Transport and retention of sinking microplastics in a well-mixed estuary.

Estuaries have been shown to be potential hotspots of microplastic accumulation, but the hydrodynamic conditions and particle properties that control this process need further investigation. We have designed a series of numerical particle-tracking experiments to examine the sensitivity of retention in estuaries to particle size, particle density and varying tides and freshwater flow. At the end of the simulation, over 90 % of sinking particles are retained in the estuary, and the retention rate is further increased by high river runoff. In contrast, increased river discharge increases the number of marginally-buoyant (i.e. density close to estuarine water) particles that escape the estuary. Larger particle size tends to limit the downstream transport of sinking particles but can facilitate the transport of marginally-buoyant particles. Tidal asymmetry, vertical turbulent mixing and the vertical structure of the subtidal circulation are proposed as the underlying mechanisms controlling the fate of particles.

Feasibility of Addressing the Spiritual Well-Being of Persons With Multiple Sclerosis: A Mixed-Methods Program Evaluation.

IMPORTANCE: Spiritual well-being is an important aspect of health-related quality of life for persons with chronic illnesses such as multiple sclerosis (MS), yet research on interventions remains limited. OBJECTIVE: To assess the feasibility of an occupational therapy intervention addressing the spiritual well-being of people with MS. DESIGN: Mixed-methods program evaluation using theoretical thematic analysis of qualitative data. SETTING: Community center serving people with MS in a midwestern U.S. city. PARTICIPANTS: A total of 42 participants attended at least one session; 22 participants provided qualitative data. Ten met the inclusion criteria for quantitative analysis, including completion of pretest and posttest measures and attendance of at least half of the sessions. INTERVENTION: Making Meaning, a group intervention based on the Model of Occupational Wholeness, was conducted over eight weekly 45-min sessions. The focus was on exploring and integrating spiritual practices into daily life. OUTCOMES AND MEASURES: Participants completed the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being 12-Item Scale (FACIT-Sp-12) to measure spiritual well-being and answered open-ended questions. Attendance was recorded and the facilitator and observers provided qualitative observations. RESULTS: Pretest-posttest comparisons of FACIT-Sp-12 scores indicated a moderate improvement in spiritual well-being (d = 0.41). Attendance and qualitative data supported the intervention's feasibility and suggested areas for refinement. CONCLUSIONS AND RELEVANCE: Making Meaning is a feasible intervention, showing promise for promoting spiritual well-being for people with MS. Further research is warranted. Plain-Language Summary: This study introduces a practical and acceptable occupational therapy group intervention, Making Meaning, which shows promising potential for improving the spiritual well-being of people with multiple sclerosis.

Cystic fibrosis screening, evaluation, and management of hepatobiliary disease consensus recommendations.

Cystic fibrosis (CF) may cause a spectrum of hepatobiliary complications, including portal hypertension, multilobular cirrhosis, and liver failure. Current guidelines on the detection and monitoring of hepatobiliary complications in CF were published in 1999. The CF Foundation assembled a committee to evaluate research advances and formulate revised guidelines for CF-associated liver disease. A committee of hepatologists, gastroenterologists, pulmonologists, pharmacists, nurses, dietitians, individuals with CF, and the parents of a child with CF devised "population, intervention, comparison, and outcome" questions regarding hepatobiliary disease in CF. PubMed literature searches were performed for each population, intervention, comparison, and outcome question. Recommendations were voted on with 80% agreement required to approve a recommendation. Public comment on initial recommendations was solicited prior to the formulation of final recommendations. Thirty-one population, intervention, comparison, and outcome questions were assembled, 6401 manuscripts were title screened for relevance, with 1053 manuscripts undergoing detailed full-text review. Seven recommendations were approved for screening, 13 for monitoring of existing disease, and 14 for treatment of CF-associated hepatobiliary involvement or advanced liver disease. One recommendation on liver biopsy did not meet the 80% threshold. One recommendation on screening ultrasound was revised and re-voted on. Through a multidisciplinary committee and public engagement, we have assembled updated recommendations and guidance on screening, monitoring, and treatment of CF-associated hepatobiliary involvement and advanced liver disease. While research gaps remain, we anticipate that these recommendations will lead to improvements in CF outcomes through earlier detection and increased evidence-based approaches to monitoring and treatment.

Retention of buoyant plastic in a well-mixed estuary due to tides, river discharge and winds.

Estuaries can act as plastic retention hotspots, but the hydrodynamic controls on retention are not well understood. This study investigates the retention of river-sourced buoyant plastics in a well-mixed estuary, the Waitemata Estuary, using validated numerical simulations of floats with different tides, winds, and freshwater discharge. The proportion of floats grounded on the shore in all seven simulations is higher than 60 % and over 90 % in five simulations after ten days. <20 % of the floats leave the estuarine mouth in any of the simulations. An increase of two orders of magnitude in freshwater discharge doubles the likelihood for floats to reach the lower estuary. However, we find increased freshwater discharge doubles the lateral circulation towards the shore and results in similar proportions of grounding (90 %) as the low discharge cases. These findings challenge the conventional view that plastics preferentially enter the open ocean after high river discharge.

