Timing, rates, and causes of death in a large South African tuberculosis programme.

BACKGROUND: Tuberculosis (TB) mortality remains high across sub-Saharan Africa despite integration of TB and HIV/ART programmes. To inform programme design and service delivery, we estimated mortality by time from starting TB treatment. METHODS: Routinely collected data on TB treatment, vital status, and the timing and causes of death, were linked to cardio-respiratory autopsy data, from 1995-2008, from a cohort of male platinum miners in South Africa. Records were expanded into person-months at risk (pm). RESULTS: 4162 TB episodes were registered; 3170 men were treated for the first time and 833 men underwent retreatment. Overall, 509 men died, with a case fatality of 12.2% and mortality rate of 2.0/100 pm. Mortality was highest in the first month after starting TB treatment for first (2.3/100 pm) and retreatment episodes (4.8/100 pm). When stratified by HIV status, case fatality was higher in HIV positive men not on ART (first episode 14.0%; retreatment episode 26.2%) and those on ART (12.0%; 22.0%) than men of negative or unknown HIV status (2.6%; 3.6%). Mortality was also highest in the first month for each of these groups. Mortality risk factors included older age, previous TB, HIV, pulmonary TB, and diagnostic uncertainty. The proportion of deaths attributable to TB was consistently overestimated in clinical records versus cardio-respiratory autopsy. CONCLUSIONS: Programme mortality was highest in those with HIV and during the first month of TB treatment in all groups, and many deaths were not caused by TB. Resource allocation should prioritise TB prevention and accurate earlier diagnosis, recognise the role of HIV, and ensure effective clinical care in the early stages of TB treatment

Multidecadal observations of the Antarctic ice sheet from restored analog radar records.

Airborne radar sounding can measure conditions within and beneath polar ice sheets. In Antarctica, most digital radar-sounding data have been collected in the last 2 decades, limiting our ability to understand processes that govern longer-term ice-sheet behavior. Here, we demonstrate how analog radar data collected over 40 y ago in Antarctica can be combined with modern records to quantify multidecadal changes. Specifically, we digitize over 400,000 line kilometers of exploratory Antarctic radar data originally recorded on 35-mm optical film between 1971 and 1979. We leverage the increased geometric and radiometric resolution of our digitization process to show how these data can be used to identify and investigate hydrologic, geologic, and topographic features beneath and within the ice sheet. To highlight their scientific potential, we compare the digitized data with contemporary radar measurements to reveal that the remnant eastern ice shelf of Thwaites Glacier in West Antarctica had thinned between 10 and 33% between 1978 and 2009. We also release the collection of scanned radargrams in their entirety in a persistent public archive along with updated geolocation data for a subset of the data that reduces the mean positioning error from 5 to 2.5 km. Together, these data represent a unique and renewed extensive, multidecadal historical baseline, critical for observing and modeling ice-sheet change on societally relevant timescales

Reconstruction of ice-sheet changes in the Antarctic Peninsula since the Last Glacial Maximum

This paper compiles and reviews marine and terrestrial data constraining the dimensions and configuration of the Antarctic Peninsula Ice Sheet (APIS) from the Last Glacial Maximum (LGM) through deglaciation to the present day. These data are used to reconstruct grounding-line retreat in 5ka time-steps from 25kaBP to present. Glacial landforms and subglacial tills on the eastern and western Antarctic Peninsula (AP) shelf indicate that the APIS was grounded to the outer shelf/shelf edge at the LGM and contained a series of fast-flowing ice streams that drained along cross-shelf bathymetric troughs. The ice sheet was grounded at the shelf edge until ~20calkaBP. Chronological control on retreat is provided by radiocarbon dates on glacimarine sediments from the shelf troughs and on lacustrine and terrestrial organic remains, as well as cosmogenic nuclide dates on erratics and ice moulded bedrock. Retreat in the east was underway by about 18calkaBP. The earliest dates on recession in the west are from Bransfield Basin where recession was underway by 17.5calkaBP. Ice streams were active during deglaciation at least until the ice sheet had pulled back to the mid-shelf. The timing of initial retreat decreased progressively southwards along the western AP shelf; the large ice stream in Marguerite Trough may have remained grounded at the shelf edge until about 14calkaBP, although terrestrial cosmogenic nuclide ages indicate that thinning had commenced by 18kaBP. Between 15 and 10calkaBP the APIS underwent significant recession along the western AP margin, although retreat between individual troughs was asynchronous. Ice in Marguerite Trough may have still been grounded on the mid-shelf at 10calkaBP. In the Larsen-A region the transition from grounded to floating ice was established by 10.7-10.6calkaBP. The APIS had retreated towards its present configuration in the western AP by the mid-Holocene but on the eastern peninsula may have approached its present configuration several thousand years earlier, by the start of the Holocene. Mid to late-Holocene retreat was diachronous with stillstands, re-advances and changes in ice-shelf configuration being recorded in most places. Subglacial topography exerted a major control on grounding-line retreat with grounding-zone wedges, and thus by inference slow-downs or stillstands in the retreat of the grounding line, occurring in some cases on reverse bed slopes

