Changes in the Gulf Stream preceded rapid warming of the Northwest Atlantic Shelf

The Northwest Atlantic Shelf provides ecological and economic benefits along the heavily populated North American coastline and beyond. In 2009-2010, abrupt warming prompted an ecosystem shift with consequences for fisheries, yet the cause of this event is unclear. Here we use satellite altimetry and in situ measurements to show that, in 2008, the Gulf Stream migrated closer to the Tail of the Grand Banks, a shift that has persisted ever since. This change reduced the westward connectivity of the Labrador Current that otherwise supplies cold, fresh, oxygen-rich waters to the shelf. Within one year after the appearance of anomalously warm and saline water at the Tail of Grand Banks, subsurface warming progressed south-westwards. Historical observations suggest a similar sequence of events may have occurred in the 1970s. Therefore, monitoring water properties at the Tail of Grand Banks may offer predictability for shelf properties and ecosystem perturbations with substantial lead time

Decreased Nursing Staffing Adversely Affects Emergency Department Throughput Metrics

Introduction: The effect of nurse staffing on emergency department (ED) efficiency remains a significant area of interest to administrators, physicians, and nurses. We believe that decreased nursing staffing adversely affects key ED throughput metrics. Methods: We conducted a retrospective observational review of our electronic medical record database from 1/1/2015 to 12/31/2015 at a high-volume, urban public hospital. We report nursing hours, door-to-discharge length of stay (LOS) and door-to-admit LOS, and percentage of patients who left without being seen (LWBS). ED nursing hours per day was examined across quartiles with the effect evaluated using analysis of covariance and controlled for total daily ED volume, hospital occupancy and ED admission rate. Results: From 1/1/15–12/31/15, 105,887 patients presented to the ED with a range of 336 to 580 nursing hours per day with a median of 464.7. Independent of daily ED volume, hospital occupancy and ED admission rate, days in the lowest quartile of nursing hours experienced a 28.2-minute increase per patient in door-to-discharge LOS compared to days in the highest quartile of nursing hours. Door-to-admit LOS showed no significant change across quartiles. There was also an increase of nine patients per day who left without being seen by a provider in the lowest quartile of nursing hours compared to the highest quartile. Conclusion: Lower nursing hours contribute to a statistically significant increase in door-to-discharge LOS and number of LWBS patients, independent of daily ED volume, hospital occupancy and ED admission rate. Consideration of the impact of nursing staffing is needed to optimize throughput metrics for our urban, safety-net hospital