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During summer and fall 2023, Louisiana experienced a historic local drought while dry conditions elsewhere in the central US withheld vital runoff from the Mississippi River, leading to below‐normal discharge into the Gulf of Mexico. Thus, by late October 2023, Louisiana was gripped by two super‐imposed water crises: a severe local drought and saltwater contamination in the Mississippi River channel. This study frames the development of the water emergency through the lens of flash drought using the Evaporative Demand Drought Index (EDDI). The EDDI shows south Louisiana experience a flash drought during June 2023, while the Mississippi River basin was subsequently characterized by large expanses of high‐percentile EDDI in August‐September 2023 shortly before the saltwater intrusion episode along the lower Mississippi River. Over the last 15 years, MRB‐wide EDDI percentile has oscillated between years‐long elevated and depressed states, accounting for 23.7% of the monthly discharge anomaly near New Orleans. Plain Language Summary: In 2023, Louisiana experienced one of its driest and hottest summers on record. While drought developed across the state, rain shortfalls further north led to low water levels in the Mississippi River, a major navigation corridor and drinking water source for the state. As river levels fell, seawater moved into the channel, threatening to contaminate the water supply with salt. The statewide drought, particularly in coastal Louisiana, is shown to have developed rapidly during June 2023 through a process called flash drought. Meanwhile, high evaporation rates and low rainfall upriver exacerbated Louisiana's water shortage by limiting runoff into the Mississippi River. Over the last 15 years, evaporative demand over the Mississippi River watershed varies closely with river discharge near New Orleans, and even corresponds to river conditions more closely than rainfall itself. Key Points: Louisiana experienced 5 months of exceptional evaporative demand and low precipitation, including a flash drought during June 2023Historically low flows on the lower Mississippi River in fall 2023 were accompanied by several episodes of high evaporative demand upbasinBasin‐wide high evaporative demand coincides with low discharge near New Orleans, with a trend toward this combination since the 2019 flood [ABSTRACT FROM AUTHOR]

Shoal margin collapses of several million cubic meters have occurred in the Western Scheldt estuary, the Netherlands, on average five times a year over the last decades. While these collapses involve significant volumes of material, their effect on the channel‐shoal morphology is unknown. We hypothesize that collapses dynamicize the channel‐shoal interactions, which could impact the ecological functioning, flood safety, and navigation in the estuary. The objective is to investigate how locations, probability, type, and volume of shoal margin collapse affect the channel‐shoal dynamics. We implemented an empirically validated parameterization for shoal margin collapses and tested its effect on simulated estuary morphological development in a Delft3D schematization of the Western Scheldt. Three sets of scenarios were analyzed for near‐field and far‐field effects on flow pattern and channel‐shoal morphology: (1) an observed shoal margin collapse of 2014, (2) initial large collapses on 10 locations, and (3) continuous collapses predicted by our novel probabilistic model over a time span of decades. Results show that a single shoal margin collapse only affects the local dynamics in the longitudinal flow direction and dampen out within a year for typical volumes, whereas larger disturbances that reach the seaward or landward sill at tidal channel junctions grow. The direction of the strongest tidally averaged flow determined the redistribution of the collapsed sediment. We conclude that adding the process of shoal margin collapses increases the channel‐shoal interactions and that in intensively dredged estuaries shoal margins oversteepen, amplifying the number of collapses, but because of dredging the natural morphological response is interrupted. Key Points: Shoal margin collapses perturb the channel‐shoal network of sandy estuariesDisturbances cause long‐term morphological changesDisturbances amplify asymmetry and instability at channel junctions [ABSTRACT FROM AUTHOR]

We studied the efficacy of caffeine in improving pneumogram abnormalities and relieving clinically important apnoea of infancy in 23 infants. After obtaining a 12 hour pneumogram we administered caffeine citrate in a loading dose of 20 mg/kg followed by 5 mg/kg once daily. This dose achieved a trough caffeine blood concentration of 9.6 (SD 2.0) micrograms/ml. A repeat pneumogram performed seven to 10 days after the first pneumogram showed a significant reduction in the number of short and prolonged attacks of apnoea as well as in the per cent periodic breathing and apnoea density. Episodes of prolonged apnoea disappeared in all infants after administration of caffeine and in 11 infants all pneumogram abnormalities resolved. This improvement in the results of pneumograms was associated with resolution of clinically important apnoea requiring intervention. Caffeine was administered for 3.4 (SD 1.3) months and was well tolerated by all except two infants. We conclude that treatment with caffeine is helpful in preventing attacks of apnoea that require intervention, and improvement in the results of pneumograms after administration of caffeine predicts this favourable response. [ABSTRACT FROM AUTHOR]

