Assessment of quality indicators among nurse practitioners performing upper endoscopy.

Background and study aims Limited international data have shown that non-physicians can safely perform upper endoscopy, but no such study has been performed in the United States. Our aim was to assess the quality of outpatient upper endoscopies performed by nurse practitioners (NPs).Patients and methods Retrospective chart review of upper endoscopies performed by 3 NPs between 2010 and 2013 was performed. Comparisons among all NPs performing upper endoscopy and assessment of individual NP performance over time with respect to quality indicators were performed.Results Three NPs performed 333 upper endoscopies (distribution of 166, 44, and 123, respectively). Of the cases, 98.2 %s were successfully completed to the second portion of the duodenum. In most cases, photo-documentation of required anatomical landmarks was performed: GE junction (84.2 %), GE junction in retroflexed view (84.2 %), antrum (82.1 %) and duodenum (80.9 %). Photo-documentation improved with increasing experience. NPs appropriately performed biopsies for specific medical conditions: 10/11 (90.9 %) gastric ulcers were biopsied and 63/66 (95.5) of patients with iron deficiency had duodenal biopsies performed for celiac disease. A physician endoscopist was required during the procedure 22.5 % of the time. Important parameters such as documenting informed consent (100 %) and documenting a discharge plan (99.4 %) in the procedure reports were overwhelming present. There was a single adverse event during the study period.Conclusion In the first US study of NPs performing upper endoscopy, they were able to perform high-quality and safe upper endoscopies. These findings support incorporation of non-physicians alongside physicians to help meet the growing demand for endoscopic services across the United States

The Rapid Imaging Planetary Spectrograph

The Rapid Imaging Planetary Spectrograph (RIPS) was designed as a long-slit high-resolution spectrograph for the specific application of studying atmospheres of spatially extended solar system bodies. With heritage in terrestrial airglow instruments, RIPS uses an echelle grating and order-sorting filters to obtain optical spectra at resolving powers up to R~127,000. An ultra-narrowband image from the reflective slit jaws is captured concurrently with each spectrum on the same EMCCD detector. The "rapid" portion of RIPS' moniker stems from its ability to capture high frame rate data streams, which enables the established technique known as "lucky imaging" to be extended to spatially resolved spectroscopy. Resonantly scattered emission lines of alkali metals, in particular, are sufficiently bright to be measured in short integration times. RIPS has mapped the distributions of Na and K emissions in Mercury's tenuous exosphere, which exhibit dynamic behavior coupled to the planet's plasma and meteoroid environment. An important application is daylight observations of Mercury at solar telescopes since synoptic context on the exosphere's distribution comprises valuable ground-based support for the upcoming BepiColombo orbital mission. As a conventional long slit spectrograph, RIPS has targeted the Moon's surface-bound exosphere where structure in linewidth and brightness as a function of tangent altitude are observed. At the Galilean moons, RIPS can study the plasma interaction with Io and place new constraints on the sputtered atmosphere of Europa, which in turn provides insight into the salinity of Europa's subsurface ocean. The instrumental design and construction are described herein, and these astronomical observations are presented to illustrate RIPS' performance as a visiting instrument at three different telescope facilities.Comment: Accepted for publication by Publications of the Astronomical Society of the Pacific (07-2023

Characterization of a Double Mesospheric Bore Over Europe

Observations of a pair of mesospheric bore disturbances that propagated through the nighttime mesosphere over Europe are presented. The observations were made at the Padua Observatory, Asiago (45.9\ub0N, 11.5\ub0E), by the Boston University all-sky imager on 11 March 2013. The bores appeared over the northwest horizon, approximately 30 min apart, and propagated toward the southeast. Using additional satellite and radar data, we present evidence indicating the bores originated in the mesosphere from a single, larger-scale mesospheric disturbance propagating through the mesopause region. Furthermore, the large-scale mesospheric disturbance appeared to be associated with an intense weather disturbance that moved southeastward over the United Kingdom and western Europe during 10 and 11 March

