Antarctic link to deep flow speed variation during Marine Isotope Stage 3 in the western North Atlantic

The Western Boundary Undercurrent (WBUC), off eastern America, is an important component of the Atlantic Meridional Overturning circulation and is the principal route for southward transport of North Atlantic waters and southward return of Southern Source Water (SSW). Here a direct flow speed proxy (mean grain size of the sortable silt) is used to infer the vigour of flow of the palaeo-WBUC at Blake Outer Ridge, (ODP Site 1060, depth 3481 m) during Marine Isotope Stage (MIS) 3. The overall\ud shape of the flow speed proxy record shows a complex pattern of variability, with generally more vigorous flow and larger-scale flow variations between 35 and 60 ka than in the younger part of MIS 3 and MIS 2 (b35 ka). Six events of reduced bottom flow vigour (Slow Events, SEs) occur. These appear uncorrelated with Heinrich events, but are instead synchronous with the warming phases of Antarctic Warm Events A-1 to A-4 (with one new one, A-1a and one poorly defined, ‘A-0’). This indicates that Antarctic\ud climate exerts a stronger control on deep flow vigour in the North Atlantic during MIS 3 than Northern Hemisphere climate. The correspondence of SEs with Antarctic warming suggests a weaker WBUC flow due to reduced volume flux at SSW source or reduced SSW density. Because the variability of the lower limb of the WBUC was not connected to sharp North Atlantic changes in temperature, it is unlikely that the Dansgaard/Oeschger cycles were associated with a mode of MOC variation involving whole-\ud ocean overturn, but more likely with perturbations of only the shallow Glacial Gulf Stream–Glacial Northern Source Intermediate Water cell. Nutrient proxies (benthic carbon isotopes and Cd/Ca of Uvigerina peregrina) at this site show similar trends to the GRIP δ18O record. This correlation has previously been attributed mainly to hydrographic and flow changes but is here shown to\ud be better explained by variations in surface ocean productivity and subsequent decomposition of 12C rich organic material on the sea floor

Abrupt wind regime changes in the North Atlantic Ocean during the past 30,000-60,000 years

The inputs of higher plants in Blake Outer Ridge (subtropical western North Atlantic) during marine isotope stage 3 (MIS3) have been recorded at high resolution by quantification of C23–C33 odd carbon numbered n-alkanes and C20–C30 even carbon numbered n-alkan-1-ols in sediment sections of Ocean Drilling Program Site 1060. The changes of these proxies at this open marine site are mainly related to eolian inputs. Their concentrations and fluxes exhibit major abrupt variations that are correlated with Dansgaard/Oeschger (D/O) patterns in Greenland ice cores. The ratios between interstadials and stadials range between 2 and 9 times. The intense flux increases in the D/O stadials are linked to strong enhancements of the westerly wind regime at these subtropical latitudes during stadials. The observed variation was paralleled by changes in wind-blown dust and the polar circulation index in Greenland ice, which is in agreement with previously hypothesized atmospheric teleconnections between northern and middle-low latitudes of the Northern Hemisphere. The close correspondence between sedimentary and ice core proxies is evidence that crossings of the glacial climate thresholds involved major reorganizations of the troposphere. The observed large rise in higher plant biomarkers indicates that climate stabilization in the D/O stadial conditions led to main increases in wind intensity

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112

Glacial expansion of oxygen-depleted seawater in the eastern tropical Pacific

Increased storage of carbon in the oceans has been proposed as a mechanism to explain lower concentrations of atmospheric carbon dioxide during ice ages; however, unequivocal signatures of this storage have not been found1. In seawater, the dissolved gases oxygen and carbon dioxide are linked via the production and decay of organic material, with reconstructions of low oxygen concentrations in the past indicating an increase in biologically mediated carbon storage. Marine sediment proxy records have suggested that oxygen concentrations in the deep ocean were indeed lower during the last ice age, but that near-surface and intermediate waters of the Pacific Ocean—a large fraction of which are poorly oxygenated at present—were generally better oxygenated during the glacial1,2,3. This vertical opposition could suggest a minimal net basin-integrated change in carbon storage. Here we apply a dual-proxy approach, incorporating qualitative upper-water-column and quantitative bottom-water oxygen reconstructions4,5, to constrain changes in the vertical extent of low-oxygen waters in the eastern tropical Pacific since the last ice age. Our tandem proxy reconstructions provide evidence of a downward expansion of oxygen depletion in the eastern Pacific during the last glacial, with no indication of greater oxygenation in the upper reaches of the water column. We extrapolate our quantitative deep-water oxygen reconstructions to show that the respired carbon reservoir of the glacial Pacific was substantially increased, establishing it as an important component of the coupled mechanism that led to low levels of atmospheric carbon dioxide during the glacial

Terrestrial biosphere changes over the last 120 kyr

A new global synthesis and biomization of long (> 40 kyr) pollen-data records is presented and used with simulations from the HadCM3 and FAMOUS climate models and the BIOME4 vegetation model to analyse the dynamics of the global terrestrial biosphere and carbon storage over the last glacial–interglacial cycle. Simulated biome distributions using BIOME4 driven by HadCM3 and FAMOUS at the global scale over time generally agree well with those inferred from pollen data. Global average areas of grassland and dry shrubland, desert, and tundra biomes show large-scale increases during the Last Glacial Maximum, between ca. 64 and 74 ka BP and cool substages of Marine Isotope Stage 5, at the expense of the tropical forest, warm-temperate forest, and temperate forest biomes. These changes are reflected in BIOME4 simulations of global net primary productivity, showing good agreement between the two models. Such changes are likely to affect terrestrial carbon storage, which in turn influences the stable carbon isotopic composition of seawater as terrestrial carbon is depleted in 13C