Anvers-Hugo Trough palaeo-ice stream, Antarctic Peninsula: geomorphological evidence for the role of subglacial water in facilitating ice stream flow

We will present new multibeam bathymetry data that make the Anvers-Hugo Trough west of the Antarctic Peninsula one of the most completely surveyed palaeo-ice stream pathways in Antarctica. We interpret landforms revealed by these data as indicating that subglacial water availability played an important role in facilitating ice stream flow in the trough during late Quaternary glacial periods. Specifically, we observe a set of northward-shoaling valleys that are eroded into the upstream edge of a sedimentary basin, extend northwards from a zone containing landforms typical of erosion by subglacial water flow, and coincide spatially with the onset of mega-scale glacial lineations. Water was likely supplied to the ice stream bed episodically as a result of outbursts from a subglacial lake previously hypothesized to have been located in the Palmer Deep basin on the inner continental shelf. In a palaeo-ice stream confluence area, close juxtaposition of mega-scale glacial lineations with landforms that are characteristic of slow, dry-based ice flow, suggests that water availability was also an important control on the lateral extent of these palaeo-ice streams. These interpretations are consistent with the hypothesis that subglacial lakes or areas of elevated geothermal heat flux play a critical role in the onset of many large ice streams. The interpretations also have implications for the dynamic behaviour of the Anvers-Hugo Trough palaeo-ice stream and, potentially, of several other Antarctic palaeo-ice streams. Keywords: multibeam bathymetry, ice stream, subglacial water, landfor

Evidence of marine ice-cliff instability in Pine Island Bay from iceberg-keel plough marks.

Marine ice-cliff instability (MICI) processes could accelerate future retreat of the Antarctic Ice Sheet if ice shelves that buttress grounding lines more than 800 metres below sea level are lost. The present-day grounding zones of the Pine Island and Thwaites glaciers in West Antarctica need to retreat only short distances before they reach extensive retrograde slopes. When grounding zones of glaciers retreat onto such slopes, theoretical considerations and modelling results indicate that the retreat becomes unstable (marine ice-sheet instability) and thus accelerates. It is thought that MICI is triggered when this retreat produces ice cliffs above the water line with heights approaching about 90 metres. However, observational evidence confirming the action of MICI has not previously been reported. Here we present observational evidence that rapid deglacial ice-sheet retreat into Pine Island Bay proceeded in a similar manner to that simulated in a recent modelling study, driven by MICI. Iceberg-keel plough marks on the sea-floor provide geological evidence of past and present iceberg morphology, keel depth and drift direction. From the planform shape and cross-sectional morphologies of iceberg-keel plough marks, we find that iceberg calving during the most recent deglaciation was not characterized by small numbers of large, tabular icebergs as is observed today, which would produce wide, flat-based plough marks or toothcomb-like multi-keeled plough marks. Instead, it was characterized by large numbers of smaller icebergs with V-shaped keels. Geological evidence of the form and water-depth distribution of the plough marks indicates calving-margin thicknesses equivalent to the threshold that is predicted to trigger ice-cliff structural collapse as a result of MICI. We infer rapid and sustained ice-sheet retreat driven by MICI, commencing around 12,300 years ago and terminating before about 11,200 years ago, which produced large numbers of icebergs smaller than the typical tabular icebergs produced today. Our findings demonstrate the effective operation of MICI in the past, and highlight its potential contribution to accelerated future retreat of the Antarctic Ice Sheet

