Finale: impact of the ORCHESTRA/ENCORE programmes on Southern Ocean heat and carbon understanding.

The 5-year Ocean Regulation of Climate by Heat and Carbon Sequestration and Transports (ORCHESTRA) programme and its 1-year extension ENCORE (ENCORE is the National Capability ORCHESTRA Extension) was an approximately 11-million-pound programme involving seven UK research centres that finished in March 2022. The project sought to radically improve our ability to measure, understand and predict the exchange, storage and export of heat and carbon by the Southern Ocean. It achieved this through a series of milestone observational campaigns in combination with model development and analysis. Twelve cruises in the Weddell Sea and South Atlantic were undertaken, along with mooring, glider and profiler deployments and aircraft missions, all contributing to measurements of internal ocean and air-sea heat and carbon fluxes. Numerous forward and adjoint numerical experiments were developed and supported by the analysis of coupled climate models. The programme has resulted in over 100 peer-reviewed publications to date as well as significant impacts on climate assessments and policy and science coordination groups. Here, we summarize the research highlights of the programme and assess the progress achieved by ORCHESTRA/ENCORE and the questions it raises for the future. This article is part of a discussion meeting issue 'Heat and carbon uptake in the Southern Ocean: the state of the art and future priorities'.

Internal tsunamigenesis and ocean mixing driven by glacier calving in Antarctica.

Ocean mixing around Antarctica exerts key influences on glacier dynamics and ice shelf retreats, sea ice, and marine productivity, thus affecting global sea level and climate. The conventional paradigm is that this is dominated by winds, tides, and buoyancy forcing. Direct observations from the Antarctic Peninsula demonstrate that glacier calving triggers internal tsunamis, the breaking of which drives vigorous mixing. Being widespread and frequent, these internal tsunamis are at least comparable to winds, and much more important than tides, in driving regional shelf mixing. They are likely relevant everywhere that marine-terminating glaciers calve, including Greenland and across the Arctic. Calving frequency may change with higher ocean temperatures, suggesting possible shifts to internal tsunamigenesis and mixing in a warming climate.

Gateway-driven weakening of ocean gyres leads to Southern Ocean cooling.

Declining atmospheric CO2 concentrations are considered the primary driver for the Cenozoic Greenhouse-Icehouse transition, ~34 million years ago. A role for tectonically opening Southern Ocean gateways, initiating the onset of a thermally isolating Antarctic Circumpolar Current, has been disputed as ocean models have not reproduced expected heat transport to the Antarctic coast. Here we use high-resolution ocean simulations with detailed paleobathymetry to demonstrate that tectonics did play a fundamental role in reorganising Southern Ocean circulation patterns and heat transport, consistent with available proxy data. When at least one gateway (Tasmanian or Drake) is shallow (300 m), gyres transport warm waters towards Antarctica. When the second gateway subsides below 300 m, these gyres weaken and cause a dramatic cooling (average of 2-4 °C, up to 5 °C) of Antarctic surface waters whilst the ACC remains weak. Our results demonstrate that tectonic changes are crucial for Southern Ocean climate change and should be carefully considered in constraining long-term climate sensitivity to CO2.

The prevalence of non-communicable disease in older people in prison: a systematic review and meta-analysis.

BACKGROUND: people in prison often experience poor health. Those aged 50 and over are the fastest growing age-group in prison and present particular challenges to criminal justice systems around the world. Non-communicable diseases (NCDs) account for two-thirds of deaths globally and no estimate of the prevalence of NCDs in this vulnerable population exists. METHODS: we searched PubMed, Medline, CINAHL, EMBASE and Global Health databases to identify original research papers that met our pre-defined inclusion criteria. No date or language restrictions were applied. Two authors undertook full-text screening as well as quality assessment and data extraction for all included studies. A random effects model was used to calculate pooled prevalence of any disease that was reported in two or more articles. RESULTS: the initial search identified 2,712 articles. 119 underwent full-text screening with 26 meeting the inclusion criteria. This provided prevalence data on 28 NCDs in 93,862 individuals from prisons in 11 countries. Pooled prevalence for the most significant NCDs was a follows; cancer 8% (95% CI 6-10%), cardiovascular disease 38% (95% CI 33-42%), hypertension 39% (95% CI 32-47%), diabetes 14% (95% CI 12-16%), COPD prevalence estimates ranged from 4% to 18%. Heterogeneity across studies was high. CONCLUSIONS: those in prison over 50 years of age experience a high burden of NCDs which is often higher than younger prison and age-matched community peers. This health inequality is influenced by lifestyle, environmental and societal factors. Prison services should be adapted to serve the needs of this growing population.

Does the sensitivity of Southern Ocean circulation depend upon bathymetric details?

