An ecosystem modeling approach to predicting cod recruitment

Abstract The NORWECOM ocean model system implemented with the ROMS ocean circulation model has been run to simulate conditions over the last 25 years for the North Atlantic. Modelled time series of volume fluxes, primary production and drift of cod larvae through their modelled ambient temperature have been analysed in conjunction with observational based VPA estimated time series of 3-year old cod recruits in the Barents Sea. Individual time series account for less than 50% of the recruitment variability, however a combination of simulated inflow of Atlantic water and primary production accounts for 70% of the variability with a 3-year lead. The prediction indicates an increased recruitment from 2007 to 2008 from about 450 to 700 million individuals with a standard error of near 150 million. Keywords Ecosystem modelling, volume and larval transport, primary production, cod recruitment and prediction, Barents Se

The Impact of Inpatient Boarding on ED Efficiency: A Discrete-Event Simulation Study

In this study, a discrete-event simulation approach was used to model Emergency Department’s (ED) patient flow to investigate the effect of inpatient boarding on the ED efficiency in terms of the National Emergency Department Crowding Scale (NEDOCS) score and the rate of patients who leave without being seen (LWBS). The decision variable in this model was the boarder-released-ratio defined as the ratio of admitted patients whose boarding time is zero to all admitted patients. Our analysis shows that the Overcrowded+ (a NEDOCS score over 100) ratio decreased from 88.4% to 50.4%, and the rate of LWBS patients decreased from 10.8% to 8.4% when the boarder-released-ratio changed from 0% to 100%. These results show that inpatient boarding significantly impacts both the NEDOCS score and the rate of LWBS patient and this analysis provides a quantification of the impact of boarding on emergency department patient crowding

The 2017 reversal of the Beaufort Gyre: Can dynamic thickening of a seasonal ice cover during a reversal limit summer ice melt in the Beaufort Sea?

During winter 2017 the semi‐permanent Beaufort High collapsed and the anticyclonic Beaufort Gyre reversed. The reversal drove eastward ice motion through the Western Arctic, causing sea ice to converge against Banks Island, and halted the circulation of multiyear sea ice via the gyre, preventing its replenishment in the Beaufort Sea. Prior to the reversal, an anomalously thin seasonal ice cover had formed in the Beaufort following ice‐free conditions during September 2016. With the onset of the reversal in January 2017, convergence drove uncharacteristic dynamic thickening during winter. By the end of March, despite seasonal ice comprising 97% of the ice cover, the reversal created the thickest, roughest and most voluminous regional ice cover of the CryoSat‐2 record. Within the Beaufort Sea, previous work has shown that winter ice export can precondition the region for increased summer ice melt, but that a short reversal during April 2013 contributed to a reduction in summer ice loss. Hence the deformed ice cover at the end of winter 2017 could be expected to limit summer melt. In spite of this, the Beaufort ice cover fell to its fourth lowest September area as the gyre re‐established during April and divergent ice drift broke up the pack, negating the reversal's earlier preconditioning. Our work highlights that dynamic winter thickening of a regional sea ice cover, for instance during a gyre reversal, offers the potential to limit summer ice loss, but that dynamic forcing during spring dictates whether this conditioning carries through to the melt season

Smittepress fra lakselus på vill laksefisk – estimert fra luselarvefelt med stor variabilitet

publishedVersio

Emergency Department Escalation in Theory and Practice: A Mixed-Methods Study Using a Model of Organizational Resilience

Study objective Escalation policies are used by emergency departments (EDs) when responding to an increase in demand (eg, a sudden inflow of patients) or a reduction in capacity (eg, a lack of beds to admit patients). The policies aim to maintain the ability to deliver patient care, without compromising safety, by modifying “normal” processes. The study objective is to examine escalation policies in theory and practice. Methods This was a mixed-method study involving a conceptual analysis of National Health Service escalation policies (n=12) and associated escalation actions (n=92), as well as a detailed ethnographic study of escalation in situ during a 16-month period in a large UK ED (n=30 observations). Results The conceptual analysis of National Health Service escalation policies found that their use requires the ability to dynamically reconfigure resources (staff and equipment), change work flow, and relocate patients. In practice, it was discovered that when the ED is under pressure, these prerequisites cannot always be attained. Instead, escalation processes were adapted to manage pressures informally. This adaptive need (“work as done”) was found to be incompletely specified in policies (“work as imagined”). Conclusion Formal escalation actions and their implementation in practice differed and varied in their effectiveness. Monitoring how escalation works in practice is essential in understanding whether and how escalation policies help to manage workload

Parents' Experiences of Receiving the Initial Positive Newborn Screening (NBS) Result for Cystic Fibrosis and Sickle Cell Disease

The clinical advantages of the newborn screening programme (NBS) in the UK are well described in the literature. However, there has been little exploration of the psychosocial impact on the family. This study followed the principles of grounded theory to explore parents' experiences of receiving the initial positive NBS result for their child with cystic fibrosis (CF) or sickle cell disease (SCD). Semi-structured, qualitative interviews were conducted with 22 parents (12 mothers and 10 fathers) whose children had been diagnosed with CF or SCD via NBS and were under the age of 1 year at the time of interview. The main themes that arose from the data were; parents previous knowledge of the condition and the NBS programme, the method of delivery and parental reactions to the result, sharing the results with others, the impact on parental relationships and support strategies. Study conclusions indicate that most parents thought initial positive NBS results should be delivered by a health professional with condition specific knowledge, preferably with both parents present. Genetic counselling needs to include a focus on the impact of NBS results on parental relationships. Careful consideration needs to be given to strategies to support parents of babies who have positive NBS results both in terms of the psychological health and to assist them in sharing the diagnosis