Multidisciplinary guidance for safe tracheostomy care during the COVID-19 pandemic: the NHS National Patient Safety Improvement Programme (NatPatSIP).

The COVID-19 pandemic is causing a significant increase in the number of patients requiring relatively prolonged invasive mechanical ventilation and an associated surge in patients who need a tracheostomy to facilitate weaning from respiratory support. In parallel, there has been a global increase in guidance from professional bodies representing staff who care for patients with tracheostomies at different points in their acute hospital journey, rehabilitation and recovery. Of concern are the risks to healthcare staff of infection arising from tracheostomy insertion and caring for patients with a tracheostomy. Hospitals are also facing extraordinary demands on critical care services such that many patients who require a tracheostomy will be managed outside established intensive care or head and neck units and cared for by staff with little tracheostomy experience. These concerns led NHS England and NHS Improvement to expedite the National Patient Safety Improvement Programme's 'Safe Tracheostomy Care' workstream as part of the NHS COVID-19 response. Supporting this workstream, UK stakeholder organisations involved in tracheostomy care were invited to develop consensus guidance based on: expert opinion; the best available published literature; and existing multidisciplinary guidelines. Topics with direct relevance for frontline staff were identified. This consensus guidance includes: infectivity of patients with respect to tracheostomy indications and timing; aerosol-generating procedures and risks to staff; insertion procedures; and management following tracheostomy.

Climate research priorities for policy-makers, practitioners, and scientists in Georgia, USA.

Climate change has far-reaching effects on human and ecological systems, requiring collaboration across sectors and disciplines to determine effective responses. To inform regional responses to climate change, decision-makers need credible and relevant information representing a wide swath of knowledge and perspectives. The southeastern U. S. State of Georgia is a valuable focal area for study because it contains multiple ecological zones that vary greatly in land use and economic activities, and it is vulnerable to diverse climate change impacts. We identified 40 important research questions that, if answered, could lay the groundwork for effective, science-based climate action in Georgia. Top research priorities were identified through a broad solicitation of candidate research questions (180 were received). A group of experts across sectors and disciplines gathered for a workshop to categorize, prioritize, and filter the candidate questions, identify missing topics, and rewrite questions. Participants then collectively chose the 40 most important questions. This cross-sectoral effort ensured the inclusion of a diversity of topics and questions (e.g., coastal hazards, agricultural production, ecosystem functioning, urban infrastructure, and human health) likely to be important to Georgia policy-makers, practitioners, and scientists. Several cross-cutting themes emerged, including the need for long-term data collection and consideration of at-risk Georgia citizens and communities. Workshop participants defined effective responses as those that take economic cost, environmental impacts, and social justice into consideration. Our research highlights the importance of collaborators across disciplines and sectors, and discussing challenges and opportunities that will require transdisciplinary solutions.

High-accuracy measurement of the blackbody radiation frequency shift of the ground-state hyperfine transition in 133Cs.

We report a high-accuracy direct measurement of the blackbody radiation shift of the 133Cs ground-state hyperfine transition. This frequency shift is one of the largest systematic frequency biases encountered in realizing the current definition of the International System of Units (SI) second. Uncertainty in the blackbody radiation frequency shift correction has led to its being the focus of intense theoretical effort by a variety of research groups. Our experimental measurement of the shift used three primary frequency standards operating at different temperatures. We achieved an uncertainty a factor of five smaller than the previous best direct measurement. These results tend to validate the claimed accuracy of the recently calculated values.

Precision atomic spectroscopy for improved limits on variation of the fine structure constant and local position invariance.

We report tests of local position invariance and the variation of fundamental constants from measurements of the frequency ratio of the 282-nm 199Hg+ optical clock transition to the ground state hyperfine splitting in 133Cs. Analysis of the frequency ratio of the two clocks, extending over 6 yr at NIST, is used to place a limit on its fractional variation of <5.8x10(-6) per change in normalized solar gravitational potential. The same frequency ratio is also used to obtain 20-fold improvement over previous limits on the fractional variation of the fine structure constant of |alpha/alpha|<1.3x10(-16) yr-1, assuming invariance of other fundamental constants. Comparisons of our results with those previously reported for the absolute optical frequency measurements in H and 171Yb+ vs other 133Cs standards yield a coupled constraint of -1.5x10(-15)

Testing local position invariance with four cesium-fountain primary frequency standards and four NIST hydrogen masers.

We report the most sensitive tests to date of the assumption of local position invariance (LPI) underlying general relativity, based on a 7 yr comparison of cesium and hydrogen atomic clocks (frequency standards). The latest results place an upper limit that is over 20 times smaller than the previous most sensitive tests; this is consistent with the null shift predicted by LPI. The result is based on precise comparisons of frequencies of four hydrogen masers maintained by NIST, with four independent Cs fountain clocks--one at NIST and three in Europe--as the Sun's gravitational potential at Earth's surface varies due to Earth's orbital eccentricity.

Around-the-World Relativistic Sagnac Experiment.

In 1971 Hafele and Keating carried portable atomic clocks east and then west around the world and verified the Sagnac effect, a special relativity effect attributable to the earth's rotation. In the study reported here observations of the effect were made by using electromagnetic signals instead of portable clocks to make clock comparisons. Global Positioning System satellites transmit signals that can be viewed simultaneously from remote stations on the earth; thus an around-the-world Sagnac experiment can be performed with electromagnetic signals. The effect is larger than that occurring when portable clocks are used. The average error over a 3-month experiment was only 5 nanoseconds.