Remote Sensing Of The Cryosphere In High Mountain Asia

High Mountain Asia (HMA), often referred to as the "third pole" of the world because its high elevation glaciers, contains the largest amount of fresh water outside the polar ice sheets. The region's hydrology is strongly controlled by variations in the timing and distribution of runoff from snow and glacier melt. Recent improvements in remote sensing technologies and atmospheric / land surface models provides new approaches for assessing the HMA cryosphere. A recently-funded NASA program aims to apply these tools to advance understanding of HMA cryospheric processes. Here we present an overview of planned team activities during the three-year project

Early Outcomes of MDR-TB Treatment in a High HIV-Prevalence Setting in Southern Africa

BACKGROUND: Little is known about treatment of multidrug-resistant tuberculosis (MDR-TB) in high HIV-prevalence settings such as sub-Saharan Africa. METHODOLOGY/PRINCIPAL FINDINGS: We did a retrospective analysis of early outcomes of the first cohort of patients registered in the Lesotho national MDR-TB program between July 21, 2007 and April 21, 2008. Seventy-six patients were included for analysis. Patient follow-up ended when an outcome was recorded, or on October 21, 2008 for those still on treatment. Fifty-six patients (74%) were infected with HIV; the median CD4 cell count was 184 cells/microl (range 5-824 cells/microl). By the end of the follow-up period, study patients had been followed for a median of 252 days (range 12-451 days). Twenty-two patients (29%) had died, and 52 patients (68%) were alive and in treatment. In patients who did not die, culture conversion was documented in 52/54 patients (96%). One patient had defaulted, and one patient had transferred out. Death occurred after a median of 66 days in treatment (range 12-374 days). CONCLUSIONS/SIGNIFICANCE: In a region where clinicians and program managers are increasingly confronted by drug-resistant tuberculosis, this report provides sobering evidence of the difficulty of MDR-TB treatment in high HIV-prevalence settings. In Lesotho, an innovative community-based treatment model that involved social and nutritional support, twice-daily directly observed treatment and early empiric use of second-line TB drugs was successful in reducing mortality of MDR-TB patients. Further research is urgently needed to improve MDR-TB treatment outcomes in high HIV-prevalence settings

Sensitivity of Pine Island Glacier to observed ocean forcing

We present subannual observations (2009–2014) of a major West Antarctic glacier (Pine Island Glacier) and the neighboring ocean. Ongoing glacier retreat and accelerated ice flow were likely triggered a few decades ago by increased ocean-induced thinning, which may have initiated marine ice-sheet instability. Following a subsequent 60% drop in ocean heat content from early 2012 to late 2013, ice flow slowed, but by < 4%, with flow recovering as the ocean warmed to prior temperatures. During this cold-ocean period, the evolving glacier-bed/ice-shelf system was also in a geometry favorable to stabilization. However, despite a minor, temporary decrease in ice discharge, the basin-wide thinning signal did not change. Thus, as predicted by theory, once marine ice-sheet instability is underway, a single transient high-amplitude ocean cooling has only a relatively minor effect on ice flow. The long-term effects of ocean-temperature variability on ice flow, however, are not yet known

Rehabilitation versus surgical reconstruction for non-acute anterior cruciate ligament injury (ACL SNNAP): a pragmatic randomised controlled trial

BackgroundAnterior cruciate ligament (ACL) rupture is a common debilitating injury that can cause instability of the knee. We aimed to investigate the best management strategy between reconstructive surgery and non-surgical treatment for patients with a non-acute ACL injury and persistent symptoms of instability.MethodsWe did a pragmatic, multicentre, superiority, randomised controlled trial in 29 secondary care National Health Service orthopaedic units in the UK. Patients with symptomatic knee problems (instability) consistent with an ACL injury were eligible. We excluded patients with meniscal pathology with characteristics that indicate immediate surgery. Patients were randomly assigned (1:1) by computer to either surgery (reconstruction) or rehabilitation (physiotherapy but with subsequent reconstruction permitted if instability persisted after treatment), stratified by site and baseline Knee Injury and Osteoarthritis Outcome Score—4 domain version (KOOS4). This management design represented normal practice. The primary outcome was KOOS4 at 18 months after randomisation. The principal analyses were intention-to-treat based, with KOOS4 results analysed using linear regression. This trial is registered with ISRCTN, ISRCTN10110685, and ClinicalTrials.gov, NCT02980367.FindingsBetween Feb 1, 2017, and April 12, 2020, we recruited 316 patients. 156 (49%) participants were randomly assigned to the surgical reconstruction group and 160 (51%) to the rehabilitation group. Mean KOOS4 at 18 months was 73·0 (SD 18·3) in the surgical group and 64·6 (21·6) in the rehabilitation group. The adjusted mean difference was 7·9 (95% CI 2·5–13·2; p=0·0053) in favour of surgical management. 65 (41%) of 160 patients allocated to rehabilitation underwent subsequent surgery according to protocol within 18 months. 43 (28%) of 156 patients allocated to surgery did not receive their allocated treatment. We found no differences between groups in the proportion of intervention-related complications.InterpretationSurgical reconstruction as a management strategy for patients with non-acute ACL injury with persistent symptoms of instability was clinically superior and more cost-effective in comparison with rehabilitation management

Quantifying Debris Thickness of Debris-Covered Glaciers in the Everest Region of Nepal Through Inversion of a Subdebris Melt Model

Debris-covered glaciers are ubiquitous in the Himalaya, and supraglacial debris significantly alters how glaciers respond to climate forcing. Estimating debris thickness at the glacier scale, however, remains a challenge. This study inverts a subdebris melt model to estimate debris thickness for three glaciers in the Everest region from digital elevation model difference-derived elevation change. Flux divergences are estimated from ice thickness and surface velocity data. Monte Carlo simulations are used to incorporate the uncertainties associated with debris properties, flux divergence, and elevation change. On Ngozumpa Glacier, surface lowering data from 2010 to 2012 and 2012 to 2014 are used to calibrate and validate the method, respectively. The debris thickness estimates are consistent with existing in situ measurements. The method performs well over both actively flowing and stagnant parts of the glacier and is able to accurately estimate thicker debris (&gt;0.5 m). Uncertainties associated with the thermal conductivity and elevation change contribute the most to uncertainties of the debris thickness estimates. The surface lowering associated with ice cliffs and supraglacial ponds was found to significantly reduce debris thickness, especially for thicker debris. The method is also applied to Khumbu and Imja-Lhotse Shar Glaciers to highlight its potential for regional application.</p

Pre-collapse motion of the February 2021 Chamoli rock-ice avalanche, Indian Himalaya

On the 7th of February 2021, a large rock-ice avalanche triggered a debris flow in Chamoli district, Uttarakhand, India, leaving over 200 dead or missing. The rock-ice avalanche originated from a steep, glacierized north-facing slope. In this work, we assess the precursory signs exhibited by this slope prior to the catastrophic collapse. We evaluate monthly slope motion from 2015 to 2021 through feature tracking of high-resolution optical satellite imagery. We then combine these data with a time series of pre- and post-event DEMs, which we use to evaluate elevation change over the same area. Both datasets show that the 26.9 Mm3 collapse block moved over 10 m horizontally and vertically in the five years preceding collapse, with particularly rapid motion occurring in the summers of 2017 and 2018. We propose that the collapse results from a combination of snow-loading in a deep headwall crack and permafrost degradation in the heavily jointed bedrock. Our observation of a clear precursory signal highlights the potential of satellite imagery for monitoring the stability of high-risk slopes. We find that the timing of the Chamoli rock-ice avalanche could likely not have been forecast from satellite data alone