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Inorganic sediment supply is a critical component of a salt marsh’s ability to vertically aggrade in response to relative sea level rise, yet there remains significant uncertainty on the primary sources, timing, and rates of sediment delivery to marshes. This is particularly true for the Northeastern, U.S. Atlantic coastline where the magnitude and sourcing of sediment varies widely due to post-glaciated landscapes. Here we present results from a 3-year study between 2020 and 2023 designed to inform management and restoration decisions related to northeast marshes through the development of a scalable method for assessing the availability and distribution of inorganic sediment to and within marshes, including the identification of thresholds of inorganic sediment delivery required to maintain a stable marsh platform under various rates of sea level rise for the region. Field investigations involved instrumental observations, deployment and recovery of seasonal sediment traps, and the collection and analysis of marsh core samples. The study targets 12 marsh systems spanning environmental gradients for the region that allowed us to examine different sources and delivery mechanisms of sediment. Our compilation of existing data reveals spatial variability in marsh accretion rates, but also highlights regional trends and the general agreement among rates determined through a variety of different methodologies and time spans. Our instrumental observations and sediment trap deployments confirm differences in sediment delivery among marshes. Back barrier marshes with relatively small watersheds predominantly accumulated inorganic sediment during the fall in response to large storms and wave activity suspending coastal and offshore sediment deposits (marine sources) that are carried into marshes through tidal advection. In contrast, marshes proximal to large rivers (>10,000 km2 watersheds) have higher accumulation rates and receive the bulk of their inorganic sediment in response to fluvial delivery of terrestrial sediment during spring freshet events. Among our 12 study marshes, only one experienced its highest rate of sediment accumulation during summer months, which we attribute to substantially greater crab herbivory promoting internal recycling of sediment. Overall, we have measured sediment accumulation in over 450 individual traps across spring, summer and fall seasons in twelve marshes. The results from the analysis of these samples represents the largest dataset of its kind for the region and enable defining regionally appropriate input variables for modeling the spatial variations of sedimentation across marsh surfaces as a function of tidal inundation and distance to the nearest channel, as well as providing defined sedimentation limits needed to sustain healthy marsh growth under future sea level rise and various potential restoration pathways.

This is a report on a videoconference conducted by a Japanese university seminar, the topic of which is language learning with online language exchange partners. The Japanese students are studying English and their partners are English speakers studying Japanese at American universities. While the technology used in the videoconference was limited to on-hand hardware and free software, it was staged as an interactive television show informed by the author’s past experience in distance learning programming. The reactions to the videoconference, from seminar and remote students, are discussed and suggestions for further exploration are offered. これは、日本の大学のゼミで行われた「オンラインによる言語交換パートナーとの言語学習」をテーマにしたビデオ会議のレポートである。日本の大学生は英語を学んでおり、言語交換相手はアメリカの大学で日本語を学ぶ大学生たちだ。ビデオ会議に使用された技術は、手持ちのハードウェアと無料のソフトというごく限られたものだったが、筆者が過去に経験した遠隔教育番組の経験を生かし、インタラクティブなテレビ番組のように演出がされている。日本のゼミ生や相手側の学生によるビデオ会議への反応を考察し、さらなる調査のための提案が薦められる。

Aerosol-generating procedures are medical interventions considered high risk for transmission of airborne pathogens. Tracheal intubation of anaesthetised patients is not high risk for aerosol generation; however, patients often perform respiratory manoeuvres during awake tracheal intubation which may generate aerosol. To assess the risk, we undertook aerosol monitoring during a series of awake tracheal intubations and nasendoscopies in healthy participants. Sampling was undertaken within an ultraclean operating theatre. Procedures were performed and received by 12 anaesthetic trainees. The upper airway was topically anaesthetised with lidocaine and participants were not sedated. An optical particle sizer continuously sampled aerosol. Passage of the bronchoscope through the vocal cords generated similar peak median (IQR [range]) aerosol concentrations to coughing, 1020 (645–1245 [120–48,948]) vs. 1460 (390–2506 [40–12,280]) particles.l-1 respectively, p = 0.266. Coughs evoked when lidocaine was sprayed on the vocal cords generated 91,700 (41,907–166,774 [390–557,817]) particles.l-1 which was significantly greater than volitional coughs (p

