reducing to about 5 Wm-2 towards the end of the year. Outside the equatorial region, inferred diapycnal heat fluxes are comparably low rarely exceeding 10 Wm-2. Integrating the obtained heat flux estimates in the ML heat budget at 10°W on the equator accentuates the diapycnal heat flux as the largest ML cooling term during boreal summer and early autumn. In the western equatorial ACT elevated meridional velocity shear in the upper thermocline contributes to the enhanced diapycnal heat flux within this region during boreal summer and autumn. The elevated meridional velocity shear appears to be associated with intra-seasonal wave activity.