Total and weak-acid-soluble trace elements in suspended matter from the Duwamish River and Elliott Bay were determined from samples collected in February and September 1980. The results indicate that Mn scavenging in the water column is coincident with enrichments of Cr, Ni, Cu, Zn, and Pb in the suspended matter, suggesting a possible enrichment of these trace elements in a hydrous Mn oxide phase. This process occurs primarily in the sub-surface waters of Elliott Bay. Since mass balance calculations show a net export of Mn out of the bay, this mechanism may be an important means of transporting toxic trace metals from polluted estuaries and embayments to cleaner coastal environments.

Possible evidence for enrichment of trace elements in the hydrous manganese oxide phases of suspended matter from an urbanized embayment

Tides and tidal currents of the inland waters of western Washington

Particle transport in Elliott Bay, a 20 km2 embayment in Puget Sound, Washington, was studied in an integrated program employing shipboard CTD/transmissometer observations, moored sediment traps, and moored transmissometer/current meter observations. Surface and bottom high/turbidity layers are present throughout the bay during both summer and winter seasons. Particles added to the surface layer by river input and phytoplankton production are rapidly advected out of the bay and provide only a minor contribution to the local sedimentation rate. The benthic nepheloid layer is maintained not by local resuspension but by particles advected into Elliott Bay with turbid deep water from the adjoining Main Basin of Puget Sound. A severalfold drop in mean current speed as Main Basin water enters Elliott Bay results in increased particle fallout within the benthic nepheloid layer, a high sedimentation rate, and the embayment functioning as a sink for particles from throughout Puget Sound.

Particle transport processes in a small marine bay

The distributions of dissolved and particulate trace metals in Elliott Bay, Washington were determined in April,1985 during the period of maximum discharge of freshwater for the year The high freshwater discharge generated a thin buoyant plume (

Estuarine transport of trace metals in a buoyant riverine plume

Dissolved trace metals in the surface waters of Puget Sound

Physical transport processes and circulation in Elliott Bay

This review describes the evolution of hiatal hernia repair for the past several decades: From the use of a primary tissue repair only, the subsequent inclusion of synthetic mesh and its complications, to current day indications for mesh use. We will highlight the recent research in biologic and composite meshes as well as the ongoing limitations in studying their efficacy. Finally, we will describe our institutional indications and surgical technique practices in the utilization of biologic mesh.

Mesh Versus No Mesh for Cruroplasty.

Health care accounts for almost 10% of the United States' greenhouse gas emissions, accounting for a loss of 470,000 disability-adjusted life years based on the health effects of climate change. Telemedicine has the potential to decrease health care's carbon footprint by reducing patient travel and clinic-related emissions. At our institution, telemedicine visits for evaluation of benign foregut disease were implemented for patient care during the COVID-19 pandemic. We aimed to estimate the environmental impact of telemedicine usage for these clinic encounters.We used life cycle assessment (LCA) to compare greenhouse gas (GHG) emissions for an in-person and a telemedicine visit. For in-person visits, travel distances to clinic were retrospectively assessed from 2020 visits as a representative sample, and prospective data were gathered on materials and processes related to in-person clinic visits. Prospective data on the length of telemedicine encounters were collected and environmental impact was calculated for equipment and internet usage. Upper and lower bounds scenarios for emissions were generated for each type of visit.For in-person visits, 145 patient travel distances were recorded with a median [IQR] distance travel distance of 29.5 [13.7, 85.1] miles resulting in 38.22-39.61 carbon dioxide equivalents (kgCO2-eq) emitted. For telemedicine visits, the mean (SD) visit time was 40.6 (17.1) min. Telemedicine GHG emissions ranged from 2.26 to 2.99 kgCO2-eq depending on the device used. An in-person visit resulted in 25 times more GHG emissions compared to a telemedicine visit (p < 0.001).Telemedicine has the potential to decrease health care's carbon footprint. Policy changes to facilitate telemedicine use are needed, as well as increased awareness of potential disparities of and barriers to telemedicine use. Moving toward telemedicine preoperative evaluations in appropriate surgical populations is a purposeful step toward actively addressing our role in health care's large carbon footprint. 

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R. L. Sillcox

Papers

Physical transport processes and circulation in Elliott Bay

Mesh Versus No Mesh for Cruroplasty.

The environmental impact of surgical telemedicine: life cycle assessment of virtual vs. in-person preoperative evaluations for benign foregut disease

Telemedicine Use Decreases the Carbon Footprint of the Bariatric Surgery Preoperative Evaluation

Preoperative esophageal testing predicts postoperative reflux status in sleeve gastrectomy patients