The cost differences between film-based mammography (FBM) and digital mammography (DM) were estimated after discussions with hospital personnel and industry representatives. Human resource costs were not included. The fixed cost of FBM per machine was estimated to be $50,000 and the variable cost $4.60 per examination. The fixed cost of DM per machine was estimated to be $102,000 and the variable cost $0.10 per examination. The total number of examinations required to break even was therefore 11,556. At a rate of 15 examinations per machine per day and with 251 working days per year, it would take 3.1 years to break even. In the first year after the break-even point had been attained, $16,943 would be saved for every 3765 examinations performed. Extrapolating to the USA as a whole, in which 23 million mammographic examinations are performed each year, suggests that the annual savings from going filmless would be more than $103 million. [ABSTRACT FROM AUTHOR]

Abstract Background Monitoring of the electrocardiogram (ECG) in premature infants with conventional adhesive-backed electrodes can harm their sensitive skin. Use of an electrode belt prevents skin irritation, but the effect of belt pressure on respiratory function is unknown. A strain gauge sensor is described which measures applied belt tension. Method The device frame was comprised of an aluminum housing and slide to minimize the device weight. Velcro tabs connected housing and slide to opposite tabs located at the electrode belt ends. The slide was connected to a leaf spring, to which were bonded two piezoresistive transducers in a half-bridge circuit configuration. The device was tested for linearity and calibrated. The effect on infant respiratory function of constant belt tension in the normal range (30 g–90 g) was determined. Results The mechanical response to a step input was second order (fn = 401 Hz, ζ = 0.08). The relationship between applied tension and output voltage was linear in the range 25–225 gm of applied tension (r2 = 0.99). Measured device sensitivity was 2.18 mV/gm tension using a 5 V bridge excitation voltage. When belt tension was increased in the normal range from 30 gm to 90 gm, there was no significant change in heart rate and most respiratory functions during monitoring. At an intermediate level of tension of 50 gm, pulmonary resistance and work of breathing significantly decreased. Conclusion The mechanical and electrical design of a device for monitoring electrocardiogram electrode belt tension is described. Within the typical range of application tension, cardiovascular and respiratory function are not substantially negatively affected by electrode belt force.

Background: Vascular endothelial growth factor (VEGF) and its receptors (VEGFRs) regulate both vasculogenesis, the development of blood vessels from precursor cells, and angiogenesis, the formation of blood vessels from preexisting vessels. In the fetal lung, high-affinity receptors for VEGF are expressed mainly in alveolar epithelial cells and myocytes, suggesting a paracrine role for VEGF in modulating activities in adjacent vascular endothelium. Previous studies have shown that vascular growth is impaired in bronchopulmonary dysplasia (BPD)., Objective: The goal of this study was to examine tracheal (T-VEGF) and gastric (G-VEGF) levels in premature infants in the first and third day of life and examine if these levels were associated with the development of BPD., Design/methods: Tracheal aspirates from intubated infants and gastric samples from others were obtained on postnatal days 1 (D1) and 3 (D3) from 43 preterm infants (<2000 g birth weight, ≤34 wks gestation). VEGF was quantified by a VEGF Elisa Kit. Demographic, clinical, and pulmonary outcome data were collected including information on respiratory support (oxygenation index (OI) and ventilatory index (VI)) and on the development of BPD, determined at 36 weeks PMA using NICHD criteria., Results: The mean birth weight was 1060 ± 379 g and gestational age 27.5 ± 2.8 wks. BPD was diagnosed in 26 infants who were less mature than the 17 controls without BPD. Day 1 and day 3T-VEGF concentrations did not correlate, but day 3 levels correlated with gestational age ( r  = 0.75, p  < .05). BPD infants, characterized by longer ventilator, CPAP and oxygen days, had day 1T-VEGF levels similar to control infants (126.6 ± 194.7 vs. 149.7 ± 333.2 pg/ml) but day 3 levels were significantly lower (168.9 ± 218.8 vs. 1041.6 ± 676.7 pg/ml). Day 1G-VEGF levels reflected tracheal samples, trending lower in BPD infants. Mode of delivery, race, sex, antenatal steroid administration, chorioamnionitis, sepsis, or growth restriction did not impact VEGF levels. However, lower VEGF levels were associated with a lower VI and lower OI: Day 3 OI correlated with day 3T-VEGF ( r  = 0.72, p  > .05), albeit not significantly. T-VEGF increased from day 1 to day 3 in controls and decreased in BPD infants. There was no relationship between oxygen, CPAP and ventilator days and day 1 or day 3T-VEGF levels., Conclusions: BPD may be associated with low-serum VEGF levels during the first week of life. This finding is likely related to decreased expression in the lungs of the less mature infants, who are at the highest risk for BPD.

