Platelet ice, the Southern Ocean’s hidden ice: a review

Basal melt of ice shelves is not only an important part of Antarctica’s ice-sheet mass budget, but it is also the origin of one of the most peculiar types of sea ice found in the polar oceans: platelet ice. In many regions around coastal Antarctica, tiny ice crystals form and grow in supercooled plumes of Ice Shelf Water, releasing heat into the surrounding ocean. They usually rise towards the surface, eventually becoming trapped under an ice shelf as marine ice. Frequently, masses of those crystals are advected out of the ice-shelf cavity, and accumulate below a solid sea-ice cover to form a semiconsolidated layer. When the overlying sea ice grows into this so-called sub-ice platelet layer, the loose crystals are consolidated, adding additional thickness to the sea ice. These phenomena are generally referred to as platelet ice, although confusion about the terminology is widespread in the literature. The presence of platelet ice has a profound impact on sea-ice properties and processes in several regions of Antarctica, with numerous implications for the local polar marine biosphere. Most notably, sub-ice platelet layers provide a stable, sheltered, nutrient- and food-rich habitat which usually results in a highly productive and uniquely adapted ecosystem. It has also been hypothesised that platelet ice may be an indicator of the state of an ice shelf, although comprehensive time series are limited to the Ross Sea. This paper clears up the terminology by providing exact definitions of the relevant terms.We review platelet-ice formation, observational methods as well as geographical and seasonal occurrence. The physical properties and ecological implications are merged in a way understandable for physicists and biologists alike, to lay the foundation for the interdisciplinary research that is necessary to tackle the current knowledge gaps

Interactions between increasing CO2 and Antarctic melt rates

Meltwater from the Antarctic ice sheet is expected to increase the sea ice extent. However, such an expansion may be moderated by sea ice decline associated with global warming. Here we investigate the relative balance of these two processes through experiments using HadGEM3-GC3.1 and compare these to two standard idealized CMIP6 experiments. Our results show that the decline in sea ice projected under scenarios of increasing CO 2 may be inhibited by simultaneously increasing melt fluxes. We find that Antarctic Bottom Water formation, projected to decline as CO 2 increases, is likely to decline further with an increasing meltwater flux. In our simulations, the response of the westerly wind jet to increasing CO 2 is enhanced when the meltwater flux increases, resulting in a stronger peak wind stress than is found when either CO 2 or melt rates increase exclusively. We find that the sensitivity of the Antarctic Circumpolar Current to increasing melt fluxes in the Southern Ocean is countered by increasing CO 2, removing or reducing a feedback mechanism that may otherwise allow more heat to be transported to the polar regions and drive increasing ice shelf melt rates. The insights presented here and in a companion paper (which focuses on the effect of increasing melt fluxes under preindustrial forcings) provide insights helpful to the interpretation of both future climate projections and sensitivity studies into the effect of increasing melt fluxes from the Antarctic ice sheet when different forcing scenarios are used

Climate response to increasing Antarctic iceberg and ice shelf melt

Mass loss from the Antarctic continent is increasing; however, climate models either assume a constant mass loss rate or return snowfall over land to the ocean to maintain equilibrium. Numerous studies have investigated sea ice and ocean sensitivity to this assumption and reached different conclusions, possibly due to different representations of melt fluxes. The coupled atmosphere-land-ocean-sea ice model, HadGEM3-GC3.1, includes a realistic spatial distribution of coastal melt fluxes, a new ice shelf cavity parameterization, and explicit representation of icebergs. This configuration makes it appropriate to revisit how increasing melt fluxes influence ocean and sea ice and to assess whether responses to melt from ice shelves and icebergs are distinguishable. We present results from simulated scenarios of increasing meltwater fluxes and show that these drive sea ice increases and, for increasing ice shelf melt, a decline in Antarctic Bottom Water formation. In our experiments, the mixed layer around the Antarctic coast deepens in response to rising ice shelf meltwater and shallows in response to stratification driven by iceberg melt. We find similar surface temperature and salinity responses to increasing meltwater fluxes from ice shelves and icebergs, but midlayer waters warm to greater depths and farther north when ice shelf melt is present. We show that as meltwater fluxes increase, snowfall becomes more likely at lower latitudes and Antarctic Circumpolar Current transport declines. These insights are helpful for interpretation of climate simulations that assume constant mass loss rates and demonstrate the importance of representing increasing melt rates for both ice shelves and icebergs

Sea ice formation in a coupled climate model including grease ice

Sea ice formation processes occur on sub‐grid scales and the detailed physics describing the processes are therefore not generally represented in climate models. One likely consequence of this is the premature closing of areas of open water in model simulations, which may result in a misrepresentation of heat and gas exchange between the ocean and atmosphere. This work demonstrates the implementation of a more realistic model of sea ice formation, introducing grease ice as a wind‐ and oceanic‐ stress‐dependant intermediary state between water and new sea ice. We use the fully coupled land‐atmosphere‐ocean‐ sea ice model, HadGEM3‐GC3.1 and perform a three member ensemble with the new grease ice scheme from 1964 to 2013. Comparing our sea ice results with the existing ensemble without grease ice formation shows an increase in sea ice thickness and volume in the Arctic. In the Antarctic, including grease ice processes results in large local changes to both simulated sea ice concentration and thickness, but no change to the total area or volume

Uncovering treatment burden as a key concept for stroke care: a systematic review of qualitative research