The response of the major ocean currents to changes in wind stress forcing is investigated with a series of idealized, but eddy-permitting, model simulations. Previously, ostensibly similar models have shown considerable variation in the oceanic response to changing wind stress forcing. Here, it is shown that a major reason for these differences in model sensitivity is subtle modification of the idealized bathymetry. The key bathymetric parameter is the extent to which the strong eddy field generated in the circumpolar current can interact with the bottom water formation process. The addition of an embayment, which insulates bottom water formation from meridional eddy fluxes, acts to stabilize the deep ocean density and enhances the sensitivity of the circumpolar current. The degree of interaction between Southern Ocean eddies and Antarctic shelf processes may thereby control the sensitivity of the Southern Ocean to change.

Proximal colon cancer and serrated adenomas - hunting the missing 10%.

There is a 10% shortfall in the number of proximal colorectal cancer cases detected by the UK Bowel Cancer Screening Programme and the actual number of UK-registered proximal colorectal cancers. Sessile serrated adenomas/polyps (SSA/P) are common premalignant lesions in the proximal colon and are notoriously difficult to spot endoscopically. Missed or dismissed SSA/Ps might contribute to this UK proximal colon cancer detection disparity. In Oxfordshire, a service evaluation audit and histological review has shown a linear increase in the detection rate of these lesions over the past 4 years. This is the result of increased endoscopist and pathologist awareness of these lesions and improved interdisciplinary communication. This is the result of increased endoscopist and pathologist awareness of these lesions, together with improved interdisciplinary communication, and we predict that this will lead to a comparable detection increase nationwide. Ongoing surveillance of an increasing number of these premalignant lesions could become a significant endoscopic resource requirement once UK guidelines on serrated lesion follow up are established.

Tissue encapsulation of the proximal Essure micro-insert from the uterine cavity following hysteroscopic sterilization.

STUDY OBJECTIVE: To assess the interaction between the trailing ends of a sterilization micro-insert extending into the uterine cavity and the surrounding uterine tissue environment over time. DESIGN: Multicenter, retrospective observational study (Canadian Task Force classification II-1). SETTING: Hospital-based clinical research centers. PATIENTS: A subset of a study population of 545 women who had undergone a hysteroscopic sterilization procedure. INTERVENTION: A second-look hysteroscopy was performed in 22 (20 with uterine bleeding, 2 pre IVF) of these 545 women between 4 and 43 months from the sterilization procedure. MEASUREMENTS AND MAIN RESULTS: Over a mean time period of 19.73 months, the trailing coils of the micro-inserts into the uterine cavity shortened from a mean of 5.7 mm to 2.0 mm and from 5.4 mm to 1.8 mm on the right and left sides, respectively. In cases observed within 12 months or fewer post-procedure, the complete tissue encapsulation of both micro-inserts had already occurred in 17% of the observations. Among cases evaluated from 13 to 43 months post-procedure, 25% evidenced complete encapsulation. CONCLUSION: Two mechanisms appear to be responsible for this process. First, there is an initial mechanical "winding-in" of the micro-insert of approximately 1 rotation of its outer coil, accounting for 1 mm of its length, after release from its delivery system. Second, the tissue around the ostium appears to use the trailing coils of the micro-insert as a scaffolding structure, gradually encapsulating and excluding them from the uterine cavity. The gradual tissue exclusion of the micro-insert from the uterine cavity may make it pregnancy-compatible after in vitro fertilization and embryo transfer procedures.

Essure hysteroscopic sterilization: results based on utilizing a new coil catheter delivery system.

STUDY OBJECTIVE: To assess the safety and placement effectiveness of a new delivery catheter for the Essure micro-insert hysteroscopic sterilization system. DESIGN: Prospective, multicenter, single-arm clinical study. (Canadian Task Force classification II-3). SETTING: Hospital-based clinical research centers. PATIENTS: One hundred two women of reproductive age and proven fertility. INTERVENTION: A new coil catheter delivery system was used for micro-insert placement. MEASUREMENTS AND MAIN RESULTS: The bilateral placement of micro-inserts using the coil catheter delivery system occurred in 100 women out of 102 attempts (98%). The two women who did not have successful micro-insert placement were subsequently shown to have proximal tubal stenotic disease. CONCLUSION: These findings indicate that the introduction of the coil catheter delivery system for Essure hysteroscopic sterilization improves the micro-insert bilateral placement rate when compared with previous studies. It is hypothesized that the coil catheter has superior navigational properties, particularly within tortuous or narrowed tubal lumens.

Retrorectal endometrial cyst.

CASE REPORT: An unusual case of retrorectal endometriosis is presented. This presented as an asymptomatic pelvic mass at the level of the pelvic floor not contiguous with the pelvis or peritoneal cavity. RESULT: It was successfully excised via an abdominal approach.