Reconstruction of changes in the Amundsen Sea and Bellingshausen Sea sector of the West Antarctic Ice Sheet since the Last Glacial Maximum

Marine and terrestrial geological and marine geophysical data that constrain deglaciation since the Last Glacial Maximum (LGM) of the sector of the West Antarctic Ice Sheet (WAIS) draining into the Amundsen Sea and Bellingshausen Sea have been collated and used as the basis for a set of time-slice reconstructions. The drainage basins in these sectors constitute a little more than one-quarter of the area of the WAIS, but account for about one-third of its surface accumulation. Their mass balance is becoming increasingly negative, and therefore they account for an even larger fraction of current WAIS discharge. If all of the ice in these sectors of the WAIS were discharged to the ocean, global sea level would rise by ca2m. There is compelling evidence that grounding lines of palaeo-ice streams were at, or close to, the continental shelf edge along the Amundsen Sea and Bellingshausen Sea margins during the last glacial period. However, the few cosmogenic surface exposure ages and ice core data available from the interior of West Antarctica indicate that ice surface elevations there have changed little since the LGM. In the few areas from which cosmogenic surface exposure ages have been determined near the margin of the ice sheet, they generally suggest that there has been a gradual decrease in ice surface elevation since pre-Holocene times. Radiocarbon dates from glacimarine and the earliest seasonally open marine sediments in continental shelf cores that have been interpreted as providing approximate ages for post-LGM grounding-line retreat indicate different trajectories of palaeo-ice stream recession in the Amundsen Sea and Bellingshausen Sea embayments. The areas were probably subject to similar oceanic, atmospheric and eustatic forcing, in which case the differences are probably largely a consequence of how topographic and geological factors have affected ice flow, and of topographic influences on snow accumulation and warm water inflow across the continental shelf. Pauses in ice retreat are recorded where there are "bottle necks" in cross-shelf troughs in both embayments. The highest retreat rates presently constrained by radiocarbon dates from sediment cores are found where the grounding line retreated across deep basins on the inner shelf in the Amundsen Sea, which is consistent with the marine ice sheet instability hypothesis. Deglacial ages from the Amundsen Sea Embayment (ASE) and Eltanin Bay (southern Bellingshausen Sea) indicate that the ice sheet had already retreated close to its modern limits by early Holocene time, which suggests that the rapid ice thinning, flow acceleration, and grounding line retreat observed in this sector over recent decades are unusual in the context of the past 10,000 years

The Impact of HIV, an Antiretroviral Programme and Tuberculosis on Mortality in South African Platinum Miners, 1992–2010

HIV and tuberculosis (TB) are the most common causes of death in South Africa. Antiretroviral therapy (ART) programmes should have had an impact on mortality rates. This study describes the impact of HIV, a Wellness (HIV/ART) programme and TB on population-wide trends in mortality and causes of death among South African platinum miners, from before the HIV epidemic into the ART era

A community-based geological reconstruction of Antarctic Ice Sheet deglaciation since the Last Glacial Maximum

A robust understanding of Antarctic Ice Sheet deglacial history since the Last Glacial Maximum is important in order to constrain ice sheet and glacial-isostatic adjustment models, and to explore the forcing mechanisms responsible for ice sheet retreat. Such understanding can be derived from a broad range of geological and glaciological datasets and recent decades have seen an upsurge in such data gathering around the continent and Sub-Antarctic islands. Here, we report a new synthesis of those datasets, based on an accompanying series of reviews of the geological data, organised by sector. We present a series of timeslice maps for 20ka, 15ka, 10ka and 5ka, including grounding line position and ice sheet thickness changes, along with a clear assessment of levels of confidence. The reconstruction shows that the Antarctic Ice sheet did not everywhere reach the continental shelf edge at its maximum, that initial retreat was asynchronous, and that the spatial pattern of deglaciation was highly variable, particularly on the inner shelf. The deglacial reconstruction is consistent with a moderate overall excess ice volume and with a relatively small Antarctic contribution to meltwater pulse 1a. We discuss key areas of uncertainty both around the continent and by time interval, and we highlight potential priorit. © 2014 The Authors

