Impact of an Advanced Cardiac Life Support Process Improvement Initiative on Leadership Role Comfort

Extracorporeal Cardiopulmonary Resuscitation (ECPR) in the Emergency Department (ED) requires optimized advanced cardiac life support (ACLS). An ACLS leader monitors compressions, orders medications, performs rhythm checks, directs defibrillation, and times events. This role was reassigned from physicians to nurses. Nurse led ACLS may allow physicians to assess ECPR inclusion criteria. There is limited research on ACLS leader role comfort for nurses. We hypothesized an ECPR initiative in the ED would improve personnel comfort in the ACLS leader role. ECPR initiative implementation included didactics and simulation training. A survey was distributed to ED residents, attending physicians, and nurses, and included six Likert-scale items on comfort with the ACLS leader role. Surveys were administered 6 months prior to and 3 months after implementation. There were 91 respondents at baseline and 100 respondents in the follow-up, resulting in a 43% and 48% response rate, respectively. We used Mann-Whitney tests to compare ordinal variables and non-parametric tests to assess the impact of initiative completion and level of experience on a cumulative score for comfort. We observed no significant changes for the six comfort items from the baseline survey regardless of respondent group. In the post-period, nurses (22.6/30) and resident physicians (23.9/30) had significantly lower mean cumulative comfort scores when compared to attending physicians (27.5/30) (p\u3c .001). Experience leading ACLS in the past 12 months was a significant predictor of cumulative comfort score for nurses in the post-period (p = .029), even when completion of ECPR requirements was controlled. While most report comfort acting in the role of ACLS leader there was no significant improvement post-initiative. These findings, combined with the significance of experience leading ACLS on comfort for nurses and resident physicians, suggest continued experiential learning and opportunities for simulation

Risk-Sensitive Resource Defense in a Territorial Reef Fish

As coral reefs are home to dense aggregations of a variety of species, aggressive territoriality is often a critical component of individual behavior. Identification and assessment of the risk posed by intruders is crucial to defending a territory, and fishes on coral reefs have been found to attend to body shape, body size, and coloration when responding to intruders. We examined the extent to which dusky damselfish (Stegastes adustus) discriminate among distinct categories of intruders by measuring the distance at which a fish attacks an intruder and the relative intensity and frequency of those attacks. We found that S. adustus discriminated among perceived threats, attacking conspecifics more intensely and more often than egg-predators and herbivores, and showing a trend of attacking those groups more often than invertebrate-feeders, which do not compete with damselfish for resources. Furthermore, territory holders attacked initial-phase wrasses from a farther distance than terminal-phase wrasses, suggesting that they can discriminate among classes of individuals within a species other than their own. Dusky damselfish thus exhibit the ability to make fine distinctions among intruders in a diverse ecosystem

Atmospheric radiative profiles during EUREC(4)A

The couplings among clouds, convection, and circulation in trade-wind regimes remain a fundamental puzzle that limits our ability to constrain future climate change. Radiative heating plays an important role in these couplings. Here we calculate clear-sky radiative profiles from 2580 in situ soundings (1068 dropsondes and 1512 radiosondes) collected during the field campaign EUREC4A (Elucidating the role of clouds&ndash;circulation coupling in climate). EUREC4A took place in the downstream trades of the western tropical Atlantic in January&ndash;February 2020. We describe the method used to calculate these cloud-free, aerosol-free radiative profiles. We then present preliminary results sampling variability at multiple scales, from the variability across all soundings to groupings by diurnal cycle and mesoscale organization, as well as individual soundings associated with elevated moisture layers. We also perform an uncertainty assessment and find that the errors resulting from uncertainties in observed sounding profiles and ERA5 reanalysis employed as upper and lower boundary conditions are small. The present radiative profile data set can provide important additional details missing from calculations based on passive remote sensing and aid in understanding the interplay of radiative heating with dynamic and thermodynamic variability in the trades. The data set can also be used to investigate the role of low-level radiative cooling gradients in generating shallow circulations. All data are archived and freely available for public access on AERIS (Albright et&nbsp;al.,&nbsp;2020a, https://doi.org/https://doi.org/10.25326/78). </div

Service Learning and Perceived Student Value

Many students graduate from college with no idea about what to do with the knowledge they just spent four years acquiring. However, for years service learning has provided a way for students to apply the knowledge they learn in the classroom to a real-world setting. Students who have participated in service learning activities have an opportunity to enhance both their professional development and civic engagement. Based on our research and experience, problem-solving, teamwork, and self-confidence were key developmental areas perceived to be of value to students who participated in a service learning project

Cloud transition across the daily cycle illuminates model responses of trade cumuli to warming