Channels in rivers and estuaries are the main paths of fluvial and tidal currents that transport sediment through the system. While network representations of multi-channel systems and their connectivity are quite useful for characterisation of braiding patterns and dynamics, the recognition of channels and their properties is complicated because of the large bed elevation variations, such as shallow shoals and bed steps that render channels visually disconnected. We present and analyse two mathematically rigorous methods to identify channel networks from a terrain model of the river bed. Both methods construct a dense network of locally steepest-descent channels from saddle points on the terrain, and select a subset of channels with a certain minimum sediment volume between them. This is closely linked to the main mechanism of channel formation and change by displacement of sediment volume. The two methods differ in how they compute these sediment volumes: either globally through the entire length of the river, or locally. We compare the methods for the measured bathymetry of the Western Scheldt estuary, The Netherlands, over the past decades. The global method is overly sensitive to small changes elsewhere in the network compared to the local method. We conclude that the local method works best conceptually and for stability reasons. The associated concept of alluvial connectivity between channels in a network is thus the inverse of the volume of sediment that must be displaced to merge the channels. Our method opens up possibilities for new analyses as shown in two examples. First, it shows a clear pattern of scale dependence on volume of the total network length and of the number of nodes by a power law relation, showing that the smaller channels are relatively much shorter. Second, channel bifurcations were found to be predominantly mildly asymmetrical, which is unexpected from fluvial bifurcation theory., Competing Interests: The authors identify no conflicts of interest., (© 2021 The Authors. Earth Surface Processes and Landforms published by John Wiley & Sons Ltd.)

Hurricanes are recurring high-energy disturbances in coastal regions that change community structure and function of mangrove wetlands. However, most of the studies assessing hurricane impacts on mangroves have focused on negative effects without considering the positive influence of hurricane-induced sediment deposition and associated nutrient fertilization on mangrove productivity and resilience. Here, we quantified how Hurricane Irma influenced soil nutrient pools, vertical accretion, and plant phosphorus (P) uptake after its passage across the Florida Coastal Everglades in September 2017. Vertical accretion from Irma's deposits was 6.7 to 14.4 times greater than the long-term (100 y) annual accretion rate (0.27 ± 0.04 cm y -1 ). Storm deposits extended up to 10-km inland from the Gulf of Mexico. Total P (TP) inputs were highest at the mouth of estuaries, with P concentration double that of underlying surface (top 10 cm) soils (0.19 ± 0.02 mg cm -3 ). This P deposition contributed 49 to 98% to the soil nutrient pool. As a result, all mangrove species showed a significant increase in litter foliar TP and soil porewater inorganic P concentrations in early 2018, 3 mo after Irma's impact, thus underscoring the interspecies differences in nutrient uptake. Mean TP loading rates were five times greater in southwestern (94 ± 13 kg ha -1 d -1 ) mangrove-dominated estuaries compared to the southeastern region, highlighting the positive role of hurricanes as a natural fertilization mechanism influencing forest productivity. P-rich, mineral sediments deposited by hurricanes create legacies that facilitate rapid forest recovery, stimulation of peat soil development, and resilience to sea-level rise., Competing Interests: The authors declare no competing interest.

Automatic extraction of channel networks from topography in systems with multiple interconnected channels, like braided rivers and estuaries, remains a major challenge in hydrology and geomorphology. Representing channelized systems as networks provides a mathematical framework for analyzing transport and geomorphology. In this paper, we introduce a mathematically rigorous methodology and software for extracting channel network topology and geometry from digital elevation models (DEMs) and analyze such channel networks in estuaries and braided rivers. Channels are represented as network links, while channel confluences and bifurcations are represented as network nodes. We analyze and compare DEMs from the field and those generated by numerical modeling. We use a metric called the volume parameter that characterizes the volume of deposited material separating channels to quantify the volume of reworkable sediment deposited between links, which is a measure for the spatial scale associated with each network link. Scale asymmetry is observed in most links downstream of bifurcations, indicating geometric asymmetry and bifurcation stability. The length of links relative to system size scales with volume parameter value to the power of 0.24-0.35, while the number of links decreases and does not exhibit power law behavior. Link depth distributions indicate that the estuaries studied tend to organize around a deep main channel that exists at the largest scale while braided rivers have channel depths that are more evenly distributed across scales. The methods and results presented establish a benchmark for quantifying the topology and geometry of multichannel networks from DEMs with a new automatic extraction tool., (©2019. The Authors.)