Atmosphere-ocean-ice interactions in the Amundsen Sea Embayment, West Antarctica

Over recent decades outlet glaciers of the Amundsen Sea Embayment (ASE), West Antarctica, have accelerated, thinned and retreated, and are now contributing approximately 10% to global sea level rise. All the ASE glaciers flow into ice shelves, and it is the thinning of these since the 1970s, and their ungrounding from “pinning points” that is widely held to be responsible for triggering the glaciers’ decline. These changes have been linked to the inflow of warm Circumpolar Deep Water (CDW) onto the ASE's continental shelf. CDW delivery is highly variable, and is closely related to the regional atmospheric circulation. The ASE is south of the Amundsen Sea Low (ASL), which has a large variability and which has deepened in recent decades. The ASL is influenced by the phase of the Southern Annular Mode, along with tropical climate variability. It is not currently possible to simulate such complex atmosphere-ocean-ice interactions in models, hampering prediction of future change. The current retreat could mark the beginning of an unstable phase of the ASE glaciers that, if continued, will result in collapse of the West Antarctic Ice Sheet, but numerical ice-sheet models currently lack the predictive power to answer this question. It is equally possible that the recent retreat will be short-lived and that the ASE will find a new stable state. Progress is hindered by incomplete knowledge of bed topography in the vicinity of the grounding line. Furthermore, a number of key processes are still missing or poorly represented in models of ice-flow

Morphology of the upper continental slope in the Bellingshausen and Amundsen Seas - implications for sedimentary processes at the shelf edge of West Antarctica

Swath bathymetric and sub-bottom profiler data reveal a variety of submarine landforms such as gullies, slide scars, subtle shelf edge-parallel ridges and elongated depressions, and small debris flows along the continental shelf break and upper slope of West Antarctica. Gullies cutting through debris flow deposits on the Belgica Trough Mouth Fan (TMF) suggest formation after full-glacial deposition on the continental slope. The gullies were most likely eroded by sediment-laden subglacial meltwater flows released from underneath the ice margin grounded at the shelf edge at the onset of deglaciation. Scarcity of subglacial meltwater flow features on the outer shelf suggests that the meltwater reached the shelf edge mainly either through the topmost layer of soft diamict or in the form of dispersed flow beneath the ice, although locally preserved erosional channels indicate that more focused and higher-energy flows also existed. Concentration of gullies on the upper continental slope in front of the marginal areas of the major cross-shelf troughs, as contrasted to their axial parts, is indicative of higher-energy gully-eroding processes there, possibly due to additional subglacial meltwater flow from beneath the slow moving ice lying over the higher banks of the troughs. The shallow and sinuous gully heads observed on the outermost shelf within the Pine Island West Trough may indicate postglacial modification by near-bed currents resulting either from the subglacial meltwater flow from underneath the ice margin positioned at some distance landward from the shelf edge, or from the currents formed by brine rejection during sea ice formation. On the continental slope outside major troughs, slide scars as well as shelf-edge parallel ridges and elongated depressions indicate an unstable and failure-prone uppermost slope, although failures were probably mainly associated with rapid sediment loading during glacial periods. Complex, cauliflower- and amphitheatre-shaped gully heads biting back into the shelf edge suggest upslope retrogressive, multi-stage small-scale sliding as a contributing factor to the formation of gullies in these areas. Small debris fans immediately downslope of the slide scars suggest that small-scale debris flows have been the main downslope sediment transfer processes in the areas of weak or absent subglacial meltwater flow. (C) 2008 Elsevier B.V. All rights reserved