Climate Evolution through the onset and intensification of Northern Hemisphere Glaciation

This is the author accepted manuscript. The final version is available from Wiley via the DOI in this recordData availability statement: All original data-sets are available via the NOAA and PANGAEA online repositories and can be accessed through the citations and database DOIs given in Table 1, with full references provided below. The data used here, including any which were changed from the original publication due to differences in age control or proxy calibration, and the results of the analyses we performed, are available at https://doi.org/10.1594/PANGAEA.956158 (under moratorium). Data that we retrieved which was not on the NOAA or PANGAEA databases is also available at https://doi.org/10.1594/PANGAEA.956158. The data we have used can also be accessed via our interactive web portal (https://pliovar.github.io/iNHG.html), including an option to download all data as a single fileThe Pliocene Epoch (~5.3-2.6 million years ago, Ma) was characterized by a warmer than present climate with smaller Northern Hemisphere ice sheets, and offers an example of a climate system in long-term equilibrium with current or predicted near-future atmospheric CO2 concentrations (pCO2). A long-term trend of ice-sheet expansion led to more pronounced glacial (cold) stages by the end of the Pliocene (~2.6 Ma), known as the “intensification of Northern Hemisphere Glaciation” (iNHG). We assessed the spatial and temporal variability of ocean temperatures and ice-volume indicators through the late Pliocene and early Pleistocene (from 3.3 to 2.4 Ma) to determine the character of this climate transition. We identified asynchronous shifts in long-term means and the pacing and amplitude of shorter-term climate variability, between regions and between climate proxies. Early changes in Antarctic glaciation and Southern Hemisphere ocean properties occurred even during the mid-Piacenzian warm period (~3.264-3.025 Ma) which has been used as an analogue for future warming. Increased climate variability subsequently developed alongside signatures of larger Northern Hemisphere ice sheets (iNHG). Yet, some regions of the ocean felt no impact of iNHG, particularly in lower latitudes. Our analysis has demonstrated the complex, non-uniform and globally asynchronous nature of climate changes associated with the iNHG. Shifting ocean gateways and ocean circulation changes may have pre-conditioned the later evolution of ice sheets with falling atmospheric pCO2. Further development of high-resolution, multi-proxy reconstructions of climate is required so that the full potential of the rich and detailed geological records can be realized.Natural Environment Research Council (NERC)Leverhulme TrustMinistry of Science and Technology, TaiwanMICINRoyal SocietyResearch Council of NorwayGerman Research FoundationAgencia Nacional de Investigación y Desarrollo, AnilloUniversidad de Santiago de ChileUKRINational Science Foundation (NSF)Agence Nationale de la Recherche in Franc

Pooled analysis of who surgical safety checklist use and mortality after emergency laparotomy

Background: The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods: In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results: Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89⋅6 per cent) compared with that in countries with a middle (753 of 1242, 60⋅6 per cent; odds ratio (OR) 0⋅17, 95 per cent c.i. 0⋅14 to 0⋅21, P &lt; 0⋅001) or low (363 of 860, 42⋅2 percent; OR 0⋅08, 0⋅07 to 0⋅10, P &lt; 0⋅001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference −9⋅4 (95 per cent c.i. −11⋅9 to −6⋅9) per cent; P &lt; 0⋅001), but the relationship was reversed in low-HDI countries (+12⋅1 (+7⋅0 to +17⋅3) per cent; P &lt; 0⋅001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0⋅60, 0⋅50 to 0⋅73; P &lt; 0⋅001). The greatest absolute benefit was seen for emergency surgery in low-and middle-HDI countries. Conclusion: Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries

Reviews and syntheses: Review of proxies for low-oxygen paleoceanographic reconstructions

A growing body of observations has revealed rapid changes in both the total inventory and the distribution of marine oxygen over the latter half of the 20th century, leading to increased interest in extending oxygenation records into the past. The use of paleo-oxygen proxies has the potential to extend the spatial and temporal range of current records, constrain pre-anthropogenic baselines, provide datasets necessary to test climate models under different boundary conditions, and ultimately understand how ocean oxygenation responds beyond decadal-scale changes. This review seeks to summarize the current state of knowledge about proxies for reconstructing Cenozoic marine oxygen: sedimentary features, sedimentary redox-sensitive trace elements and isotopes, biomarkers, nitrogen isotopes, foraminiferal trace elements, foraminiferal assemblages, foraminiferal morphometrics, and benthic foraminiferal carbon isotope gradients. Taking stock of each proxy reveals some common limitations as the majority of proxies functions best at low-oxygen concentrations, and many reflect multiple environmental drivers. We also highlight recent breakthroughs in geochemistry and proxy approaches to constraining pelagic (in addition to benthic) oxygenation that are rapidly advancing the field. In light of both the emergence of new proxies and the persistent multiple driver problem, the need for multi-proxy approaches and data storage and sharing that adhere to the principles of findability, accessibility, interoperability, and reusability (FAIR) is emphasized. Continued refinements of proxy approaches and both proxy–proxy and proxy–model comparisons are likely to support the growing needs of both oceanographers and paleoceanographers interested in paleo-oxygenation records.</p