Direct Mechanical Intervention Versus Combined Intravenous and Mechanical Intervention in Large Artery Anterior Circulation Stroke: A Matched-Pairs Analysis.

BACKGROUND AND PURPOSE Five randomized controlled trials have consistently shown that mechanical thrombectomy (MT) in addition to best medical treatment (±intravenous tissue-type plasminogen activator) improves outcome after acute ischemic stroke in patients with large artery anterior circulation stroke. Whether direct MT is equally effective as combined intravenous thrombolysis with MT (ie, bridging thrombolysis) remains unclear. METHODS We retrospectively compared clinical and radiological outcomes in 167 bridging patients with 255 patients receiving direct MT because of large artery anterior circulation stroke. We matched all patients from the direct MT group who would have qualified for intravenous tissue-type plasminogen activator with controls from the bridging group, using multivariate and propensity score analyses. Functional independence was defined as modified Rankin Scale score of 0 to 2. RESULTS From February 2009 to August 2014, 40 patients from the direct MT group would have qualified for bridging thrombolysis but were treated with MT only. Clinical and radiological characteristics did not differ from the bridging cohort, except for higher rates of hypercholesterolemia (P=0.019), coronary heart disease (P=0.039), and shorter intervals from symptom onset to endovascular intervention (P=0.01) in the direct MT group. Functional independence, mortality, and intracerebral hemorrhage rates did not differ (P>0.1). After multivariate matching analysis outcome in both groups did not differ, except for lower rates of asymptomatic intracerebral hemorrhage (P=0.023) and lower mortality (P=0.007) in the direct MT group. CONCLUSIONS In patients with large anterior circulation stroke, direct mechanical intervention seems to be equally effective as bridging thrombolysis. A randomized trial comparing direct MT with bridging therapy is warranted.

A Model Study of the Circulation in the Pearl River Estuary (PRE) and Its Adjacent Coastal Waters: 2. Sensitivity Experiments

The Princeton Ocean Model is used to study the circulation in the Pear River Estuary (PRE) and the adjacent coastal waters in the winter and summer seasons. Wong et al. [2003] compares the simulation results with the in situ measurements collected during the Pearl River Estuary Pollution Project (PREPP). In this paper, sensitivity experiments are carried out to examine the plume and the associated frontal dynamics in response to seasonal discharges and monsoon winds. During the winter, convergence between the seaward spreading plume water and the saline coastal water sets up a salinity front that aligns from the northeast to the southwest inside the PRE. During the summer the plume water fills the PRE at the surface and spreads eastward in the coastal waters in response to the prevailing southwesterly monsoon. The overall alignment of the plume is from the northwest to the southeast. The subsurface front is similar to that in the winter and summer except that the summer front is closer to the mouth and the winter front closer to the head of the estuary. Inside the PRE, bottom flows are always toward the head of the estuary, attributed to the density gradient associated with the plume front. In contrast, bottom flows in the shelf change from offshore in winter to onshore in summer, reflecting respectively the wintertime downwelling and summertime upwelling. Wind also plays an essential role in controlling the plume at the surface. An easterly wind drives the plume westward regardless winter or summer. The eastward spreading of the plume during the summer can be attributed to the southerly component of the wind. On the other hand, the surface area of the plume is positively proportional to the amount of discharge.

OPAC Design Enhancements and Their Effects on Circulation and Resource Sharing within the Library Consortium Environment

A longitudinal study of three discrete online public access catalog (OPAC) design enhancements examined the possible effects such changes may have on circulation and resource sharing within the automated library consortium environment. Statistical comparisons were made of both circulation and interlibrary loan (ILL) figures from the year before enhancement to the year after implementation. Data from sixteen libraries covering a seven-year period were studied in order to determine the degree to which patrons may or may not utilize increasingly broader OPAC ILL options over time. Results indicated that while ILL totals increased significantly after each OPAC enhancement, such gains did not result in significant corresponding changes in total circulation.

(Table 1) Insoluble aerosol concentrations and vertical fluxes at the eastern shelf of the Black Sea during breeze circulation in October 1987

Amounts of aerosols transported to the shelf surface were calculated on the basis of in situ measurements of concentrations of eolian matter (insoluble aerosol fraction) and vertical fluxes of settling dust in five areas of the Black Sea shelf from the Danube delta to the Inguri River mouth. More than 8.3 mln t of eolian matter are annually transported from the land over the shelf of the former USSR. At the same time more than 5.4 mln t are supplied to the northwestern shelf area, 1.7 mln t are supplied to the Crimean area, about 0.8 mln t are supplied to the Kerch-Taman' area, and about 0.45 mln t are supplied to the Caucasian area.

