A Sedimentological Record of Early Miocene Ice Advance and Retreat, AND-2A drill hole, McMurdo Sound, Antarctica

The lowest 501 m (∼1139–638 m) of the AND-2A core from southern McMurdo Sound is the most detailed and complete record of early Miocene sediments in Antarctica and indicates substantial variability in Antarctic ice sheet activity during early Miocene time. There are two main pulses of diamictite accumulation recorded in the core, and three significant intervals with almost no coarse clasts. Each diamictite package comprises several sequences consistent with ice advance-retreat episodes. The oldest phase of diamictite deposition, Composite Sequence 1 (CS1), has evidence for grounded ice at the drill site and has been dated around 20.2–20.1 Ma. It likely coincides with cooling associated with isotope event Mi1aa. This is overlain by a diamictite-free, sandstone-dominated interval, CS2 that includes three coarsening-upward deltaic cycles, is inferred to mark substantial warming, and has an inferred age range between 20.1 and 20.05 Ma. Above this is an interval with variable amounts of diamictite (CS3), with indicators of ice grounding, that is inferred to record ice advance relative to CS2, and is overlain by an ∼100-m-thick mud-rich interval (CS4) with no sedimentological evidence for direct glacial influence at the drill site (ca. 19.4–18.7 Ma). A third overlying diamictite-rich interval (CS5) overlies an unconformity spanning 18.7–17.8 Ma (coinciding with isotope event Mi1b), and records a return to more ice-influenced conditions at the drill site in late early Miocene time. The overall picture for the early Miocene (spanning the period 20.2–17.35 Ma) is one of ice advance alternating with periods of ice retreat and hence significant global climate fluctuations after the permanent establishment of the Antarctic ice sheet at the Eocene/Oligocene boundary, and preceding the relative warmth of the middle Miocene climatic optimum (ca. 17.5–14.5 Ma). Sedimentary cyclicity in CS1 and CS2 is consistent with ∼21 k.y. precession but in CS3 the frequency is closer to 100 k.y. (consistent with eccentricity), with a possible change to 20 k.y. precession in CS4. CS5 cyclicity is consistent with obliquity forcing. Provenance data are consistent with local Transantarctic Mountains glacial activity under precessional control in CS1 and more southerly ice-cap build up under 100 k.y. eccentricity and obliquity control during CS3 and CS5, respectively

Expedition 306 summary

The overall aim of the North Atlantic paleoceanography study of Integrated Ocean Drilling Program Expedition 306 is to place late Neogene–Quaternary climate proxies in the North Atlantic into a chronology based on a combination of geomagnetic paleointensity, stable isotope, and detrital layer stratigraphies, and in so doing generate integrated North Atlantic millennial-scale stratigraphies for the last few million years. To reach this aim, complete sedimentary sections were drilled by multiple advanced piston coring directly south of the central Atlantic “ice-rafted debris belt” and on the southern Gardar Drift. In addition to the North Atlantic paleoceanography study, a borehole observatory was successfully installed in a new ~180 m deep hole close to Ocean Drilling Program Site 642, consisting of a circulation obviation retrofit kit to seal the borehole from the overlying ocean, a thermistor string, and a data logger to document and monitor bottom water temperature variations through time

Feasibility and acceptability of an acceptance and commitment therapy intervention for caregivers of adults with Alzheimer’s disease and related dementias

