Ocean circulation along the southern Chile transition region (38°-46°S): Mean, seasonal and interannual variability, with a focus on 2014-2016.

Satellite and atmospheric model fields are used to describe the wind forcing, surface ocean circulation, temperature and chlorophyll-a pigment concentrations along the coast of southern Chile in the transition region between 38° and 46°S. Located inshore of the bifurcation of the eastward South Pacific Current into the equatorward Humboldt and the poleward Cape Horn Currents, the region also includes the Chiloé Inner Sea and the northern extent of the complex system of fjords, islands and canals that stretch south from near 42°S. The high resolution satellite data reveal that equatorward currents next to the coast extend as far south as 48°-51°S in spring-summer. They also display detailed distributions of forcing from wind stress and wind stress curl near the coast and within the Inner Sea. Between 38°-46°S, both winds and surface currents during 1993-2016 change directions seasonally from equatorward during summer upwelling to poleward during winter downwelling, with cooler SST and greater surface chlorophyll-a concentrations next to the coast during upwelling, opposite conditions during downwelling. Over interannual time scales during 1993-2016, there is a strong correlation between equatorial El Niño events and sea level and a moderate correlation with alongshore currents. Looking more closely at the 2014-2016 period, we find a marginal El Niño during 2014 and a strong El Niño during 2015 that connect the region to the tropics through the oceanic pathway, with some atmospheric connections through the phenomenon of atmospheric blocking (as noted by others). The period also includes a Harmful Algal Bloom of the dinoflagellate Alexandrium catenella during early-2016 that occurred during a sequence of physical conditions (winds, currents and temperatures) that would favor such a bloom. The most anomalous physical condition during this specific bloom is an extreme case of atmospheric blocking that creates a long period of calm in austral autumn after strong upwelling in austral summer. The blocking is related to the 2015-2016 El Niño and an unusual coincident positive phase of the Southern Annular Mode.

How chronic pain changes a person's life story in relation to participation in occupational roles: A narrative exploration.

BACKGROUND: Chronic pain (CP) affects a large part of the population worldwide, decreasing physical and mental health and causing a shift in occupational roles. This has created a need for a better understanding to address this problem. OBJECTIVES: To explore possible changes in occupational roles and the participation levels within among people diagnosed with CP over time. MATERIAL AND METHODS: The study used a qualitative, narrative methodology. Five people with CP were included in the study. They participated in a single-life story interview coupled with timeline drawings. Data analysis was conducted using a narrative analysis. RESULTS: The results revealed that occupational roles and the participation therein changed over time. Employee was considered the most important role, whereby the participants tried to maintain this role by sacrificing other roles within their lives. Moreover, CMP forced a change in their occupational identity. CONCLUSION: CP can disrupt a person's life and demand a change in occupational roles and the participation levels within. This process was accompanied by possible changes in their occupational identity.

Climatic forcing: effects of el nino on a small, temperate lake.

Temperature profiles measured regularly for 21 years reveal the interannual differences in winter-to-summer heat gain in Castle Lake, California, a small subalpine lake. Year-to-year changes in large-scale climatic surface forcing, especially the amount of snowfall from February through April (which determines the date of thaw) coupled with the early heating and wind mixing after thaw, causes this interannual variation. The seasonal thermal structure for years in which the lake gains significantly more or less heat than normal-all of the El Niño years and several others-shows that the depth of the mixed layer and the mixing of heat into the stratified thermocline region control the storage of heat. The temperature of the mixed layer does not reflect abnormal thermal storage. Variations in mixing during early spring, which controls the heat content at Castle Lake, may also affect the annual average of the primary productivity.

The pelagic ecosystem in the Northern California Current off Oregon during the 2014-2016 warm anomalies within the context of the past 20 years.

A warm anomaly in the upper ocean, colloquially named "the Blob," appeared in the Gulf of Alaska during the calm winter of 2013-2014, spread across the northern North Pacific (NP) Ocean, and shifted eastward and onto the Oregon shelf. At least 14 species of copepods occurred which had never been observed in shelf/slope waters off Oregon, some of which are known to have NP Gyre affinities, indicating that the source waters of the coastal "Blob" were likely of both offshore (from the west) and subtropical/tropical origin. The anomalously warm conditions were reduced during strong upwelling in spring 2015 but returned when upwelling weakened in July 2015 and transitioned to downwelling in fall 2015. The extended period of warm conditions resulted in prolonged effects on the ecosystem off central Oregon, lasting at least through 2016. Impacts to the lower trophic levels were unprecedented and include a novel plankton community composition resulting from increased copepod, diatom, and dinoflagellate species richness and increased abundance of dinoflagellates. Additionally, the multiyear warm anomalies were associated with reduced biomass of copepods and euphausiids, high abundance of larvaceans and doliolids (indictors of oligotrophic ocean conditions), and a toxic diatom bloom (Pseudo-nitzschia) throughout the California Current in 2015, thereby changing the composition of the food web that is relied upon by many commercially and ecologically important species.