Imaging space weather over Europe

[1] We describe the introduction of the first all-sky imaging system for low-light-level optical observations of the disturbed ionosphere over mid-latitude Europe. Using 6300 angstrom auroral emissions that come from the 200-400 km altitude range, we demonstrate that sub-visual optical patterns spanning the European continent can be obtained from a single site in Italy. Pilot observations during the 26-27 September 2011 geomagnetic storm show that the diffuse aurora's low latitude boundary can be used to find where the poleward wall of the ionospheric trough is located. This relates directly to regions of radiowave disruptions caused by the precipitation of energetic particles from the magnetospheric plasma sheet that move to lower latitudes during space weather events. Images of stable auroral red (SAR) arcs can be used to track the magnetospheric ring current and plasmapause location, a second region of radiowave interference. Comparisons with ground-based and satellite observations of the ionosphere during the same storm demonstrate how ASI images reveal the lowest energy components of magnetospheric input to the ionosphere-thermosphere system. Such observations can be used, potentially, for both now-casting of storm effects spanning Europe, and for retrospective validation of existing models of space weather impacts at sub-auroral locations. Citation: Baumgardner, J., et al. (2013), Imaging space weather over Europe, Space Weather, 11, 69-78, doi:10.1002/swe.20027

Long-term evolution of the coupled boundary layers (STRATUS) mooring recovery and deployment cruise report NOAA Research Vessel R H Brown • cruise RB-01-08 9 October - 25 October 2001

This report documents the work done on cruise RB-01-08 of the NOAA R/V Ron Brown. This was Leg 2 of R/V Ron Brown’s participation in Eastern Pacific Investigation of Climate (EPIC) 2001, a study of air-sea interaction, the atmosphere, and the upper ocean in the eastern tropical Pacific. The science party included groups from the Woods Hole Oceanographic Institution (WHOI), NOAA Environmental Technology Laboratory (ETL), the University of Washington (UW), the University of California, Santa Barbara (UCSB), and the University Nacional Autonoma de Mexico (UNAM). The work done by these groups is summarized in this report. In addition, the routine underway data collected while aboard R/V Ron Brown is also summarized here.Funding was provided by the National Oceanic and Atmospheric Administration under Grant Numbers NA96GPO429 and NA17RJ1223

Long‐term observations and physical processes in the Moon's extended sodium tail

The lunar surface is constantly bombarded by the solar wind, photons, and meteoroids, which can liberate Na atoms from the regolith. These atoms are subsequently accelerated by solar photon pressure to form a long comet-like tail opposite the sun. Near new moon, these atoms encounter the Earth's gravity and are “focused” into a beam of enhanced density. This beam appears as the ∼3° diameter Sodium Moon Spot (SMS). Data from the all sky imager at the El Leoncito Observatory have been analyzed for changes in the SMS shape and brightness. New geometry-based relationships have been found that affect the SMS brightness. The SMS is brighter when the Moon is north of the ecliptic at new moon; the SMS is brighter when new moon occurs near perigee; and the SMS peaks in brightness ∼5 h after new moon. After removing these effects, the data were analyzed for long term and seasonal patterns that could be attributed to changes in source mechanisms. No correlation was found between the SMS brightness and the 11-year solar-cycle, the proton or the He++ flow pressure, the density, the speed or the plasma temperature of the solar wind, but an annual pattern was found. A ∼0.83 correlation (Pearson's “r”) was found between the SMS brightness and a 4-year average of sporadic meteor rates at Earth, suggesting a cause-and-effect. The new insights gained from this long-term study put new constraints on the variability of the potential sources of the Na atoms escaping from the Moon.Accepted manuscrip

Imaging the Sources and Full Extent of the Sodium Tail of the Planet Mercury

Observations of sodium emission from Mercury can be used to describe the spatial and temporal patterns of sources and sinks in the planet s surface-boundary-exosphere. We report on new data sets that provide the highest spatial resolution of source regions at polar latitudes, as well as the extraordinary length of a tail of escaping Na atoms. The tail s extent of approx.1.5 degrees (nearly 1400 Mercury radii) is driven by radiation pressure effects upon Na atoms sputtered from the surface in the previous approx.5 hours. Wide-angle filtered-imaging instruments are thus capable of studying the time history of sputtering processes of sodium and other species at Mercury from ground-based observatories in concert with upcoming satellite missions to the planet. Plasma tails produced by photo-ionization of Na and other gases in Mercury s neutral tails may be observable by in-situ instruments