High-resolution marine record of sediment core MD99-2343 in the Balearic Sea

The IMAGES core MD99-2343, recovered from a sediment drift north of the island of Minorca, in the north-western Mediterranean Sea, holds a high-resolution sequence that is perfectly suited to study the oscillations of the overturning system of the Western Mediterranean Deep Water (WMDW). Detailed analysis of grain-size and bulk geochemical composition reveals the sensitivity of this region to climate changes at both orbital and centennial-millennial temporal scales during the last 50 kyr. The dominant orbital pattern in the K/Al record indicates that sediment supply to the basin was controlled by the insolation evolution at 40°N, which forced changes in the fluvial regime, with more efficient sediment transport during insolation maxima. This orbital control also modulated the long-term pattern of the WMDW intensity as illustrated by the silt/clay ratio. However, deep convection was particularly sensitive to climatic changes at shorter time-scales, i.e. to centennial-millennial glacial and Holocene oscillations that are well documented by all the paleocurrent intensity proxies (Si/Al, Ti/Al and silt/clay ratios). Benthic isotopic records (d13C and d18O) show a Dansgaard-Oeschger (D-O) pattern of variability of WMDW properties, which can be associated with changing intensities of the deep currents system. The most prominent reduction on the WMDW overturning was caused by the post-glacial sea level rise. Three main scenarios of WMDW overturning are revealed: a strong mode during D-O Stadials, a weak mode during D-O Interstadials and an intermediate mode during cooling transitions. In addition, D-O Stadials associated with Heinrich events (HEs) have a very distinct signature as the strong mode of circulation, typical for the other D-O Stadials, was never reached during HE due to the surface freshening induced by the inflowing polar waters. Consequently, the WMDW overturning system oscillated around the intermediate mode of circulation during HE. Though surface conditions were more stable during the Holocene, the WMDW overturning cell still reacted synchronously to short-lived events, as shown by increments in the planktonic d18O record, triggering quick reinforcements of the deep water circulation. Overall, these results highlight the sensitivity of the WMDW to rapid climate change which in the recent past were likely induced by oceanographic and atmospheric reorganizations in the North Atlantic region.

Deep thermohaline Circulation in the low-latitude Atlantic during the Last Glacial

Present-day low-latitude eastern and western Atlantic basins are geochemically distinct below the sill depth of the Mid-Atlantic Ridge. While Antarctic Bottom Water (AABW) circulates freely in the western Atlantic, flow into the eastern Atlantic is restricted below 4 km which results in filling the abyssal depths of this basin with water of geochemical similarity to nutrient depleted North Atlantic Deep Water. Using carbon isotopes and Cd/Ca ratios in benthic foraminifera we reconstruct the geochemistry of these basins during the last glacial maximum. Results indicate that deep eastern and western Atlantic basins became geochemically identical during the last glacial. This was achieved by shoaling of the upper surface of AABW above the sill depth of the Mid-Atlantic Ridge, which allowed bottom waters in both basins to be filled with the same water mass. Although AABW became the dominant water mass in the deep eastern Atlantic basin during the glacial, Holocene-glacial delta13C-PO4 shifts in this basin are in Redfield proportions, unlike the disproportionate Holocene-glacial delta13C-PO4 shifts observed in the Southern Ocean. By examining the composition of deep and intermediate waters throughout the Atlantic, we show that this effect was induced by a change in gradient of the delta13C-PO4 deepwater mixing line during glacial times. Evidence from high-latitude planktonic data suggests that the change in gradient of the deepwater mixing line was brought about through a significant reduction in the thermodynamic effect on Southern Ocean surface waters. By using coupled delta13C-PO4 data to constrain the composition of end member water masses in the glacial Atlantic, we conclude that deep waters in the low-latitude glacial Atlantic were composed of a mixture of northern and southern source waters in a ratio of 1:3.

Carbonate cements and fluid circulation of ODP Leg 116 samples

The carbonate cements found in Sites 717-719 of ODP Leg 116 correspond to the precipitation of inorganic calcite due to circulation of hot fluid associated with intraplate deformation in the central Indian Ocean. A first burst of hydrothermal activity may have occurred 7.5-9 Ma and a second burst less than 0.5 Ma. These fluids were probably derived from the basaltic basement and the immediately overlying sediments.