Blended sea level anomaly fields with enhanced coastal coverage along the U.S. West Coast.

We form a new 'blended' data set of sea level anomaly (SLA) fields by combining gridded daily fields derived from altimeter data with coastal tide gauge data. Within approximately 55-70 km of the coast, the altimeter data are discarded and replaced by a linear interpolation between the tide gauge and remaining offshore altimeter data. To create a common reference height for altimeter and tide gauge data, a 20-year mean is subtracted from each time series (from each tide gauge and altimeter grid point) before combining the data sets to form a blended mean sea level anomaly (SLA) data set. Daily mean fields are produced for the 22-year period 1 January 1993-31 December 2014. The primary validation compares geostrophic velocities calculated from the height fields and velocities measured at four moorings covering the north-south range of the new data set. The blended data set improves the alongshore (meridional) component of the currents, indicating an improvement in the cross-shelf gradient of the mean SLA data set.

Intra-seasonal sea level variability along the west coast of India.

The importance of local versus distant forcing is studied for the wind-driven intra-seasonal (30-120 day) sea level anomaly (SLA) variations along the west coast of India. Significant correlations of altimeter-derived SLA on the west coast are found with the mid-basin SLA east of Sri Lanka and SLA as far as Sumatra and the equator, with increased lags, connecting with the remote forcing from the equator in the form of reflected Rossby waves. The highest correlations between SLA on the west coast and winds are found with the winds at the southern tip of India. Coherence calculations help to identify the importance of a narrow band (40-60 day) for the interactions of winds with the intra-seasonal SLA variations. A multivariate regression model, along with the coherences within this narrower band, suggest the lags of SLA on the west coast with winds to range from 0 to 2 days with the local forcing to 11-13 days with the forcing along south east coast of India. Hovmöller diagrams illustrate the propagation of signals by estimating phase speed for Rossby waves (57 cm/s) across the Indian Ocean from Sumatra and Coastal Trapped Waves (CTWs) along the west coast of India (178 cm/s). Propagation from the south-east coast of India is not as robust as Rossby waves from Sumatra.

Sea level anomaly on the Patagonian continental shelf: Trends, annual patterns and geostrophic flows.

We study the annual patterns and linear trend of satellite sea level anomaly (SLA) over the southwest South Atlantic continental shelf (SWACS) between 54ºS and 36ºS. Results show that south of 42°S the thermal steric effect explains nearly 100% of the annual amplitude of the SLA, while north of 42°S it explains less than 60%. This difference is due to the halosteric contribution. The annual wind variability plays a minor role over the whole continental shelf. The temporal linear trend in SLA ranges between 1 and 5 mm/yr (95% confidence level). The largest linear trends are found north of 39°S, at 42°S and at 50°S. We propose that in the northern region the large positive linear trends are associated with local changes in the density field caused by advective effects in response to a southward displacement of the South Atlantic High. The causes of the relative large SLA trends in two southern coastal regions are discussed as a function meridional wind stress and river discharge. Finally, we combined the annual cycle of SLA with the mean dynamic topography to estimate the absolute geostrophic velocities. This approach provides the first comprehensive description of the seasonal component of SWACS circulation based on satellite observations. The general circulation of the SWACS is northeastward with stronger/weaker geostrophic currents in austral summer/winter. At all latitudes, geostrophic velocities are larger (up to 20 cm/s) close to the shelf-break and decrease toward the coast. This spatio-temporal pattern is more intense north of 45°S.

Altimeter-derived seasonal circulation on the southwest Atlantic shelf: 27°-43°S.