Background: The COVID-19 pandemic has disrupted routine hospital services globally. This study estimated the total number of adult elective operations that would be cancelled worldwide during the 12 weeks of peak disruption due to COVID-19. Methods: A global expert response study was conducted to elicit projections for the proportion of elective surgery that would be cancelled or postponed during the 12 weeks of peak disruption. A Bayesian β-regression model was used to estimate 12-week cancellation rates for 190 countries. Elective surgical case-mix data, stratified by specialty and indication (surgery for cancer versus benign disease), were determined. This case mix was applied to country-level surgical volumes. The 12-week cancellation rates were then applied to these figures to calculate the total number of cancelled operations. Results: The best estimate was that 28 404 603 operations would be cancelled or postponed during the peak 12 weeks of disruption due to COVID-19 (2 367 050 operations per week). Most would be operations for benign disease (90·2 per cent, 25 638 922 of 28 404 603). The overall 12-week cancellation rate would be 72·3 per cent. Globally, 81·7 per cent of operations for benign conditions (25 638 922 of 31 378 062), 37·7 per cent of cancer operations (2 324 070 of 6 162 311) and 25·4 per cent of elective caesarean sections (441 611 of 1 735 483) would be cancelled or postponed. If countries increased their normal surgical volume by 20 per cent after the pandemic, it would take a median of 45 weeks to clear the backlog of operations resulting from COVID-19 disruption. Conclusion: A very large number of operations will be cancelled or postponed owing to disruption caused by COVID-19. Governments should mitigate against this major burden on patients by developing recovery plans and implementing strategies to restore surgical activity safely.

AbsractObjectivesTo evaluate the relationship between Emergency Physician (EP) productivity and patient satisfaction with Emergency Department (ED) care.MethodsThis retrospective observational study linked administrative and patient experience databases to measure correlations between the patient experience and EP productivity. The study was performed across three Calgary EDs (from June 2010 to July 2013). Patients>16 years old with completed Health Quality Council of Alberta (HQCA) ED Patient Experience Surveys were included. EP productivity was measured at the individual physician level and defined as the average number of patients seen per hour. The association between physician productivity and patient experience scores from six composite domains of the HQCA ED Patient Experience Survey were examined using Pearson correlation coefficients, linear regression modelling, and a path analysis.ResultsWe correlated 3,794 patient experience surveys with productivity data for 130 EPs. Very weak non-significant negative correlations existed between productivity and survey composites: “Staff Care and Communication” (r=-0.057, p=0.521), “Discharge Communication” (r=-0.144, p=0.102), and “Respect” (r=-0.027, p=0.760). Very weak, non-significant positive correlations existed between productivity and the composite domains: “Medication Communication” (r=0.003, p=0.974) and “Pain management” (r=0.020, p=0.824). A univariate general linear model yielded no statistically significant correlations between EP productivity and patient experience, and the path analysis failed to show a relationship between the variables.ConclusionWe found no correlation between EP productivity and the patient experience.