Benthic foraminiferal carbon isotopic records and the development of abyssal circulation at DSDP Sites 9-77, 12-119, 30-289, 82-563 and 94-608

The North Atlantic at present is ventilated by overflow of the Denmark Strait, Iceland-Faeroe Ridge, Faeroe Bank Channel, and Wyville-Thompson Ridge. The evolution of Cenozoic abyssal circulation of this region was related to tectonic opening and subsidence of these sills. We used d13C records of the benthic foraminifer Cibicidoides to decipher the timing of tectonically controlled changes in bottom-water circulation in the eastern basins (Biscay and Iberian) of the northern North Atlantic. Records from Site 608 (Kings Trough, northeastern North Atlantic) show that from about 24 to 15 Ma (early to early middle Miocene), d13C values in the Kings Trough area were depleted relative to western North Atlantic values and were more similar to Pacific d13C values. This reflects less ventilation of the Kings Trough region as compared to the well-oxygenated western North Atlantic. Comparison of Oligocene d13C records from Site 119 (Bay of Biscay) with western North Atlantic records suggests that the eastern basin was also relatively isolated prior to 24 Ma. At about 15 Ma, d13C values at Site 608 attained values similar to the western North Atlantic, indicating increased eastern basin ventilation in the middle Miocene. This increased advection into the eastern basin predated a major d18O increase which occurred at about 14.6 Ma. Subsidence estimates of the Greenland-Scotland Ridge indicate that the deepening of the Iceland-Faeroe Ridge was coincident with the marked change in eastern basin deep-water ventilation.

Numerical modeling of marine radiocarbon reservoir ages during the last deglaciation

A critical problem in radiocarbon dating is the spatial and temporal variability of marine reservoir ages (MRAs). We assessed the MRA evolution during the last deglaciation by numerical modeling, applying a self-consistent iteration scheme in which an existing radiocarbon chronology (derived by Hughen et al., Quat. Sci. Rev., 25, pp. 3216-3227, 2006) was readjusted by transient, 3-D simulations of marine and atmospheric Delta14C. To estimate the uncertainties regarding the ocean ventilation during the last deglaciation, we considered various ocean overturning scenarios which are based on different climatic background states (PD: modern climate, GS: LGM climate conditions). Minimum and maximum MRAs are included in file 'MRAminmax_21-14kaBP.nc'. Three further files include MRAs according to equilibrium simulations of the preindustrial ocean (file 'C14age_preindustrial.nc'; this is an update of our results published in 2005) and of the glacial ocean (files 'C14age_spinupLGM_GS.nc' and 'C14age_spinupLGM_PD.nc').

Past circulation along the western Iberian margin

Fifteen Iberian margin sediment cores, distributed between 43°12'N and 35°53'N, have been used to reconstruct spatial and temporal (sub)surface circulation along the Iberian margin since the Last Glacial period. Time-slice maps of planktonic foraminiferal derived summer sea surface temperature (SST) and export productivity (Pexp) were established for specific time intervals within the last 35 ky: the Holocene (Recent and last 8 ky), Younger Dryas (YD), Heinrich Stadials (HS) 1, 2a, 2b, 3, and the Last Glacial Maximum (LGM). The SST during the Holocene shows the same latitudinal gradient along the western Iberian margin as present-day with cold but productive areas that reflect the influence of coastal upwelling centers. The LGM appears as a slightly less warm, but more productive period relative to the Holocene and present-day conditions, suggesting that sea-level minima forced a westward displacement of the coastal upwelling centers possibly accompanied by a strengthening of northward winds. During the YD, a longitudinal thermal front is depicted at 10°W, with cold polar waters offshore and warmer subtropical waters inshore, suggesting that the subtropical Paleo-Iberian Poleward Current more likely flowed at a more inshore location masking the local SST signal and amplitude of variation. A substantial cooling and drop in productivity is observed during all HS, in particular HS1 and HS3, reflecting the penetration of icebergs-derived meltwater. These most extreme southward extensions of very cold waters define a strong SST gradient that marks a possible Paleo-Azores Front. Higher production south of this front was likely fed by frontal nutrient advection.

