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The ocean influences on mass loss at tidewater glaciers are poorly understood, leading to uncertainty in sea level rise projections. Subglacial discharge plumes drive mass loss via submarine melting and may also facilitate mass loss by modulating calving rates. However, current theories underpredict submarine melt rates at terminus regions that are far from discharge plumes, suggesting that they may miss key ocean processes. A new set of observations from autonomously deployed moorings less than 100 m from the terminus of LeConte Glacier, Alaska, and a high-resolution numerical model, reveal that the near-glacier ocean is filled with energetic internal waves. We find that the internal wave kinetic energy and frequency are correlated with subglacial discharge fluxes on weekly to seasonal timescales. The waves radiate away from the discharge plume and could enhance ice-ocean boundary layer fluxes of heat and salt along the terminus. Accounting for waves within current submarine melt rate parameterizations increases predicted melt rates by up to 70%. Because the dynamical ingredients - a buoyant plume rising through a stratified ocean - are common to many tidewater glacier systems, such internal waves are likely to be widespread.

Objective To determine if postnatal transfer or birth in a non-tertiary hospital is associated with adverse outcomes. Design Observational cohort study with propensity score matching. Setting National health service neonatal care in England; population data held in the National Neonatal Research Database. Participants Extremely preterm infants born at less than 28 gestational weeks between 2008 and 2015 (n=17 577) grouped based on birth hospital and transfer within 48 hours of birth: upward transfer (non-tertiary to tertiary hospital, n=2158), non-tertiary care (born in non-tertiary hospital; not transferred, n=2668), and controls (born in tertiary hospital; not transferred, n=10 866). Infants were matched on propensity scores and predefined background variables to form subgroups with near identical distributions of confounders. Infants transferred between tertiary hospitals (horizontal transfer) were separately matched to controls in a 1:5 ratio. Main outcome measures Death, severe brain injury, and survival without severe brain injury. Results 2181 infants, 727 from each group (upward transfer, non-tertiary care, and control) were well matched. Compared with controls, infants in the upward transfer group had no significant difference in the odds of death before discharge (odds ratio 1.22, 95% confidence interval 0.92 to 1.61) but significantly higher odds of severe brain injury (2.32, 1.78 to 3.06; number needed to treat (NNT) 8) and significantly lower odds of survival without severe brain injury (0.60, 0.47 to 0.76; NNT 9). Compared with controls, infants in the non-tertiary care group had significantly higher odds of death (1.34, 1.02 to 1.77; NNT 20) but no significant difference in the odds of severe brain injury (0.95, 0.70 to 1.30) or survival without severe brain injury (0.82, 0.64 to 1.05). Compared with infants in the upward transfer group, infants in the non-tertiary care group had no significant difference in death before discharge (1.10, 0.84 to 1.44) but significantly lower odds of severe brain injury (0.41, 0.31 to 0.53; NNT 8) and significantly higher odds of survival without severe brain injury (1.37, 1.09 to 1.73; NNT 14). No significant differences were found in outcomes between the horizontal transfer group (n=305) and controls (n=1525). Conclusions In extremely preterm infants, birth in a non-tertiary hospital and transfer within 48 hours are associated with poor outcomes when compared with birth in a tertiary setting. We recommend perinatal services promote pathways that facilitate delivery of extremely preterm infants in tertiary hospitals in preference to postnatal transfer.

