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Fulltext Anomalous wind triggered the largest phytoplankton bloom in the oligotrophic North Pacific Subtropical Gyre

Chow CH, Cheah W, Tai JH, Liu SF

Sci Rep, 2019 10 29;9(1):15550.
PMID: 31664110 DOI: 10.1038/s41598-019-51989-x

In summer 2010, a massive bloom appeared in the middle (16-25°N, 160-200°E) of the North Pacific Subtropical Gyre (NPSG) creating a spectacular oasis in the middle of the largest oceanic desert on Earth. Peaked in June 2010 covering over two million km2 in space, this phytoplankton bloom is the largest ever recorded by ocean color satellites in the NPSG over the period from 1997 to 2013. The initiation and mechanisms sustaining the massive bloom were due to atmospheric and oceanic anomalies. Over the north (25-30°N) of the bloom, strong anticyclonic winds warmed sea surface temperature (SST) via Ekman convergence. Subsequently, anomalous westward ocean currents were generated by SST meridional gradients between 19°N and 25°N, producing strong velocity shear that caused large number of mesoscale (100-km in order) cyclonic eddies in the bloom region. The ratio of cyclonic to anticyclonic eddies of 2.7 in summer 2010 is the highest over the 16-year study period. As a result of the large eddy-number differences, eddy-eddy interactions were strong and induced submesoscale (smaller than 100 km) vertical pumping as observed in the in-situ ocean profiles. The signature of vertical pumping was also presented in the in-situ measurements of chlorophyll and nutrients, which show higher concentrations in 2010 than other years.
Erratum to: Withholding and withdrawal of life-sustaining treatments in low-middle-income versus high-income Asian countries and regions

Phua J, Joynt GM, Nishimura M, Deng Y, Myatra SN, Chan YH, et al.

Intensive Care Med, 2016 07;42(7):1202.
PMID: 27161082 DOI: 10.1007/s00134-016-4365-9
Withholding and withdrawal of life-sustaining treatments in intensive care units in Asia

Phua J, Joynt GM, Nishimura M, Deng Y, Myatra SN, Chan YH, et al.

JAMA Intern Med, 2015 Mar;175(3):363-71.
PMID: 25581712 DOI: 10.1001/jamainternmed.2014.7386

Little data exist on end-of-life care practices in intensive care units (ICUs) in Asia.
Withholding and withdrawal of life-sustaining treatments in low-middle-income versus high-income Asian countries and regions

Phua J, Joynt GM, Nishimura M, Deng Y, Myatra SN, Chan YH, et al.

Intensive Care Med, 2016 Jul;42(7):1118-27.
PMID: 27071388 DOI: 10.1007/s00134-016-4347-y

PURPOSE: To compare the attitudes of physicians towards withholding and withdrawing life-sustaining treatments in intensive care units (ICUs) in low-middle-income Asian countries and regions with those in high-income ones, and to explore differences in the role of families and surrogates, legal risks, and financial considerations between these countries and regions.
METHODS: Questionnaire study conducted in May-December 2012 on 847 physicians from 255 ICUs in 10 low-middle-income countries and regions according to the World Bank's classification, and 618 physicians from 211 ICUs in six high-income countries and regions.
RESULTS: After we accounted for personal, ICU, and hospital characteristics on multivariable analyses using generalised linear mixed models, physicians from low-middle-income countries and regions were less likely to limit cardiopulmonary resuscitation, mechanical ventilation, vasopressors and inotropes, tracheostomy and haemodialysis than those from high-income countries and regions. They were more likely to involve families in end-of-life care discussions and to perceive legal risks with limitation of life-sustaining treatments and do-not-resuscitate orders. Nonetheless, they were also more likely to accede to families' requests to withdraw life-sustaining treatments in a patient with an otherwise reasonable chance of survival on financial grounds in a case scenario (adjusted odds ratio 5.05, 95 % confidence interval 2.69-9.51, P
Mechanical Ventilation Discontinuation Practices in Asia: A Multinational Survey

Leung CHC, Lee A, Arabi YM, Phua J, Divatia JV, Koh Y, et al.

Ann Am Thorac Soc, 2021 08;18(8):1352-1359.
PMID: 33284738 DOI: 10.1513/AnnalsATS.202008-968OC

Rationale: There are limited data on mechanical discontinuation practices in Asia. Objectives: To document self-reported mechanical discontinuation practices and determine whether there is clinical equipoise regarding protocolized weaning among Asian Intensive Care specialists. Methods: A survey using a validated questionnaire, distributed using a snowball method to Asian Intensive Care specialists. Results: Of the 2,967 invited specialists from 20 territories, 2,074 (69.9%) took part. The majority of respondents (60.5%) were from China. Of the respondents, 42% worked in intensive care units (ICUs) where respiratory therapists were present; 78.9% used a spontaneous breathing trial as the initial weaning step; 44.3% frequently/always used pressure support (PS) alone, 53.4% intermittent spontaneous breathing trials with PS in between, and 19.8% synchronized intermittent mandatory ventilation with PS as a weaning mode. Of the respondents, 56.3% routinely stopped feeds before extubation, 71.5% generally followed a sedation protocol or guideline, and 61.8% worked in an ICU with a weaning protocol. Of these, 78.2% frequently always followed the protocol. A multivariate analysis involving a modified Poisson regression analysis showed that working in an ICU with a weaning protocol and frequently/always following it was positively associated with an upper-middle-income territory, a university-affiliated hospital, or in an ICU that employed respiratory therapists; and negatively with a low-income or lower-middle-income territory or a public hospital. There was no significant association with "in-house" intensivist at night, multidisciplinary ICU, closed ICU, or nurse-patient ratio. There was heterogeneity in agreement/disagreement with the statement, "evidence clearly supports protocolized weaning over nonprotocolized weaning." Conclusions: A substantial minority of Asian Intensive Care specialists do not wean patients in accordance with the best available evidence or current guidelines. There is clinical equipoise regarding the benefit of protocolized weaning.