Altimeter sea surface height (SSH) fields are analyzed to define and discuss the seasonal circulation over the wide continental shelf in the SW Atlantic Ocean (27°-43°S) during 2001-2012. Seasonal variability is low south of the Rio de la Plata (RdlP), where winds and currents remain equatorward for most of the year. Winds and currents in the central and northern parts of our domain are also equatorward during autumn and winter but reverse to become poleward during spring and summer. Transports of shelf water to the deep ocean are strongest during summer offshore and to the southeast of the RdlP. Details of the flow are discussed using mean monthly seasonal cycles of winds, heights, and currents, along with analyses of Empirical Orthogonal Functions. Principle Estimator Patterns bring out the patterns of wind forcing and ocean response. The largest part of the seasonal variability in SSH signals is due to changes in the wind forcing (described above) and changes in the strong boundary currents that flow along the eastern boundary of the shelf. The rest of the variability contains a smaller component due to heating and expansion of the water column, concentrated in the southern part of the region next to the coast. Our results compare well to previous studies using in situ data and to results from realistic numerical models of the regional circulation.

Evaluation of donor cardiac function for heart transplantation: experience of a French academic hospital.

OBJECTIVES: The diagnostic and therapeutic approaches for evaluation and management of cardiac function in brain-dead patients vary from country to country. The aim of the present study was to describe the results of the evaluation of brain-dead patients as potential cardiac donors in a French teaching hospital that manages the largest number of brain-dead patients in France. METHODS: Demographic parameters, the causes of brain death, clinical evolution, hemodynamic parameters, doses of inotropic and/or vasopressive drugs, the results of echocardiographic examination, and several biochemical markers of myocardial cell injury were retrospectively collected. RESULTS: Seventy-one consecutive brain-dead patients admitted to the intensive care unit of the Academic Hospital of Nancy from October 1st, 1998 to September 30, 1999 were analyzed. Twenty-nine patients were considered as potential heart donors: 22 males and 7 females aged 33 +/- 3 years (Mean + SEM). The cause of brain death was head trauma in 17 cases (59%), cerebrovascular disease in 10 cases (34%), and cerebral anoxia related to cardiac arrest in 2 cases (7%). Eighteen hearts (18/29 or 66%) were harvested and transplanted with a favorable outcome at one month in 17 cases. In 11 cases, the heart was not harvested, nine (9/29 or 31%) because of myocardial dysfunction upon subsequent echocardiographic examination and 2 because of the lack of matched recipients. CONCLUSION: Comparison of these results with those of other groups suggests that hormonal substitution with insulin and triiodothyronine in the presence of myocardial dysfunction could be of potential interest to correct myocardial dysfunction and increase the number of donor hearts.

[Value of hormonal treatment with triiodothyronine and cortisone in brain dead patients]. / Intérêt de l'hormonothérapie associant triiodothyronine et cortisone chez le patient en état de mort cérébrale.

Brain death leads to substantial falls in the plasma levels of cortisol and tri-iodothyronine (T3). These alterations may be responsible for physiological instability in these patients, and impairment in donor organ function. A double-blind study was therefore designed to assess the possible improvement in metabolism and haemodynamic stability in brain-dead organ donors treated with T3 and cortisone. Forty adult brain-dead patients were randomly assigned to two groups, the patients of the treated group were given every hour, or half hour, 2 or 4 micrograms T3 and 100 mg hydrocortisone intravenously, and those of the placebo group normal saline. Both groups of patients received conventional management for brain-dead donors. The main assessment criterion was the haemodynamic course, appreciated by the Pasys, the CVP and the needs in dobutamine; the secondary criterion was the start, or worsening, of a metabolic acidosis, as judged by the pH, the level of arterial bicarbonate, and the needs in sodium bicarbonate. The two groups were comparable for age, sex, aetiology of brain death, the delay between brain death and the start of the experimental protocol, and the duration of this protocol. There were differences between the two groups, which were not statistically significant: improvement in haemodynamic profile (hormone group 9/20 versus placebo group 10/20); worsening in haemodynamic profile (2/20 vs 4/20); increased requirements in dobutamine (2/20 vs 4/20); decreased requirements in inotropic support (15/20 vs 13/20); mean dose of dobutamine (3.1 +/- 4.2 micrograms.kg-1 vs 2.5 +/- 3.8 micrograms.kg-1); metabolic acidosis (5/20 vs 5/20); mean bicarbonate dose (30.0 +/- 67.7 mmol vs 45.0 +/- 74.2 mmol); donors harvested (20/20 vs 18/20).(ABSTRACT TRUNCATED AT 250 WORDS)

[Abscess of the atrium: a complication of central venous catheters]. / L'abcès de l'oreillette: une complication des cathéters veineux centraux.

