Quantifying the relative importance of riverine and open-ocean nitrogen sources for hypoxia formation in the northern Gulf of Mexico

The Mississippi and Atchafalaya River System discharges large amounts of freshwater and nutrients into the northern Gulf of Mexico (NGoM). These lead to increased stratification and elevate primary production in the outflow region. Consequently, hypoxia (oxygen <62.5 mmol/m3), extending over an area of roughly 15,000 km2, forms every summer in bottom waters. High‐resolution models have significantly improved our understanding of the processes controlling hypoxia formation in the NGoM and have strongly implicated riverine nutrients as the dominant nutrient source. However, the relative importance of different nutrient sources (i.e., the Mississippi and Atchafalaya Rivers and offshore) has not been assessed before now. Here, we combine a high‐resolution model with an element tracing method to directly quantify the relative contributions of nitrogen from the two rivers and the open ocean to primary production and sediment oxygen consumption, which is the main oxygen sink contributing to hypoxia in the NGoM. Our results indicate that, averaged over 2001–2011, Mississippi and Atchafalaya nitrogen support 51 ± 9% and 33 ± 9% of summer sediment oxygen consumption, respectively, while open‐ocean nitrogen supports 16 ± 2%. The higher relative impact of Mississippi inputs results from longer transit times compared to those of Atchafalaya inputs. We also analyze the effect of riverine nitrogen load reductions and a larger diversion of discharge to the Atchafalaya River. These scenario simulations show that nutrient load reductions are most effective in mitigating hypoxia

Understanding the scale and nature of outcome change in area-regeneration programmes: evidence from the New Deal for Communities Programme in England

The New Deal for Communities (NDC) Programme is one of the most intensive area-based initiatives (ABIs) launched in England. Between 1998 and 2010, 39 NDC Partnerships were charged with improving conditions in relation to six outcomes within deprived neighbourhoods, each accommodating around 9,800 people. Data point to only modest change, much of which reflected improving attitudes towards the area and the environment. There are problems in identifying positive people-based outcomes because relatively few individuals benefit from relevant initiatives. Few positive benefits leak out of NDC areas. Transformational change was always unlikely bearing in mind the limited nature of additional resources, and because only a minority of individuals directly engage with NDC projects. This evidence supports perspectives of ABIs rooted in 'local-managerialism'

Physical restraint in residential child care : the experiences of young people and residential workers

There have long been concerns about the use of physical restraint in residential care. This paper presents the findings of a qualitative study which explores the experiences of children, young people and residential workers about physical restraint. The research identifies the dilemmas and ambiguities for both staff and young people, and participants discuss the situations where they feel physical restraint is appropriate as well as their concerns about unjustified or painful restraints. They describe the negative emotions involved in restraint but also those situations where, through positive relationships and trust, restraint can help young people through unsafe situations

Ticagrelor vs. clopidogrel in patients with acute coronary syndromes and diabetes: a substudy from the PLATelet inhibition and patient Outcomes (PLATO) trial

Patients with diabetes mellitus (DM) have high platelet reactivity and are at increased risk of ischaemic events and bleeding post-acute coronary syndromes (ACS). In the PLATelet inhibition and patient Outcomes (PLATO) trial, ticagrelor reduced the primary composite endpoint of cardiovascular death, myocardial infarction, or stroke, but with similar rates of major bleeding compared with clopidogrel. We aimed to investigate the outcome with ticagrelor vs. clopidogrel in patients with DM or poor glycaemic control. We analysed patients with pre-existing DM (n = 4662), including 1036 patients on insulin, those without DM (n = 13 951), and subgroups based on admission levels of haemoglobin A1c (HbA1c; n = 15 150). In patients with DM, the reduction in the primary composite endpoint (HR: 0.88, 95% CI: 0.76-1.03), all-cause mortality (HR: 0.82, 95% CI: 0.66-1.01), and stent thrombosis (HR: 0.65, 95% CI: 0.36-1.17) with no increase in major bleeding (HR: 0.95, 95% CI: 0.81-1.12) with ticagrelor was consistent with the overall cohort and without significant diabetes status-by-treatment interactions. There was no heterogeneity between patients with or without ongoing insulin treatment. Ticagrelor reduced the primary endpoint, all-cause mortality, and stent thrombosis in patients with HbA1c above the median (HR: 0.80, 95% CI: 0.70-0.91; HR: 0.78, 95% CI: 0.65-0.93; and HR: 0.62, 95% CI: 0.39-1.00, respectively) with similar bleeding rates (HR: 0.98, 95% CI: 0.86-1.12). Ticagrelor, when compared with clopidogrel, reduced ischaemic events in ACS patients irrespective of diabetic status and glycaemic control, without an increase in major bleeding events