<b>Background</b> Patients with chronic disease may experience complicated management plans requiring significant personal investment. This has been termed ‘treatment burden’ and has been associated with unfavourable outcomes. The aim of this systematic review is to examine the qualitative literature on treatment burden in stroke from the patient perspective.<p></p> <b>Methods and findings</b> The search strategy centred on: stroke, treatment burden, patient experience, and qualitative methods. We searched: Scopus, CINAHL, Embase, Medline, and PsycINFO. We tracked references, footnotes, and citations. Restrictions included: English language, date of publication January 2000 until February 2013. Two reviewers independently carried out the following: paper screening, data extraction, and data analysis. Data were analysed using framework synthesis, as informed by Normalization Process Theory. Sixty-nine papers were included. Treatment burden includes: (1) making sense of stroke management and planning care, (2) interacting with others, (3) enacting management strategies, and (4) reflecting on management. Health care is fragmented, with poor communication between patient and health care providers. Patients report inadequate information provision. Inpatient care is unsatisfactory, with a perceived lack of empathy from professionals and a shortage of stimulating activities on the ward. Discharge services are poorly coordinated, and accessing health and social care in the community is difficult. The study has potential limitations because it was restricted to studies published in English only and data from low-income countries were scarce.<p></p> <b>Conclusions</b> Stroke management is extremely demanding for patients, and treatment burden is influenced by micro and macro organisation of health services. Knowledge deficits mean patients are ill equipped to organise their care and develop coping strategies, making adherence less likely. There is a need to transform the approach to care provision so that services are configured to prioritise patient needs rather than those of health care systems

Thyroid Hormone Therapy for Older Adults with Subclinical Hypothyroidism.

BACKGROUND: The use of levothyroxine to treat subclinical hypothyroidism is controversial. We aimed to determine whether levothyroxine provided clinical benefits in older persons with this condition. METHODS: We conducted a double-blind, randomized, placebo-controlled, parallel-group trial involving 737 adults who were at least 65 years of age and who had persisting subclinical hypothyroidism (thyrotropin level, 4.60 to 19.99 mIU per liter; free thyroxine level within the reference range). A total of 368 patients were assigned to receive levothyroxine (at a starting dose of 50 μg daily, or 25 μg if the body weight was <50 kg or the patient had coronary heart disease), with dose adjustment according to the thyrotropin level; 369 patients were assigned to receive placebo with mock dose adjustment. The two primary outcomes were the change in the Hypothyroid Symptoms score and Tiredness score on a thyroid-related quality-of-life questionnaire at 1 year (range of each scale is 0 to 100, with higher scores indicating more symptoms or tiredness, respectively; minimum clinically important difference, 9 points). RESULTS: The mean age of the patients was 74.4 years, and 396 patients (53.7%) were women. The mean (±SD) thyrotropin level was 6.40±2.01 mIU per liter at baseline; at 1 year, this level had decreased to 5.48 mIU per liter in the placebo group, as compared with 3.63 mIU per liter in the levothyroxine group (P<0.001), at a median dose of 50 μg. We found no differences in the mean change at 1 year in the Hypothyroid Symptoms score (0.2±15.3 in the placebo group and 0.2±14.4 in the levothyroxine group; between-group difference, 0.0; 95% confidence interval [CI], -2.0 to 2.1) or the Tiredness score (3.2±17.7 and 3.8±18.4, respectively; between-group difference, 0.4; 95% CI, -2.1 to 2.9). No beneficial effects of levothyroxine were seen on secondary-outcome measures. There was no significant excess of serious adverse events prespecified as being of special interest. CONCLUSIONS: Levothyroxine provided no apparent benefits in older persons with subclinical hypothyroidism. (Funded by European Union FP7 and others; TRUST ClinicalTrials.gov number, NCT01660126 .)

Effect of the Pre-erythrocytic Candidate Malaria Vaccine RTS,S/AS01E on Blood Stage Immunity in Young Children

(See the article by Greenhouse et al, on pages 19-26.

Cognitive Dysfunction Is Sustained after Rescue Therapy in Experimental Cerebral Malaria, and Is Reduced by Additive Antioxidant Therapy

Neurological impairments are frequently detected in children surviving cerebral malaria (CM), the most severe neurological complication of infection with Plasmodium falciparum. The pathophysiology and therapy of long lasting cognitive deficits in malaria patients after treatment of the parasitic disease is a critical area of investigation. In the present study we used several models of experimental malaria with differential features to investigate persistent cognitive damage after rescue treatment. Infection of C57BL/6 and Swiss (SW) mice with Plasmodium berghei ANKA (PbA) or a lethal strain of Plasmodium yoelii XL (PyXL), respectively, resulted in documented CM and sustained persistent cognitive damage detected by a battery of behavioral tests after cure of the acute parasitic disease with chloroquine therapy. Strikingly, cognitive impairment was still present 30 days after the initial infection. In contrast, BALB/c mice infected with PbA, C57BL6 infected with Plasmodium chabaudi chabaudi and SW infected with non lethal Plasmodium yoelii NXL (PyNXL) did not develop signs of CM, were cured of the acute parasitic infection by chloroquine, and showed no persistent cognitive impairment. Reactive oxygen species have been reported to mediate neurological injury in CM. Increased production of malondialdehyde (MDA) and conjugated dienes was detected in the brains of PbA-infected C57BL/6 mice with CM, indicating high oxidative stress. Treatment of PbA-infected C57BL/6 mice with additive antioxidants together with chloroquine at the first signs of CM prevented the development of persistent cognitive damage. These studies provide new insights into the natural history of cognitive dysfunction after rescue therapy for CM that may have clinical relevance, and may also be relevant to cerebral sequelae of sepsis and other disorders