A 27-year-old female patient was admitted for parenteral feeding and treatment of an acute episode of her steroid dependent Crohn's disease. An intravenous catheter was inserted, the tip being located in the right atrium. This central line was accidentally removed ten days later and replaced with another one also ending in the right atrium. The patient's condition improved over a four-week period. Thereafter, she suddenly became confused and complained of abdominal pain with contracture. She displayed renal failure, coagulation disorders, and decreased blood cell counts. This was followed by a septic shock requiring mechanical ventilation and adrenaline. Laparotomy failed to reveal a cause for the patient's condition. She improved and was extubated four days later. From then on, she had fever (39 degrees C) again. Her catheter was replaced, the tip of this third one being inside the superior vena cava. Staphylococcus epidermidis was obtained from the catheter tip, as well as from four consecutive blood cultures. Despite administration of three different antibiotics, the high fever persisted (40 degrees C). Finally, the occurrence of a systolic murmur led to the discovery, with cardiac ultrasonography, of a mobile right atrial abscess, which engaged into the tricuspid valve at every contraction. Surgery to remove this mass was rapidly carried out. The bacterium was the same as that which had been isolated from the catheter. The patient improved and was able to return home a fortnight later. The diagnosis and prevention of this complication is discussed. The tip of central venous catheter should not be kept inside the atrium.

[Rhabdomyolysis after ORL surgery in prolonged lateral position]. / Rhabdomyolyse au décours d'une chirurgie ORL en décubitus latéral prolongé.

Two cases are reported of upper limb rhabdomyolysis occurring after prolonged ENT cancer surgery, the patient being part of the time in the right lateral position, with the left forearm outstretched. Surgery consisted of a vertical hemilaryngectomy with immediate parascapular free graft reconstruction in a 48-year-old man (10 h of surgery, with 6 h in a lateral position) and the surgical removal of a neoplasm involving the mouth floor and larynx in a 62-year-old man including parascapsular free graft reconstruction (10 h of surgery, with 7 h in a lateral position). In the early postoperative period, the patients complained of severe pain in the left forearm. There was a tense painful swelling of the forearm, combined with an increase in creatinine kinase plasma concentration, and myoglobinaemia. The mechanism involved was most likely a compression of the forearm muscles, together with prolonged surgery and the patient position. The part played by the state of the patients is discussed. Diagnosis must be made as soon as possible, as the only efficient treatment consists of an early fasciotomy together with the administration of alkali to avoid renal failure.

[Development of antifactor VIII circulating anticoagulant after surgery of the biliary tract]. / Apparition d'un anticoagulant circulant antifacteur VIII après chirurgie de la voie biliare.

In a 25-year-old woman, admitted with a haemorrhagic syndrome following biliary surgery, an inhibitor of factor VIII was detected. As bleeding was major, she was re-operated on under perioperative administration of the anti-inhibitory coagulant complex Autoplex-T, associated with polyvalent i.v. immunoglobulins. The other therapeutic agents are also considered and their indications discussed, after a review of the circumstances of the diagnosis of this disease.

[Measurement of cardiac output by thoracic electrical bioimpedance or thermodilution]. / Mesure du débit cardiaque par bioimpédance électrique thoracique ou par thermodilution.

The present study was designed to assess a new non invasive method for measuring cardiac output. The thoracic electrical bioimpedance method was compared with the reference one, thermodilution. The measurements were made simultaneously with NCCOM3 (bioimpedance) using the freeze data mode, and with a Swan-Ganz catheter and a haemodynamic computer (thermodilution). The study involved 11 spontaneously breathing patients in a steady haemodynamic state. Ten measurements were carried out with both methods for each patient. Statistical analysis of the 110 paired values was carried out by computer. The various statistical tests applied confirmed that there was a highly significant correlation between values for cardiac output obtained by each of these two methods (r = 0.818; p less than 0.005); they also showed a significantly more important dispersion of the measures for each patient with thermodilution. The mean value of the thermodilution "standard deviation" (0.64 l.min-1) was significantly more important (p less than 0.005) than the one with NCCOM3 (0.24 l.min-1). Thoracic electrical bioimpedance appeared a safe method for measuring cardiac output, providing the limits of the method are kept. The objective is not to replace the Swan-Ganz catheter, but to propose an alternative method for measuring cardiac output. This method is very interesting in many circumstances, particularly for intensive care patients: it is a non invasive technique, continual measurement is not time-limited, and its use is very easy.

[Analysis of the criteria that contribute to the decision to harvest the heart in brain-dead organ donors]. / Analyse des critères qui participent à la décision de prélèvement cardiaque chez les patients en état de mort encéphalique.