Background Understanding the patient perspective on healthcare is central to the evaluation of quality. This study measured selected patient-reported outcomes after anaesthesia in order to identify targets for research and quality improvement. Methods This cross-sectional observational study in UK National Health Service hospitals, recruited adults undergoing non-obstetric surgery requiring anaesthesia care over a 48 h period. Within 24 h of surgery, patients completed the Bauer questionnaire (measuring postoperative discomfort and satisfaction with anaesthesia care), and a modified Brice questionnaire to elicit symptoms suggestive of accidental awareness during general anaesthesia (AAGA). Patient, procedural and pharmacological data were recorded to enable exploration of risk factors for these poor outcomes. Results 257 hospitals in 171 NHS Trusts participated (97% of eligible organisations). Baseline characteristics were collected on 16,222 patients; 15,040 (93%) completed postoperative questionnaires. Anxiety was most frequently cited as the worst aspect of the perioperative experience. Thirty-five per cent of patients reported severe discomfort in at least one domain: thirst (18.5%; 95% CI 17.8-19.1), surgical pain (11.0%; 10.5-11.5) and drowsiness (10.1%; 9.6-10.5) were most common. Despite this, only 5% reported dissatisfaction with any aspect of anaesthesia-related care. Regional anaesthesia was associated with a reduced burden of side-effects. The incidence of reported AAGA was one in 800 general anaesthetics (0.12%) Conclusions Anxiety and discomfort after surgery are common; despite this, satisfaction with anaesthesia care in the UK is high. The inconsistent relationship between patient-reported outcome, patient experience and patient satisfaction supports using all three of these domains to provide a comprehensive assessment of the quality of anaesthesia care.

BACKGROUND: As part of the 5th National Audit Project of the Royal College of Anaesthetists and the Association of Anaesthetists of Great Britain and Ireland concerning accidental awareness during general anaesthesia, we issued a questionnaire to every consultant and staff and associate specialist anaesthetist in the UK. METHODS: The survey was designed to ascertain the number of new cases of accidental awareness that became known to them, for patients under their direct or supervised care, for a calendar year, and also to estimate how many cases they had experienced during their careers. The survey also asked about use of monitoring designed to measure the depth of anaesthesia. RESULTS: All local co-ordinators responsible for each of 329 hospitals (organised into 265 'centres') in the UK responded, as did 7125 anaesthetists (82%). There were 153 new cases of accidental awareness notified to respondents in 2011, an estimated incidence of 1:15 414, lower than the 1-2:1000 previously reported in prospective clinical trials. Almost half the cases (72, 47%) occurred at or after induction of anaesthesia but before surgery, with 46 (30%) occurring during surgery and 35 (23%) after surgery before full recovery. Awareness during surgery appeared to lead more frequently to pain or distress than at induction and emergence (62% vs 28% and 23%, respectively). Depth of anaesthesia monitors were available in 164 centres (62%), but routinely used by only 132 (1.8%) of anaesthetists. CONCLUSION: The disparity between the incidence of awareness as notified to anaesthetists and that reported in trials warrants further examination and explanation.

Climate Reversal The climate and environment of the Arctic have changed drastically over the short course of modern observation. Kaufman et al. (p. 1236 ) synthesized 2000 years of proxy data from lakes above 60° N latitude with complementary ice core and tree ring records, to create a paleoclimate reconstruction for the Arctic with a 10-year resolution. A gradual cooling trend at the start of the record had reversed by the beginning of the 20th century, when temperatures began to increase rapidly. The long-term cooling of the Arctic is consistent with a reduction in summer solar insolation caused by changes in Earth's orbit, while the rapid and large warming of the past century is consistent with the human-caused warming.

Public participation in a disaster debris removal process is an important component to any large-scale rebuilding effort. How, then, does such an effort progress when nearly two-thirds of the affected community’s population does not come back to participate? The City of New Orleans faced just such a situation after Hurricane Katrina and the catastrophic flooding that followed. The debris removal task is the largest in US history, and very few residents returned to participate in the cleanup. This article provides a further understanding of the impact that New Orleans’ missing population had on the city’s cleanup process. This article asserts that without this city’s residents (or first filters), the enormous debris removal effort in New Orleans was further slowed and complicated. The first two sections provide background and context, identifying the size and scope of the disaster, the low residential return rate, and the role of public participation in previous large-scale debris removal efforts. The next three sections focus on the disaster debris itself, identifying specific ways in which the missing population further complicated New Orleans’ cleanup efforts with regard to (a) the duration of the debris removal process, (b) the volume of debris, and (c) the contamination of debris.The final section considers various measures that emergency planners and managers can take to facilitate “participatory repopulation,” thus mitigating the complications of a missing population.