Background: Caregivers of patients with Alzheimer's disease or a related dementia (ADRD) report high levels of distress, including symptoms of anxiety and depression, caregiving burden, and existential suffering; however, those with support and healthy coping strategies have less stress and burden. Acceptance and Commitment Therapy (ACT) aims to foster greater acceptance of internal events while promoting actions aligned with personal values to increase psychological flexibility in the face of challenges. The objective of this single-arm pilot, Telephone Acceptance and Commitment Therapy Intervention for Caregivers (TACTICs), was to evaluate the feasibility, acceptability, and preliminary effects of an ACT intervention on ADRD caregiver anxiety, depressive symptoms, burden, caregiver suffering, and psychological flexibility. Methods: ADRD caregivers ≥21 years of age with a Generalized Anxiety Disorder Scale (GAD-7) score ≥ 10 indicative of moderate or higher symptoms of anxiety were enrolled (N = 15). Participants received a telephone-based ACT intervention delivered by a non-licensed, bachelor's-prepared trained interventionist over 6 weekly 1-h sessions that included engaging experiential exercises and metaphors designed to increase psychological flexibility. The following outcome measures were administered at baseline (T1), immediately post-intervention (T2), 3 months post-intervention (T3), and 6 months post-intervention (T4): anxiety symptoms (GAD-7; primary outcome); secondary outcomes of depressive symptoms (Patient Health Questionnaire-9), burden (Zarit Burden Interview), suffering (The Experience of Suffering measure), psychological flexibility/experiential avoidance (Acceptance and Action Questionnaire-II), and coping skills (Brief COPE). Results: All 15 participants completed the study and 93.3% rated their overall satisfaction with their TACTICs experience as "completely satisfied." At T2, caregivers showed large reduction in anxiety symptoms (SRM 1.42, 95% CI [0.87, 1.97], p < 0.001) that were maintained at T3 and T4. At T4, psychological suffering (SRM 0.99, 95% CI [0.41, 1.56], p = 0.0027) and caregiver burden (SRM 0.79, 95% CI [0.21, 1.37], p = 0.0113) also decreased. Conclusions: Despite a small sample size, the 6-session manualized TACTICs program was effective in reducing anxiety, suggesting that non-clinically trained staff may be able to provide an effective therapeutic intervention by phone to maximize intervention scalability and reach

North Atlantic Paleoceanography: The Last Five Million Years

In the North Atlantic, cold, relatively salty water sinks in the icy Labrador and Greenland seas, forming North Atlantic Deep Water (NADW). This circulates through the global ocean, driving ocean overturning and global heat transport and, thus, impacting global climate. As one of the most climatically sensitive regions on Earth, the North Atlantic has experienced abrupt changes to its ocean-atmosphere-cryosphere system, triggered by fluctuations in meltwater delivery to source areas of NADW formation. For about the past 100 thousand years, these abrupt jumps in climate state have manifested as ‘Dansgaard/Oeschger’ (D/O) oscillations (millennial-scale warm-cold oscillations) and ‘Heinrich’ events in ice and marine sediment cores, respectively [e.g., Dansgaard et al.,1993; Bond and Lotti, 1995]. These Heinrich events are characterized as huge input of ice-rafted debris (IRD) and meltwater pulses, documenting episodes of sudden instability and collapse of the current Greenland ice sheets and the Laurentide ice sheet, the latter of which covered northern North America several times during the Pleistocene Epoch

Impact of Video Laryngoscopy on Advanced Airway Management by Critical Care Transport Paramedics and Nurses Using the CMAC Pocket Monitor

Accurate endotracheal intubation for patients in extremis or at risk of physiologic decompensation is the gold standard for emergency medicine. Field intubation is a complex process and time to intubation, number of attempts, and hypoxia have all been shown to correlate with increases in morbidity and mortality. Expanding laryngoscope technology which incorporates active video, in addition to direct laryngoscopy, offers providers improved and varied tools to employ in management of the advanced airway. Over a nine-year period a helicopter emergency medical services team, comprised of a flight paramedic and flight nurse, intended to intubate 790 patients. Comparative data analysis was performed and demonstrated that the introduction of the CMAC video laryngoscope improved nearly every measure of success in airway management. Overall intubation success increased from 94.9% to 99.0%, first pass success rates increased from 75.4% to 94.9%, combined first and second pass success rates increased from 89.2% to 97.4%, and mean number of intubation attempts decreased from 1.33 to 1.08