Background: Lung epithelial cells express surfactant protein D (SP-D), a calcium-dependent lectin that plays an important role in antibody-independent pulmonary host defense. Previous studies have shown that it is found in the peripheral circulation in patients with pulmonary disease, likely because of translocation into the blood when lung epithelial barriers are disrupted by inflammation or acute injury. In adults, serum SP-D levels are biomarkers for the progression and severity of chronic lung disease. In neonates, elevated SP-D levels in cord blood and on day 1 have been associated with prenatal risk factors and with an increased risk of respiratory distress syndrome and infections. It is not known whether serum SP-D during the first week of life is a marker for bronchopulmonary dysplasia (BPD), a form of chronic lung disease of prematurity that is associated with lung parenchymal maldevelopment and injury., Objective: The goal of this study is to determine whether serum SP-D on days 3 and 7 of life are associated with the development of BPD in preterm infants., Design/methods: Serum samples were obtained on postnatal days 3 and 7 from 106 preterm infants (500-2000 g birth weight, 23-32-week gestation). SP-D was quantified by Western blot. BPD was determined at 36 weeks PMA using NICHD criteria., Results: The mean birth weight was 1145 ± 347 g and gestational age 29.2 ± 7.4 weeks. BPD was diagnosed in 7 and "BPD or death" in 16 infants. Days 3 and 7 values tracked significantly (r = 0.648), and did not correlate with birth weight or gestational age. Contrary to expectations, serum SP-D was not associated with BPD. Significant gender differences were noted, with SP-D dropping from day 3 to day 7 in males, while increasing in females (p < .05)., Conclusion: Elevated serum SP-D does not appear to be a useful marker for BPD. Decreasing serum SP-D levels in males, as compared to females, during the first week of life are likely related to gender differences in lung maturation, consistent with the higher incidence of BPD in males.

The cellular and molecular mechanisms that underpin regeneration of the human lung are unknown, and the study of lung repair has been impeded by the necessity for reductionist models that may exclude key components. We hypothesized that multicellular epithelial and mesenchymal cell clusters or lung organoid units (LuOU) could be transplanted to recapitulate proximal and distal cellular structures of the native lung and airways. Transplantation of LuOU resulted in the growth of tissue-engineered lung (TELu) that contained the necessary cell types consistent with native adult lung tissue and demonstrated proliferative cells at 2 and 4 weeks. This technique recapitulated important elements of both mouse and human lungs featuring key components of both the proximal and distal lung regions. When LuOU were generated from whole lung, TELu contained key epithelial and mesenchymal cell types, and the origin of the cells was traced from both Actin GFP and SPC GFP donors to indicate that the cells in TELu were derived from the transplanted LuOU. Alveolar epithelial type 2 cells (AEC2s), club cells, ciliated cells marked by beta-tubulin IV, alveolar epithelial type I cells, Sox-2-positive proximal airway progenitors, p63-positive basal cells, and CGRP-positive pulmonary neuroendocrine cells were identified in the TELu. The mesenchymal components of peribronchial smooth muscle and nerve were identified with a CD31-positive donor endothelial cell contribution to TELu vasculature. TELu successfully grew from postnatal tissues from whole murine and human lung, distal murine lung, as well as murine and human trachea. These data support a model of postnatal lung regeneration containing the diverse cell types present in the entirety of the respiratory tract., Competing Interests: Statement No competing financial interests exist.

Staphylococcus epidermidis is an opportunistic bacterium whose infections often involve the formation of a biofilm on implanted biomaterials. In S. epidermidis, the exopolysaccharide facilitating bacterial adherence in a biofilm is polysaccharide intercellular adhesin (PIA), whose synthesis requires the enzymes encoded within the intercellular adhesin operon (icaADBC). In vitro, the formation of S. epidermidis biofilms is enhanced by conditions that repress tricarboxylic acid (TCA) cycle activity, such as growth in a medium containing glucose. In many Gram-positive bacteria, repression of TCA cycle genes in response to glucose is accomplished by catabolite control protein A (CcpA). CcpA is a member of the GalR-LacI repressor family that mediates carbon catabolite repression, leading us to hypothesize that catabolite control of S. epidermidis biofilm formation is indirectly regulated by CcpA-dependent repression of the TCA cycle. To test this hypothesis, ccpA deletion mutants were constructed in strain 1457 and 1457-acnA and the effects on TCA cycle activity, biofilm formation and virulence were assessed. As anticipated, deletion of ccpA derepressed TCA cycle activity and inhibited biofilm formation; however, ccpA deletion had only a modest effect on icaADBC transcription. Surprisingly, deletion of ccpA in strain 1457-acnA, a strain whose TCA cycle is inactive and where icaADBC transcription is derepressed, strongly inhibited icaADBC transcription. These observations demonstrate that CcpA is a positive effector of biofilm formation and icaADBC transcription and a repressor of TCA cycle activity.