Reversed Surface-Mass-Balance Gradients on Himalayan Debris-Covered Glaciers Inferred from Remote Sensing

Meltwater from the glaciers in High Mountain Asia plays a critical role in water availability and food security in central and southern Asia. However, observations of glacier ablation and accumulation rates are limited in spatial and temporal scale due to the challenges that are associated with fieldwork at the remote, high-altitude settings of these glaciers. Here, using a remote-sensing-based mass-continuity approach, we compute regional-scale surface mass balance of glaciers in five key regions across High Mountain Asia. After accounting for the role of ice flow, we find distinctively different altitudinal surface-mass-balance gradients between heavily debris-covered and relatively debris-free areas. In the region surrounding Mount Everest, where debris coverage is the most extensive, our results show a reversed mean surface-mass-balance gradient of −0.21 ± 0.18 m w.e. a−1 (100 m)−1 on the low-elevation portions of glaciers, switching to a positive mean gradient of 1.21 ± 0.41 m w.e. a−1 (100 m)−1 above an average elevation of 5520 ± 50 m. Meanwhile, in West Nepal, where the debris coverage is minimal, we find a continuously positive mean gradient of 1.18 ± 0.40 m w.e. a−1 (100 m)−1. Equilibrium line altitude estimates, which are derived from our surface-mass-balance gradients, display a strong regional gradient, increasing from northwest (4490 ± 140 m) to southeast (5690 ± 130 m). Overall, our findings emphasise the importance of separating signals of surface mass balance and ice dynamics, in order to constrain better their contribution towards the ice thinning that is being observed across High Mountain Asia

Glacier change along West Antarctica’s Marie Byrd Land Sector and links to inter-decadal atmosphere-ocean variability

Over the past 20 years satellite remote sensing has captured significant downwasting of glaciers that drain the West Antarctic Ice Sheet into the ocean, particularly across the Amundsen Sea Sector. Along the neighbouring Marie Byrd Land Sector, situated west of Thwaites Glacier to Ross Ice Shelf, glaciological change has been only sparsely monitored. Here, we use optical satellite imagery to track grounding-line migration along the Marie Byrd Land Sector between 2003 and 2015, and compare observed changes with ICESat and CryoSat-2-derived surface elevation and thickness change records. During the observational period, 33% of the grounding line underwent retreat, with no significant advance recorded over the remainder of the  ∼ 2200km long coastline. The greatest retreat rates were observed along the 650km-long Getz Ice Shelf, further west of which only minor retreat occurred. The relative glaciological stability west of Getz Ice Shelf can be attributed to a divergence of the Antarctic Circumpolar Current from the continental-shelf break at 135°W, coincident with a transition in the morphology of the continental shelf. Along Getz Ice Shelf, grounding-line retreat reduced by 68% during the CryoSat-2 era relative to earlier observations. Climate reanalysis data imply that wind-driven upwelling of Circumpolar Deep Water would have been reduced during this later period, suggesting that the observed slowdown was a response to reduced oceanic forcing. However, lack of comprehensive oceanographic and bathymetric information proximal to Getz Ice Shelf's grounding zone make it difficult to assess the role of intrinsic glacier dynamics, or more complex ice-sheet–ocean interactions, in moderating this slowdown. Collectively, our findings underscore the importance of spatial and inter-decadal variability in atmosphere and ocean interactions in moderating glaciological change around Antarctica

Using thermal UAV imagery to simulate distributed debris thicknesses and sub-debris melt rates on debris-covered glaciers

Supraglacial debris cover regulates the melt rates of many glaciers in mountainous regions around the world, thereby modifying the availability and quality of downstream water resources. However, the influence of supraglacial debris is often poorly represented within glaciological models, due to the absence of a technique to provide high-precision, spatially continuous measurements of debris thickness. Here, we use high-resolution UAV-derived thermal imagery, in conjunction with local meteorological data, visible UAV imagery and vertically profiled debris temperature time series, to model the spatially distributed debris thickness across a portion of Llaca Glacier in the Cordillera Blanca of Peru. Based on our results, we simulate daily sub-debris melt rates over a 3-month period during 2019. We demonstrate that, by effectively calibrating the radiometric thermal imagery and accounting for temporal and spatial variations in meteorological variables during UAV surveys, thermal UAV data can be used to more precisely represent the highly heterogeneous patterns of debris thickness and sub-debris melt on debris-covered glaciers. Additionally, our results indicate a mean sub-debris melt rate nearly three times greater than the mean melt rate simulated from satellite-derived debris thicknesses, emphasising the importance of acquiring further high-precision debris thickness data for the purposes of investigating glacier-scale melt processes, calibrating regional melt models and improving the accuracy of runoff predictions

Using thermal UAV imagery to model distributed debris thicknesses and sub-debris melt rates on debris-covered glaciers