Background: The global COVID-19 pandemic has had an unprecedented impact on European health and social care systems, with demands on testing, hospital and intensive care capacity exceeding available resources in many regions. This has led to concerns that some vulnerable groups,including autistic people, may be excluded from services. Methods: We reviewed policies from 15 European member states, published March-July 2020,pertaining to: 1) access to COVID-19 tests; 2) provisions for treatment, hospitalisation and intensive careunits(ICU); and 3) changes to standard health and social care. In parallel, we analysed surveydata onthelived experiences of 1,301 autistic people and caregivers. Results: Autistic peopleexperienced significant barriers accessing COVID-19services. First, despite being at elevated risk for severe illness due to co-occurring health conditions, there was a lack of accessibility ofCOVID-19 testing. Second, many COVID-19 outpatient and inpatient treatment serviceswere reported to be inaccessible -predominantly resulting from individual differences in communication needs. Third, ICU triage protocols in many European countries (directly or indirectly)resultedin discriminatory exclusion from lifesaving treatments. Last, interruptions to standard health and social care left over 70% of autistic people without everyday support. Conclusions: The COVID-19 pandemic has further exacerbated existing healthcare inequalities for autistic people, likely contributing to disproportionate increases in morbidity and mortality,mental health/behavioural difficulties and reduced qualityoflife. Current policies and guidelines regarding the accessibility of COVID-19 services require urgent update to prevent the widespread exclusion of autistic peoplefrom services, which represents a violation of international human rights law.

Objective To evaluate outcome trends of neonates born very preterm in 11 high-income countries participating in the International Network for Evaluating Outcomes of neonates. Study design In a retrospective cohort study, we included 154 233 neonates admitted to 529 neonatal units between January 1, 2007, and December 31, 2015, at 24(0/7) to 31(6/7) weeks of gestational age and birth weight

The deployment of camera traps, which automatically take pictures of wild animals moving in front of them, is now routinely used to survey terrestrial mammal communities worldwide. The resulting photographic data are used to answer questions relating to the richness and structure of mammal communities, the density of their component species, and how the latter might interact. This thesis fills key methodological gaps in how these questions are addressed. My first data chapter assesses how the exact placement of camera traps on natural game trails influences the characterisation of community richness, composition and structure in an east African savannah landscape. I find that a trail-based placement strategy leads to more species being detected more rapidly relative to a random one, and increases capture rates for carnivore species in particular. In contrast, I reveal in Chapter 3 how a non-random camera trap placement strategy can bias estimates of absolute density for an unmarked large carnivore, the lion Panthera leo, obtained using an ideal gas model approach. Chapter 4 considers spatiotemporal patterns in camera trap data, and to what extent they can be used to infer on the kleptoparasitic and predatory tendencies of spotted hyenas and lions, respectively, in Tanzania’s Ruaha landscape. I find patterns to be generally uninformative, and so, in Chapter 5, turn to another method of collecting spatiotemporal data, Global Positioning Satellite telemetry, to make inferences on the spatial response of elk to wolves in Yellowstone National park. I find no evidence for a significant spatial avoidance of wolves by elk, suggesting that species interactions may not always lead to measurable spatial patterns. Nevertheless, in my final chapter, I use an individual-based modelling framework to simulate different types of prey responses to predator movement in the absence of confounding factors, and find that a huge amount of camera trapping effort would be required to distinguish between them. This thesis highlights how camera trap placement can affect the description of mammal communities and the estimation of species density. It also shows that we cannot rely solely on spatiotemporal patterns derived from camera traps to make inferences on complex interactive processes.

The p53 tumor suppressor gene is altered in up to 70% of colorectal cancers.We infected the colorectal cancer cell lines SW620 and KM12L4, in which p53 is mutated, with the replication-defective adenovirus Ad5/CMV/p53 to evaluate the effects of adenovirus-mediated wild-type p53 gene transfer. Gene transduction was measured by cytochemical staining of cells infected with the Ad5/CMV/beta-gal virus and expression of the wildtype p53 protein in these cells was demonstrated by immunoblotting.Significant suppression of in vitro cell proliferation and induction of apoptosis (as measured by TUNEL assay labeling) were observed following Ad5/CMV/p53 infection. More importantly, similar effects were observed in vivo in an established nude mouse subcutaneous tumor model; significant suppression of tumor growth (60%-70%) and induction of apoptosis were observed following intratumoral injections of Ad5/CMV/p53.This form of therapy may provide a novel approach to colorectal cancer.