International audienceThe response of trade-wind clouds to warming has long been a major source of uncertainty for climate change projections. By analyzing a set of climate models, we identify two contrasting types of model behaviors, which are evident both at the daily timescale and under global warming. These opposing behaviors depend on whether models can simulate cloud transitions—between very shallow and deeper cumuli—in response to changes in the convective mass flux. We show that the daily cycle can be used as a laboratory for assessing the physical credibility of trade cumulus responses to warming as simulated by climate models relative to observed cloud variations and processes. Our findings can also help guide future model development using observational benchmarking

Tobacco Use in a National Sample of United States Service Member and Veteran Students

This study explored tobacco use in a national sample of service member and veteran students enrolled in postsecondary institutions with the purpose of informing the development of a tobacco cessation initiative by identifying factors associated with the use of cigarettes, water pipes, cigars and smokeless tobacco. Researchers conducted secondary analysis of data from the fall 2011 National College Health Assessment (NCHA) II, which surveyed 44 postsecondary institutions in the United States (n = 27,774). Three percent of the sample reported United States Armed Services active military or veteran status (n = 706). Of the service member and veteran respondents, 41% reported that they used some form of tobacco within the last 30 days. Tobacco use predicted problematic reactions to stressors and mental health symptoms, and correlated with suicidality in the study sample. Further research is recommended to inform culturally competent programming

Atmospheric radiative profiles during EUREC 4 A

International audienceThe couplings among clouds, convection, and circulation in trade-wind regimes remain a fundamental puzzle that limits our ability to constrain future climate change. Radiative heating plays an important role in these couplings. Here we calculate the clear-sky radiative profiles from 2001 in situ soundings (978 dropsondes and 1023 radiosondes) collected during the EUREC 4 A field campaign, which took place south and east of Barbados in January-February 2020. We describe the method used to calculate these radiative profiles and present preliminary results sampling variability at multiple scales, from the variability across all soundings to groupings by diurnal cycle and mesoscale organization state, as well as individual soundings associated with elevated moisture layers. This clear-sky radiative profiles data set can provide important missing detail to what can be learned from calculations based on passive remote sensing and help in investigating the role of radiation in dynamic and thermodynamic variability in trade-wind regimes. All data are archived and freely available for public access on AERI

Strong cloud-circulation coupling explains weak trade cumulus feedback

International audienceShallow cumulus clouds in the trade-wind regions cool the planet by reflecting solar radiation. The response of trade cumulus clouds to climate change is a key uncertainty in climate projections1-4. Trade cumulus feedbacks in climate models are governed by changes in cloud fraction near cloud base5,6, with high-climate-sensitivity models suggesting a strong decrease in cloud-base cloudiness owing to increased lower-tropospheric mixing5-7. Here we show that new observations from the EUREC4A (Elucidating the role of cloud-circulation coupling in climate) field campaign8,9 refute this mixing-desiccation hypothesis. We find the dynamical increase of cloudiness through mixing to overwhelm the thermodynamic control through humidity. Because mesoscale motions and the entrainment rate contribute equally to variability in mixing but have opposing effects on humidity, mixing does not desiccate clouds. The magnitude, variability and coupling of mixing and cloudiness differ markedly among climate models and with the EUREC4A observations. Models with large trade cumulus feedbacks tend to exaggerate the dependence of cloudiness on relative humidity as opposed to mixing and also exaggerate variability in cloudiness. Our observational analyses render models with large positive feedbacks implausible and both support and explain at the process scale a weak trade cumulus feedback. Our findings thus refute an important line of evidence for a high climate sensitivity10,11

Strong cloud-circulation coupling explains weak trade cumulus feedback

International audienceShallow cumulus clouds in the trade-wind regions cool the planet by reflecting solar radiation. The response of trade cumulus clouds to climate change is a key uncertainty in climate projections1-4. Trade cumulus feedbacks in climate models are governed by changes in cloud fraction near cloud base5,6, with high-climate-sensitivity models suggesting a strong decrease in cloud-base cloudiness owing to increased lower-tropospheric mixing5-7. Here we show that new observations from the EUREC4A (Elucidating the role of cloud-circulation coupling in climate) field campaign8,9 refute this mixing-desiccation hypothesis. We find the dynamical increase of cloudiness through mixing to overwhelm the thermodynamic control through humidity. Because mesoscale motions and the entrainment rate contribute equally to variability in mixing but have opposing effects on humidity, mixing does not desiccate clouds. The magnitude, variability and coupling of mixing and cloudiness differ markedly among climate models and with the EUREC4A observations. Models with large trade cumulus feedbacks tend to exaggerate the dependence of cloudiness on relative humidity as opposed to mixing and also exaggerate variability in cloudiness. Our observational analyses render models with large positive feedbacks implausible and both support and explain at the process scale a weak trade cumulus feedback. Our findings thus refute an important line of evidence for a high climate sensitivity10,11