Tides regulate the flow and density of Antarctic Bottom Water from the western Ross Sea.

Antarctic Bottom Water (AABW) stores heat and gases over decades to centuries after contact with the atmosphere during formation on the Antarctic shelf and subsequent flow into the global deep ocean. Dense water from the western Ross Sea, a primary source of AABW, shows changes in water properties and volume over the last few decades. Here we show, using multiple years of moored observations, that the density and speed of the outflow are consistent with a release from the Drygalski Trough controlled by the density in Terra Nova Bay (the "accelerator") and the tidal mixing (the "brake"). We suggest tides create two peaks in density and flow each year at the equinoxes and could cause changes of ~ 30% in the flow and density over the 18.6-year lunar nodal tide. Based on our dynamic model, we find tides can explain much of the decadal variability in the outflow with longer-term changes likely driven by the density in Terra Nova Bay.

Microplastic pollution in the intertidal and subtidal sediments of Vava'u, Tonga.

Plastic pollution research on a global scale intensified considerably in the current decade; however, research efforts in the South Pacific are still lagging. Here, we report on microplastic contamination of intertidal and subtidal sediments in the Vava'u archipelago, Tonga. While providing the first baseline data of its type in Tonga, the study also advances methods and adjusts them for low-budget research. The methods were based on density separation of microplastics from the sediment using CaCl2, a high-density salt which due to its high solubility, low cost and availability. Once separated, microplastics were quantified by microscopic analysis and polymers characterized via FTIR spectroscopy. Microplastics in intertidal and subtidal sediments were found in concentrations of 23.5 ± 1.9 and 15.0 ± 1.9 particles L-1 of sediment, respectively. The dominant type of microplastics in both intertidal (85 %) and subtidal sediments (62 %) were fibres.

Microplastic pollution in the surface waters of Vava'u, Tonga.

Marine plastic pollution, particularly microplastics, has been recognised as a global issue in the recent years, but research efforts in the Pacific are lagging. We carried out research on microplastics contamination of surface waters of the Vava'u archipelago, Tonga. Since microplastics smaller than the standard mesh size (333-335 µm) are readily reported in the literature on microplastics, we used a finer plankton net (100 µm) to determine the proportion of captured microplastics smaller than 300 µm. Isolated microplastics were counted and measured using stereomicroscope with polymer identification performed by FTIR spectroscopy. The analysis revealed high microplastics concentrations (329,299.7 ± 40,994.2 pcs km-2 or 1.05 ± 0.13 pcs m-3). The proportion of particles smaller than 300 µm was 40 %. The predominant type of microplastics in surface waters were small bits of white film, which we associated with cement-filled white bags used to construct docks throughout Vava'u, often heavily eroded.

Retention and dispersion of buoyant plastic debris in a well-mixed estuary from drifter observations.

Buoyant plastics enter estuaries largely from urban streams and an unknown fraction is retained before further transport to the open ocean. Plastic drifters were launched in a well-mixed estuary to simulate the movement of surface buoyant plastics. Two experiments were conducted, one during spring tides and one during neap tides, both with similar river flows and winds. Stronger tidal currents during spring tides resulted in larger dispersion and further downstream transport of the drifters. Half of the drifters were grounded within two tidal cycles. During the neap experiment, even more of the drifters (87%) were retained in the estuary. The grounding of such a high proportion of drifters suggests that much of the plastic pollution in estuaries of this type remains close to the riverine source. These findings imply that local clean-up programs removing grounded litter can reduce over half of the plastic pollution input to these estuaries.

Britain's forgotten military medical school at Fort Pitt, Kent (1860-1863).

This article considers the history of Fort Pitt (1780-1922), its military hospital (founded 1814) and, in particular, its Army Medical School (1860-63). The museum and library were the work of the hospital's first directors: Dr David MacLoughlin and Sir James McGrigor, the latter the renowned reformer of military medical education. Central to the foundation of the medical school was Florence Nightingale who visited the site in 1856. The school opened in 1860 with five sets of students attending before it was transferred in 1863 to the Royal Victoria hospital, Netley, Hampshire. Fort Pitt was a "practical" medical school with students attending for 4-9 months of clinical experience. This included "instruction in tropical medicine" delivered by members of the Indian Medical Service. The foundation of a military medical school fulfilled an ambition dating back to at least 1796. Nightingale's role (exerted through Sidney Herbert) was omitted from contemporary newspaper reports. Fort Pitt continued as a military hospital until 1922 when it was converted to a school. The medical school constitutes a landmark in British military medicine, a response to the failure of British medical care in the Crimean war (1853-1856) and a forgotten legacy of Florence Nightingale.

The role of tides in bottom water export from the western Ross Sea.

Approximately 25% of Antarctic Bottom Water has its origin as dense water exiting the western Ross Sea, but little is known about what controls the release of dense water plumes from the Drygalski Trough. We deployed two moorings on the slope to investigate the water properties of the bottom water exiting the region at Cape Adare. Salinity of the bottom water has increased in 2018 from the previous measurements in 2008-2010, consistent with the observed salinity increase in the Ross Sea. We find High Salinity Shelf Water from the Drygalski Trough contributes to two pulses of dense water at Cape Adare. The timing and magnitude of the pulses is largely explained by an inverse relationship with the tidal velocity in the Ross Sea. We suggest that the diurnal and low frequency tides in the western Ross Sea may control the magnitude and timing of the dense water outflow.

