Seasonal ice mass-balance buoys: adapting tools to the changing Arctic

Monitoring the local mass balance of Arctic sea ice provides opportunities to attribute the observed changes in a particular floe’s mass balance to specific forcing phenomena. A shift from multi- year to seasonal ice in large portions of the Arctic presents a challenge for the existing Lagrangian array of autonomous ice mass-balance buoys, which were designed with a perennial ice cover in mind. This work identifies the anticipated challenges of operation in seasonal ice and presents a new autonomous buoy designed to monitor ice mass balance in the seasonal ice zone. The new design presented incorporates features which allow the buoy to operate in thin ice and open water, and reduce its vulnerability to ice dynamics and wildlife damage, while enhancing ease of deployment. A test deployment undertaken from April to June 2009 is discussed and results are presented with analysis to illustrate both the features and limitations of the buoy’s abilities

Ethical implications of digital communication for the patient-clinician relationship : analysis of interviews with clinicians and young adults with long term conditions (the LYNC study)

Background: Digital communication between a patient and their clinician offers the potential for improved patient care, particularly for young people with long term conditions who are at risk of service disengagement. However, its use raises a number of ethical questions which have not been explored in empirical studies. The objective of this study was to examine, from the patient and clinician perspective, the ethical implications of the use of digital clinical communication in the context of young people living with long-term conditions. Methods: A total of 129 semi-structured interviews, 59 with young people and 70 with healthcare professionals, from 20 United Kingdom (UK)-based specialist clinics were conducted as part of the LYNC study. Transcripts from five sites (cancer, liver, renal, cystic fibrosis and mental health) were read by a core team to identify explicit and implicit ethical issues and develop descriptive ethical codes. Our subsequent thematic analysis was developed iteratively with reference to professional and ethical norms. Results: Clinician participants saw digital clinical communication as potentially increasing patient empowerment and autonomy; improving trust between patient and healthcare professional; and reducing harm because of rapid access to clinical advice. However, they also described ethical challenges, including: difficulty with defining and maintaining boundaries of confidentiality; uncertainty regarding the level of consent required; and blurring of the limits of a clinician’s duty of care when unlimited access is possible. Paradoxically, the use of digital clinical communication can create dependence rather than promote autonomy in some patients. Patient participants varied in their understanding of, and concern about, confidentiality in the context of digital communication. An overarching theme emerging from the data was a shifting of the boundaries of the patient-clinician relationship and the professional duty of care in the context of use of clinical digital communication. Conclusions: The ethical implications of clinical digital communication are complex and go beyond concerns about confidentiality and consent. Any development of this form of communication should consider its impact on the patient-clinician-relationship, and include appropriate safeguards to ensure that professional ethical obligations are adhered to

The Ultimate Gift Horse: Modernizing the UPC on Advancements to Avoid Unintended Redistributions

A common tax avoidance strategy is to make annual lifetime gifts in the maximum amount exempt from the gift tax in order to reduce or avoid the estate tax. These gifts are likely intended as an intergenerational transfer of wealth, only differing from passing through the estate in timing. The donors probably don\u27t intend for their tax avoidance strategy to affect the ultimate equitable distribution of their wealth. However, under the Uniform Probate Code (UPC) and case law applying it, these gifts are generally not treated as advancements, so an uneven distribution can result from something as simple as differing ages of descendants resulting in a different number of annual lifetime gifts. This article proposes to update and modernize the UPC by presuming that gifts in the exact amount of the annual gift tax exemption are advancements, thus bringing the distributive effect of these transfers in line with decedents\u27 probable intent. President Biden has proposed taxing thousands more estates, so the time to make this change is now

p16INK4a polymorphism: Associations with tumour progression in patients with sporadic colorectal cancer

Deregulated tumour expression of p16INK4a has previously been described in association with clinical progression in sporadic colorectal cancer patients (CRC). Furthermore, p16INK4a promoter hypermethylation leading to gene silencing has been shown to occur in advanced colorectal tumours and has been associated with patient survival. p16INK4a is polymorphic, with variant alleles being associated with tumour progression in melanoma. In this study we have examined p16INK4a polymorphism as a marker of tumour progression in sporadic CRC. Polymorphic sites G/A(442), C/G(500), and C/T(540), were studied, these alleles obeyed Hardy Weinberg equilibrium in a control group, but not in the CRC cases. G/A(442) and CG(500) alleles were in linkage disequilibrium in both cases and controls. In controls the C/T(540) alleles demonstrated no linkage with either other site, whilst an association was demonstrated between C/G(500) and C/T(540) alleles in the cases (p=0.011). Furthermore, the distribution of C/T(540) genotypes was different between the groups (p=0.002). Within the CRC cases, patients with the GG(442) genotype were more commonly associated with decreased tumour differentiation (p=0.018), advancing Dukes' stage (p=0.006) and T-stage (p=0.007) than patients with the GA(442) and AA(442) genotypes. Patients with the CC(500) genotype were more commonly associated with decreased tumour differentiation (p=0.012), advancing Dukes' stage (p=0.015), and N-stage (p=0.031). No associations between patient C/T(540) genotype and clinical prognostic parameters were found. An analysis of patient tumour expression with p16INK4a genotype revealed patients with the CC(500) genotype were more commonly associated with reduced tumour p16 expression (p=0.046). In summary our data indicate that p16INK4a polymorphism is associated with tumour progression in patients with sporadic CRC

Developing environmental standards for abstractions from UK rivers to implement the EU Water Framework Directive

Under the European Union Water Framework Directive Member States must put in place a river basin planning framework to determine what measures are necessary to maintain and improve the ecological status for all surface water bodies. The governmental organisations legally responsible for implementing the Directive in the UK have recognised that an appropriate river flow regime is fundamental to maintain a healthy river and as a result, they need to regulate abstractions and effluent discharges and ensure sufficient water is released from impoundments. This paper reports on the process of producing environmental standards that define the maximum abstraction allowable from UK rivers, to leave sufficient flow to maintain a healthy river ecosystem. As there are currently insufficient data available to determine the relationships between river flow and ecological status empirically, expert knowledge was captured through a series of workshops at which leading UK freshwater scientists defined maximum levels of river flow regime alteration that would achieve ecological objectives for different river water body types. For the least ecologically sensitive rivers, maximum abstractions in the range 15 to 35% of the natural flow were proposed, depending on the flow magnitude and time of year. For the most sensitive rivers the maximum abstraction proposed was in the range 7.5 to 25%. The knowledge was used by the responsible UK authorities to develop environmental standards. The authorities subsequently used the environmental standards to determine regulatory standards that could be implemented within practical constraints and current licensing policie