Cheyne-Stokes respiration in patients hospitalised for heart failure

BACKGROUND: Previous studies showing a strong relationship between Cheyne-Stokes respiration and the severity of left ventricular systolic dysfunction have usually been done in selected patient populations with lower age and a higher proportion of males than the "typical" in-hospital patient with heart failure. The purpose of the present study was test the strength of this relationship in unselected patients admitted to hospital due to decompensated chronic heart failure. METHODS: We evaluated 191 patients (32% women), mean age 73 years, ready for discharge from the heart failure unit in the University Hospital of Malmö, Sweden. The patients underwent echocardiography for determination of left ventricular ejection fraction and left ventricular inner diastolic diameter. A respiratory investigation during sleep was performed the last night before discharge. RESULTS: We found that 66% of the patients had Cheyne-Stokes respiration more than 10% of the total recording time. Only 7 (3.6%) of the patients had predominantly obstructive apnoeas. There was a significant but very weak relationship between left ventricular ejection fraction and left ventricular inner diastolic diameter on one hand and Cheyne-Stokes respiration on the other. Age was a stronger determinant of Cheyne-Stokes respiration than any of the cardiac or other clinical variables. CONCLUSION: Although presence of Cheyne-Stokes respiration indicates left ventricular dysfunction, its severity seems only weakly related to the severity of heart failure. Age was found to be a stronger determinant, which may reflect the underlying age-dependency found also in healthy subjects. Due to age restrictions or other selection criteria, the importance of age may have been underestimated in many previous studies on factors associated with Cheyne-Stokes respiration

A Global Hypothesis for Women in Journalism and Mass Communications: The Ratio of Recurrent and Reinforced Residuum

This paper examines the status of women in communications industries and on university faculties. It specifically tests the Ratio of Recurrent and Reinforced Residuum or R3 hypothesis, as developed by Rush in the early 1980s [Rush, Buck & Ogan,1982]. The R3 hypothesis predicts that the percentage of women in the communications industries and on university faculties will follow the ratio residing around 1/4:3/4 or 1/3:2/3 proportion females to males. This paper presents data from a nationwide U.S. survey and compares them to data from global surveys and United Nations reports. The evidence is overwhelming and shows the relevance and validity of the R3 hypothesis across different socio-economic and cultural contexts. The paper argues that the ratio is the outcome of systemic discrimination that operates at multiple levels. The obstacles to achieving equality in the academy as well as media industries are discussed and suggestions for breaking out of the R3 ratio are included.

A Global Hypothesis for Women in Journalism and Mass Communications: The Ratio of Recurrent and Reinforced Residuum

This paper examines the status of women in communications industries and on university faculties. It specifically tests the Ratio of Recurrent and Reinforced Residuum or R3 hypothesis, as developed by Rush in the early 1980s [Rush, Buck & Ogan,1982]. The R3 hypothesis predicts that the percentage of women in the communications industries and on university faculties will follow the ratio residing around 1/4:3/4 or 1/3:2/3 proportion females to males. This paper presents data from a nationwide U.S. survey and compares them to data from global surveys and United Nations reports. The evidence is overwhelming and shows the relevance and validity of the R3 hypothesis across different socio-economic and cultural contexts. The paper argues that the ratio is the outcome of systemic discrimination that operates at multiple levels. The obstacles to achieving equality in the academy as well as media industries are discussed and suggestions for breaking out of the R3 ratio are included.