Description: The objectives for Expedition 352 were to drill through the entire volcanic sequence of the Bonin fore arc to 1. Obtain a high-fidelity record of magmatic evolution during subduction initiation and early arc development, 2. Test the hypothesis that fore-arc basalt lies beneath boninite and understand chemical gradients within these units and across the transition, 3. Use drilling results to understand how mantle melting processes evolve during and after subduction initiation, and 4. Test the hypothesis that the fore-arc lithosphere created during subduction initiation is the birthplace of suprasubduction zone (SSZ) ophiolites. Expedition 352 successfully cored 1.22 km of igneous basement and 0.46 km of over-lying sediment, providing diverse, stratigraphically controlled suites of fore-arc basalts (FAB) and boninite related to seafloor spreading and earliest arc development. FAB were recovered at the two deeper water sites (U1440 and U1441) and boninites at the two sites (U1439 and U1442) drilled upslope to the west. FAB lavas and dikes are depleted in high-field strength trace elements such as Ti and Zr relative to mid-ocean-ridge basalt but have relatively diverse concentrations of trace elements bezcause of variation in degrees of melting and amount of subducted fluids involved in their genesis. All FAB magmas underwent significant crystal fractionation in a persistent magma chamber system. Holes U1439C and U1442A yielded entirely boninitic lavas. We defined three boninite differentiation series based on variations in MgO, SiO2, and TiO2 concentrations of the parental magmas. Lavas in both pairs of holes have compositions that generally become more primitive and have lower TiO2 concentrations upward. The presence of dikes at the base of the sections at Sites U1439 and U1440 provides evidence that boninitic and FAB lavas are both underlain by their own conduit systems and that FAB and boninite group lavas are likely offset more horizontally than vertically. We thus propose that seafloor spreading related to subduction initiation migrated from east to west after subduction initiation and during early arc development. Initial spreading was likely rapid, and an axial magma chamber was present. Melting was largely decompressional during this period, but subducted fluids affected some melting. As subduction continued and spreading migrated to the west, the embryonic mantle wedge became more depleted, and the influence of subducted constituents dramatically increased, causing the oceanic crust to be built of boninitic rather than tholeiitic magma. The general decrease in fractionation upward reflects the eventual disappearance of persistent magma chambers, either because spreading rate was decreasing with distance from the trench or because spreading was succeeded by off-axis magmatism trenchward of the ridge. The extreme depletion of the sources for all boninitic lavas was likely related to the incorporation of mantle residues from FAB generation. This mantle depletion continued during generation of lower silica boninitic magmas, exhausting clinopyroxene from the mantle such that the capping high-Si, low-Ti boninites were generated from harzburgite. Additional results of the cruise include recovery of Eocene to recent deep-sea sediment that records variation in sedimentation rates with time resulting from variations in climate, the position of the carbonate compensation depth, and local structural control. Three phases of highly explosive volcanism (latest Pliocene to Pleistocene, late Miocene to earliest Pliocene, and Oligocene) were identified, represented by 132 graded air fall tephra layers. Structures found in the cores and reflected in seismic profiles show that this area had periods of normal, reverse, and strike-slip faulting. Finally, basement rock P-wave velocities were shown to be slower than those observed during logging of normal ocean crust sites.

Description: Objectives To assess the efficacy of three different daily doses of acetazolamide in the prevention of acute mountain sickness and to determine the lowest effective dose.Design Systematic review and...

Description: Introduction Most patient safety research has focused on specialist-care settings where there is an appreciation of the frequency and causes of medical errors, and the resulting burden of adverse events. There have, however, been few large-scale robust studies that have investigated the extent and severity of avoidable harm in primary care. To address this, we will conduct a 12-month retrospective cross-sectional study involving case note review of primary care patients. Methods and analysis We will conduct electronic searches of general practice (GP) clinical computer systems to identify patients with avoidable significant harm. Up to 16 general practices from 3 areas of England (East Midlands, London and the North West) will be recruited based on practice size, to obtain a sample of around 100 000 patients. Our investigations will include an ‘enhanced sample’ of patients with the highest risk of avoidable significant harm. We will estimate the incidence of avoidable significant harm and express this as ‘per 100 000 patients per year’. Univariate and multivariate analysis will be conducted to identify the factors associated with avoidable significant harm. Ethics/Dissemination The decision regarding participation by general practices in the study is entirely voluntary; the consent to participate may be withdrawn at any time. We will not seek individual patient consent for the retrospective case note review, but if patients respond to publicity about the project and say they do not wish their records to be included, we will follow these instructions. We will produce a report for the Department of Health's Policy Research Programme and several high-quality peer-reviewed publications in scientific journals. The study has been granted a favourable opinion by the East Midlands Nottingham 2 Research Ethics Committee (reference 15/EM/0411) and Confidentiality Advisory Group approval for access to medical records without consent under section 251 of the NHS Act 2006 (reference 15/CAG/0182).