The inspiratory flow volume curve is included in the spirometric tracing provided by most pulmonary function laboratories and is useful in assessing upper airway abnormalities. We analyzed the changes in peak inspiratory flow (PIF), forced inspiratory flow at 50% (FIF50), and forced inspiratory vital capacity (FIVC) that occur with bronchodilator challenge testing (3 puffs of a β-agonist by metered-dose inhaler without a spacer device) in 145 consecutive patients. Fifty-five patients responded to bronchodilators with either a 12% or 200-mL change in FEV 1 or FVC. All of these subjects produced forced expiratory maneuvers that fulfilled American Thoracic Society criteria or acceptability. The FIVC was the only inspiratory parameter that consistently showed a similar correlation to the bronchodilator responsiveness demonstrated by the FEV 1 or FVC. With the reduction in air trapping, a 12% or 200-mL change in the FIVC is additional confirmatory evidence of bronchodilator responsiveness.

The development of the iridium-based Shell 405 catalyst for spontaneous decomposition of hydrazine was one of the key enabling technologies for today's spacecraft and launch vehicles. To ensure that this crucial technology was not lost when Shell elected to exit the business, Aerojet, supported by NASA, has developed a dedicated catalyst production facility that will supply catalyst for future spacecraft and launch vehicle requirements. We have undertaken a program to transfer catalyst production from Shell Chemical USA (Houston, TX) to Aerojet's Redmond, WA location. This technology transition was aided by Aerojet's 30 years of catalyst manufacturing experience and NASA diligence and support in sustaining essential technologies. The facility has produced and tested S-405 catalyst to existing Shell 405 specifications and standards. Our presentation will describe the technology transition effort including development of the manufacturing facility, capture of the manufacturing process, test equipment validation, initial batch build and final testing.

Interest rates have reacted strongly to the monthly employment report in recent years. The authors document the reaction of rates to the report and provide evidence that it has been stronger since the mid-1980s than in earlier years. Evidently the report now has greater impact than formerly on expectations of where the Fed is going to move the federal funds rate. These expectations influence longer-term money market rates.

An examination of the relationship between yield and maturity in the money market. The expectations theory suggests that the yield curve should be a good predictor of future spot interest rates. A substantial body of research in recent years has tested this implication of the theory and discussed possible reasons for the lack of support for the theory from these tests. This paper provides a review of this literature.

It is worth remembering, when we feel dispirited over the housing provision we can offer to the excluded today, just what it was like forty years ago ‐ and how important it is to keep the focus on practical service.

At the present time the vagrant alcoholic in this country is subject to repeated arrest and short-term imprisonment for drunkenness and allied offences. It is not difficult to find men who have had more than 100 short prison sentences. Unfor tunately, there seem to be few facilities for attempting more constructive rehabilitation. Rathcoole House was established in an attempt to show that there can be a more humane yet effective way of dealing with the Skid Row problem. There were two sources of financial help. Firstly, a grant provided by the Carnegie Trust, and, secondly, the grant paid by the Home Office for people living in aftercare hostels. The hostel is situated in the densely populated South London suburb of Clapham. In January 1966, when Rathcoole was first rented from the Greater London Council for the purpose of setting up a hostel, it was a derelict eight-roomed Victorian private house scheduled for demolition. Four months later the house had been decorated and fully furnished, mainly by the efforts of various voluntary organiza tions. The warden then took up residence and no difficulty was experienced in finding the full complement of vagrant alcoholics. The house thus began to function fully during the summer of 1966 under the general guidance of a management committee which included social workers, probation officers, and psychiatrists.

On October 6, 1979 the Federal Reserve, in an effort to improve monetary control, changed its operating procedures to give greater emphasis to managing the growth of bank reserves. Some movements in the federal funds rate under the new procedures were an automatic response to deviations of the money stock from its short-run target. Most, however, resulted from judgmental actions by the Federal Reserve.