OBJECTIVES: The number of cardiac transplantation procedures does not increase because of the lack of donor hearts despite an increase in the number of brain-dead organ donors. The criteria used to select a donor heart are not formally standardized. The aim of the present study was to analyze the criteria that contribute to the selection of a donor heart. TYPE OF STUDY: Descriptive, retrospective study. PATIENTS AND METHOD: Clinical parameters, the initial causes that lead to brain death, maximum doses of catecholamines, several biochemical markers of myocardial ischaemia/necrosis as well as several echocardiography criteria were extracted from a prospectively collected database. Univariate and multivariate (logistic regression) analyses were performed with the "harvested heart" as dependent variable and the above-cited independent variables. RESULTS: One hundred and eighty consecutive brain-dead patients admitted from 1st October 1998 to 31st December 2000 out of which 112 gave at least one organ were analyzed. Among these 112 patients, 59 (39 males and 20 females) were pre-selected as potential heart donors. Only 44 hearts were harvested. Logistic regression analysis showed that harvesting of the heart was more probable if the donor were a male, had no left ventricle systolic wall motion abnormalities, had low doses of norepinephrine and low serum troponin Ic concentrations. CONCLUSION: After an initial phase of selection, the final decision to harvest a heart is based on several criteria. These results should be an incentive to conceive a score that could allow a more formal decision process for heart harvesting.

The salinity signature of the cross-shelf exchanges in the Southwestern Atlantic Ocean: Satellite observations.

Satellite-derived sea surface salinity (SSS) data from Aquarius and SMOS are used to study the shelf-open ocean exchanges in the western South Atlantic near 35°S. Away from the tropics, these exchanges cause the largest SSS variability throughout the South Atlantic. The data reveal a well-defined seasonal pattern of SSS during the analyzed period and of the location of the export of low-salinity shelf waters. In spring and summer, low-salinity waters over the shelf expand offshore and are transferred to the open ocean primarily southeast of the river mouth (from 36°S to 37°30'S). In contrast, in fall and winter, low-salinity waters extend along a coastal plume and the export path to the open ocean distributes along the offshore edge of the plume. The strong seasonal SSS pattern is modulated by the seasonality of the along-shelf component of the wind stress over the shelf. However, the combined analysis of SSS, satellite-derived sea surface elevation and surface velocity data suggest that the precise location of the export of shelf waters depends on offshore circulation patterns, such as the location of the Brazil Malvinas Confluence and mesoscale eddies and meanders of the Brazil Current. The satellite data indicate that in summer, mixtures of low-salinity shelf waters are swiftly driven toward the ocean interior along the axis of the Brazil/Malvinas Confluence. In winter, episodic wind reversals force the low-salinity coastal plume offshore where they mix with tropical waters within the Brazil Current and create a warmer variety of low-salinity waters in the open ocean. KEY POINTS: Satellite salinity sensors capture low-salinity detrainment events from shelves SW Atlantic low-salinity detrainments cause highest basin-scale variability In summer low-salinity detrainments cause extended low-salinity anomalies.

The salinity signature of the cross-shelf exchanges in the Southwestern Atlantic Ocean: Numerical simulations.

A high-resolution model is used to characterize the dominant patterns of sea surface salinity (SSS) variability generated by the freshwater discharges of the Rio de la Plata (RdlP) and the Patos/Mirim Lagoon in the southwestern Atlantic region. We identify three dominant modes of SSS variability. The first two, which have been discussed in previous studies, represent the seasonal and the interannual variations of the freshwater plumes over the continental shelf. The third mode of SSS variability, which has not been discussed hitherto, represents the salinity exchanges between the shelf and the deep ocean. A diagnostic study using floats and passive tracers identifies the pathways taken by the freshwater plumes. During the austral winter (JJA), the plumes leave the shelf region north of the BMC. During the austral summer (DJF), the plumes are entrained more directly into the BMC. A sensitivity study indicates that the high-frequency component of the wind stress forcing controls the vertical structure of the plumes while the low-frequency component of the wind stress forcing and the interannual variations of the RdlP discharge controls the horizontal structure of the plumes. Dynamical analysis reveals that the cross-shelf flow has a dominant barotropic structure and, therefore, the SSS anomalies detected by Aquarius represent net mass exchanges between the shelf and the deep ocean. The net cross-shelf volume flux is 1.21 Sv. This outflow is largely compensated by an inflow from the Patagonian shelf.