Stable oxygen and carbon isotope record of benthic foraminifera in Pliocene sediments of the Californian margin

New benthic foraminiferal stable isotopic records of northeast Pacific intermediate water (ODP Site 1014, 1177 m) and mid-depth water (ODP Site 1018, 2476 m) were compared to isotopic records of deep water in the tropical Pacific (ODP Site 849, 3851 m) for the reconstruction of vertical profiles of nutrient and physical properties from the Early Pliocene to the Early Pleistocene (approx. 5-1.4 Ma). Our data indicate that, for the entire interval, there was enhanced north Pacific intermediate water ventilation relative to today, and a similar to modern circulation pattern with northward flowing Pacific Bottom Water (PBW) beneath its southward flowing return flow. However, the core of maximally aged return flow resided as deep as ~2500 m (as compared to ~1500 m today), probably due to the strengthened intermediate water flow. Less apparent aging of deep water along its path before 2.7 Ma indicates that thermohaline overturning may have been more rapid in the warm period of the Early Pliocene. In addition, prior to 2.7 Ma, foraminiferal oxygen isotopic values at mid-depth sites are higher than at deep sites (a reversed vertical gradient relative to today) in both the Atlantic and Pacific Oceans. We suggest that NADW was warmer and more saline than today and that it influenced mid-depth waters throughout the Atlantic and Pacific Oceans. Enhanced Pliocene formation of warmer/saltier intermediate water in the north Pacific, and deep water in the north Atlantic, may have been a result of higher than modern high/mid-latitude sea surface temperatures, evaporation, and salinity.

Model results of sensitivity experiments for marine nitrogen cycle in four NetCDF files

The marine nitrogen (N) inventory is thought to be stabilized by negative feedback mechanisms that reduce N inventory excursions relative to the more slowly overturning phosphorus inventory. Using a global biogeochemical ocean circulation model we show that negative feedbacks stabilizing the N inventory cannot persist if a close spatial association of N2 fixation and denitrification occurs. In our idealized model experiments, nitrogen deficient waters, generated by denitrification, stimulate local N2 fixation activity. But, because of stoichiometric constraints, the denitrification of newly fixed nitrogen leads to a net loss of N. This can enhance the N deficit, thereby triggering additional fixation in a vicious cycle, ultimately leading to a runaway N loss. To break this vicious cycle, and allow for stabilizing negative feedbacks to occur, inputs of new N need to be spatially decoupled from denitrification. Our idealized model experiments suggest that factors such as iron limitation or dissolved organic matter cycling can promote such decoupling and allow for negative feedbacks that stabilize the N inventory. Conversely, close spatial co-location of N2 fixation and denitrification could lead to net N loss.

Isopollen maps for 18,000 years B.P. of the offshore of Northwest Africa: Evidence for paleowind circulation

Distribution patterns of the most important pollen types from southern European and northwest African source areas for the 18,000 years B.P. time slice are reconstructed from pollen records of 14 well-dated deep-sea cores located between 37° and 9°N and compared with the modern pollen distribution in this area. It is concluded that the belt with maximum African Easterly Jet transport did not shift latitudinally during the last glacial-interglacial transition but remained at about 20°N. Furthermore, it is substantiated that the trade winds did not shift latitudinally during the last glacial-interglacial transition. This evidence is not compatible with an atmospheric circulation model that assumes a zone of surface westerlies in the northern part of northwest Africa. Trade winds during glacial episodes did, however, intensify, especially from about 36° to 24° N.

On the effects of circulation, sediment resuspension and biological incorporation by diatoms in an ocean model of aluminium, link to model data

The distribution of dissolved aluminium in the West Atlantic Ocean shows a mirror image with that of dissolved silicic acid, hinting at intricate interactions between the ocean cycling of Al and Si. The marine biogeochemistry of Al is of interest because of its potential impact on diatom opal remineralisation, hence Si availability. Furthermore, the dissolved Al concentration at the surface ocean has been used as a tracer for dust input, dust being the most important source of the bio-essential trace element iron to the ocean. Previously, the dissolved concentration of Al was simulated reasonably well with only a dust source, and scavenging by adsorption on settling biogenic debris as the only removal process. Here we explore the impacts of (i) a sediment source of Al in the Northern Hemisphere (especially north of ~ 40° N), (ii) the imposed velocity field, and (iii) biological incorporation of Al on the modelled Al distribution in the ocean. The sediment source clearly improves the model results, and using a different velocity field shows the importance of advection on the simulated Al distribution. Biological incorporation appears to be a potentially important removal process. However, conclusive independent data to constrain the Al / Si incorporation ratio by growing diatoms are missing. Therefore, this study does not provide a definitive answer to the question of the relative importance of Al removal by incorporation compared to removal by adsorptive scavenging.