Supraglacial debris cover regulates the melt rates of many glaciers in mountainous regions around the world, thereby modifying the availability and quality of downstream water resources. However, the influence of supraglacial debris is often poorly represented within glaciological models, due to the absence of a technique to provide high-precision, spatially continuous measurements of debris thickness. Here, we use high-resolution UAV-derived thermal imagery, in conjunction with local meteorological data, visible UAV imagery and vertically profiled debris temperature time series, to model the spatially distributed debris thickness across a portion of Llaca Glacier in the Cordillera Blanca of Peru. Based on our results, we simulate daily sub-debris melt rates over a 3-month period during 2019. We demonstrate that, by effectively calibrating the radiometric thermal imagery and accounting for temporal and spatial variations in meteorological variables during UAV surveys, thermal UAV data can be used to more precisely represent the highly heterogeneous patterns of debris thickness and sub-debris melt on debris-covered glaciers. Additionally, our results indicate a mean sub-debris melt rate nearly three times greater than the mean melt rate simulated from satellite-derived debris thicknesses, emphasising the importance of acquiring further high-precision debris thickness data for the purposes of investigating glacier-scale melt processes, calibrating regional melt models and improving the accuracy of runoff predictions

Analysis of lesion localisation at colonoscopy: outcomes from a multi-centre U.K. study

Background: Colonoscopy is currently the gold standard for detection of colorectal lesions, but may be limited in anatomically localising lesions. This audit aimed to determine the accuracy of colonoscopy lesion localisation, any subsequent changes in surgical management and any potentially influencing factors. Methods: Patients undergoing colonoscopy prior to elective curative surgery for colorectal lesion/s were included from 8 registered U.K. sites (2012–2014). Three sets of data were recorded: patient factors (age, sex, BMI, screener vs. symptomatic, previous abdominal surgery); colonoscopy factors (caecal intubation, scope guide used, colonoscopist accreditation) and imaging modality. Lesion localisation was standardised with intra-operative location taken as the gold standard. Changes to surgical management were recorded. Results: 364 cases were included; majority of lesions were colonic, solitary, malignant and in symptomatic referrals. 82% patients had their lesion/s correctly located at colonoscopy. Pre-operative CT visualised lesion/s in only 73% of cases with a reduction in screening patients (64 vs. 77%; p = 0.008). 5.2% incorrectly located cases at colonoscopy underwent altered surgical management, including conversion to open. Univariate analysis found colonoscopy accreditation, scope guide use, incomplete colonoscopy and previous abdominal surgery significantly influenced lesion localisation. On multi-variate analysis, caecal intubation and scope guide use remained significant (HR 0.35, 0.20–0.60 95% CI and 0.47; 0.25–0.88, respectively). Conclusion: Lesion localisation at colonoscopy is incorrect in 18% of cases leading to potentially significant surgical management alterations. As part of accreditation, colonoscopists need lesion localisation training and awareness of when inaccuracies can occur

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Seduced by System: Edmund Burke's Aesthetic Embrace of Adam Smith's Philosophy

No abstract available

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Identification of novel loci associated with gastrointestinal parasite resistance in a Red Maasai x Dorper backcross population

Gastrointestinal (GI) parasitic infection is the main health constraint for small ruminant production, causing loss of weight and/or death. Red Maasai sheep have adapted to a tropical environment where extreme parasite exposure is a constant, especially with highly pathogenic Haemonchus contortus. This breed has been reported to be resistant to gastrointestinal parasite infection, hence it is considered an invaluable resource to study associations between host genetics and resistance. The aim of this study was to identify polymorphisms strongly associated with host resistance in a double backcross population derived from Red Maasai and Dorper sheep using a SNP-based GWAS analysis. The animals that were genotyped represented the most resistant and susceptible individuals based on the tails of phenotypic distribution (10% each) for average faecal egg counts (AVFEC). AVFEC, packed cell volume (AVPCV), and live weight (AVLWT) were adjusted for fixed effects and co-variables, and an association analysis was run using EMMAX. Revised significance levels were calculated using 100,000 permutation tests. The top five significant SNP markers with - log10 p-values >3.794 were observed on five different chromosomes for AVFEC, and BLUPPf90/PostGSf90 results confirmed EMMAX significant regions for this trait. One of these regions included a cluster of significant SNP on chromosome (Chr) 6 not in linkage disequilibrium to each other. This genomic location contains annotated genes involved in cytokine signalling, haemostasis and mucus biosynthesis. Only one association detected on Chr 7 was significant for both AVPCV and AVLWT. The results generated here reveal candidate immune variants for genes involved in differential response to infection and provide additional SNP marker information that has potential to aid selection of resistance to gastrointestinal parasites in sheep of a similar genetic background to the double backcross population