Successful Use of Quality Improvement Methodology to Reduce Inpatient Length of Stay in Bronchiolitis Through Judicious Use of Intermittent Pulse Oximetry.

BACKGROUND AND OBJECTIVES: The American Academy of Pediatrics 2014 bronchiolitis guidelines recommend against the routine use of continuous pulse oximetry (CPO) because it has been implicated in prolonging the length of stay (LOS). At our institution, infants admitted with bronchiolitis were monitored by using CPO during the entire hospital stay and intermittent desaturations <90% appeared to delay discharge. This quality improvement initiative was designed to reduce the LOS by decreasing the use of CPO in stable infants with nonsevere bronchiolitis. METHODS: The quality improvement project was implemented on the inpatient units of 2 community hospitals during the 2016 and 2017 bronchiolitis seasons. In cycle 1 (January 2016 to April 2016), the bronchiolitis pathway from the associated quaternary children's hospital was used to (1) limit the use of CPO to patients with severe bronchiolitis and those at high risk for apnea or severe disease, (2) discontinue CPO as patients improved and stabilized, and (3) standardize discharge criteria. In cycle 2 (November 2016 to April 2017), the clinical pathway was adopted. The main outcome measure was LOS, measured from the time of the admission order to the time of the discharge order. Process measures included compliance with the interventions. RESULTS: The project included 373 patients, 180 preintervention and 193 postintervention. The average LOS decreased by 20 hours, from 53 hours at baseline to 33 hours in cycle 2. No adverse events were noted, and there was no significant change in the number of emergency department revisits and readmissions within 7 days. CONCLUSIONS: In our study, LOS was successfully reduced in bronchiolitis patients by using a clinical pathway that limited CPO to patients with severe bronchiolitis and those at risk for severe disease or apnea.

Double trouble in the South Pacific subtropical gyre: Increased plastic ingestion by fish in the oceanic accumulation zone.

Fish are an important food source for South Pacific (SP) island countries, yet there is little information on contamination of commercial marine fish species by plastic. The aim of our study was to perform a broad-scale assessment of plastic ingestion by fish common in the diet of SP inhabitants. We examined 932 specimens from 34 commercial fish species across four SP locations, and some of the prey they ingested, for the presence of marine plastics. Plastic was found in 33 species, with an average ingestion rate (IR) of 24.3 ±â€¯1.4% and plastic load of 2.4 ±â€¯0.2 particles per fish. Rapa Nui fish exhibited the greatest IR (50.0%), significantly greater than in other three locations. Rapa Nui is located within the SP subtropical gyre, where the concentration of marine plastics is high and food is limited. Plastic was also found in prey, which confirms the trophic transfer of microplastics.

Half a century of coastal temperature records reveal complex warming trends in western boundary currents.

Accelerated warming of western boundary currents due to the strengthening of subtropical gyres has had cascading effects on coastal ecosystems and is widely expected to result in further tropicalization of temperate regions. Predicting how species and ecosystems will respond requires a better understanding of the variability in ocean warming in complex boundary current regions. Using three ≥50 year temperature records we demonstrate high variability in the magnitude and seasonality of warming in the Southwest Pacific boundary current region. The greatest rate of warming was evident off eastern Tasmania (0.20 °C decade-1), followed by southern New Zealand (0.10 °C decade-1), while there was no evidence of annual warming in northeastern New Zealand. This regional variability in coastal warming was also evident in the satellite record and is consistent with expected changes in regional-scale circulation resulting from increased wind stress curl in the South Pacific subtropical gyre. Warming trends over the satellite era (1982-2016) were considerably greater than the longer-term trends, highlighting the importance of long-term temperature records in understanding climate change in coastal regions. Our findings demonstrate the spatial and temporal complexity of warming patterns in boundary current regions and challenge widespread expectations of tropicalization in temperate regions under future climate change.

Chaotic stirring by a mesoscale surface-ocean flow.

The horizontal stirring properties of the flow in a region of the East Australian Current are calculated. A surface velocity field derived from remotely sensed data, using the maximum cross correlation method, is integrated to derive the distribution of the finite-time Lyapunov exponents. For the region studied (between latitudes 36 degrees S and 41 degrees S and longitudes 150 degrees E and 156 degrees E) the mean Lyapunov exponent during 1997 is estimated to be lambda( infinity )=4x10(-7) s(-1). This is in close agreement with the few other measurements of stirring rates in the surface ocean which are available. Recent theoretical results on the multifractal spectra of advected reactive tracers are applied to an analysis of a sea-surface temperature image of the study region. The spatial pattern seen in the image compares well with the pattern seen in an advected tracer with a first-order response to changes in surface forcing. The response timescale is estimated to be 20 days. (c) 2002 American Institute of Physics.