BACKGROUD:Lung volume measurements are important for monitoring functional aeration and recruitment and may help guide adjustments in ventilator settings. The expiratory phase of airway pressure release ventilation (APRV) may provide physiologic information about lung volume based on the expiratory flow-time slope, angle, and time to approach a no-flow state (expiratory time [TE]). We hypothesized that expiratory flow would correlate with estimated lung volume (ELV) as measured using a modified nitrogen washout/washin technique in a large-animal lung injury model.METHODS:Eight pigs (35.2 ± 1.0 kg) were mechanically ventilated using an Engström Carescape R860 on the APRV mode. All settings were held constant except the expiratory duration, which was adjusted based on the expiratory flow curve. Abdominal pressure was increased to 15 mm Hg in normal and injured lungs to replicate a combination of pulmonary and extrapulmonary lung injury. ELV was estimated using the Carescape FRC INview tool. The expiratory flow-time slope and TE were measured from the expiratory flow profile.RESULTS:Lung elastance increased with induced lung injury from 29.3 ± 7.3 cm H2O/L to 39.9 ± 15.1cm H2O/L, and chest wall elastance increased with increasing intra-abdominal pressures (IAPs) from 15.3 ± 4.1 cm H2O/L to 25.7 ± 10.0 cm H2O/L in the normal lung and 15.8 ± 6.0 cm H2O/L to 33.0 ± 6.2 cm H2O/L in the injured lung (P = .39). ELV decreased from 1.90 ± 0.83 L in the injured lung to 0.67 ± 0.10 L by increasing IAP to 15 mm Hg. This had a significant correlation with a TE decrease from 2.3 ± 0.8 s to 1.0 ± 0.1 s in the injured group with increasing insufflation pressures (ρ = 0.95) and with the expiratory flow-time slope, which increased from 0.29 ± 0.06 L/s2 to 0.63 ± 0.05 L/s2 (ρ = 0.78).CONCLUSIONS:Changes in ELV over time, and the TE and flow-time slope, could be used to demonstrate evolving lung injury during APRV. Using the slope to infer changes in functional lung volume represents a unique, reproducible, real-time, bedside technique that does not interrupt ventilation and may be used for clinical interpretation.

BACKGROUND:Practice on fasting prior to extubation in critically ill patients is variable. Efficacy of fasting in reducing gastric volume has not been well established. The primary objective of this study was to assess the effect of 4 h of fasting on prevalence of empty stomach using gastric ultrasonography in critically ill subjects who are fasted for extubation. The secondary objectives were to evaluate the change in gastric volumes during 4 h of fasting and to determine factors associated with empty stomach after fasting.METHODS:This was a single-center, prospective, observational study on adult ICU subjects who were enterally fed for at least 6 h continuously and mechanically ventilated. Gastric ultrasound was performed immediately prior to commencement of fasting, after 4 h of fasting, and after nasogastric (NG) aspiration after 4 h of fasting. An empty stomach was defined as a gastric volume ≤ 1.5 mL/kg.RESULTS:Forty subjects were recruited, and 38 (95%) had images suitable for analysis. The prevalence of empty stomach increased after 4 h of fasting (25 [65.8%] vs 31 [81.6%], P = .041) and after 4 h of fasting with NG aspiration (25 [65.8%] vs 34 [89.5%], P = .008). There was a significant difference in median (interquartile range) gastric volume per body weight between before fasting and 4 h after fasting (1.0 [0.5–1.8] mL/kg vs 0.4 [0.2–1.0] mL/kg, P < .001). No patient factors were associated with higher prevalence of empty stomach after 4 h of fasting.CONCLUSIONS:Most mechanically ventilated subjects had empty stomachs prior to fasting for extubation. Fasting for 4 h further increased the prevalence of empty stomach at extubation to > 80%.

BACKGROUND:This study sought to estimate the overall cumulative incidence and odds of Hospital-acquired venous thromboembolism (VTE) among critically ill children with and without exposure to invasive ventilation. In doing so, we also aimed to describe the temporal relationship between invasive ventilation and hospital-acquired VTE development.METHODS:We performed a retrospective cohort study using Virtual Pediatric Systems (VPS) data from 142 North American pediatric ICUs among children < 18 y of age from January 1, 2016–December 31, 2022. After exclusion criteria were applied, cohorts were identified by presence of invasive ventilation exposure. The primary outcome was cumulative incidence of hospital-acquired VTE, defined as limb/neck deep venous thrombosis or pulmonary embolism. Multivariate logistic regression was used to determine whether invasive ventilation was an independent risk factor for hospital-acquired VTE development.RESULTS:Of 691,118 children studied, 86,922 (12.4%) underwent invasive ventilation. The cumulative incidence of hospital-acquired VTE for those who received invasive ventilation was 1.9% and 0.12% for those who did not (P < .001). The median time to hospital-acquired VTE after endotracheal intubation was 6 (interquartile range 3–14) d. In multivariate models, invasive ventilation exposure and duration were each independently associated with development of hospital-acquired VTE (adjusted odds ratio 1.64 [95% CI 1.42–1.86], P < .001; and adjusted odds ratio 1.03 [95% CI 1.02–1.03], P < .001, respectively).CONCLUSIONS:In this multi-center retrospective review from the VPS registry, invasive ventilation exposure and duration were independent risk factors for hospital-acquired VTE among critically ill children. Children undergoing invasive ventilation represent an important target population for risk-stratified thromboprophylaxis trials.

BACKGROUND:Training in mechanical ventilation is a key goal in critical care fellowship education. Web-based simulators offer a cost-effective and readily available alternative to traditional on-site simulators. However, it is unclear how effective they are as teaching tools. In this study, we evaluated the test scores of fellows who underwent mechanical ventilation training by using a web-based simulator compared with fellows who used an on-site simulator during a mechanical ventilation course.METHODS:This was a nonrandomized controlled trial conducted as part of a mechanical ventilation course that involved 70 first-year critical care fellows. The course was identical except for the simulation technology used. One group of instructors used a traditional on-site simulator, the ASL 5000 Lung Solution (n = 39). The second group was instructed in using a web-based simulator, VentSim (n = 31). Each fellow completed a pre-course test and a post-course test by using a validated, case-based ventilator waveform examination that consisted of 5 questions with a total possible score of 100. The primary outcome was a comparison of the mean scores on the posttest between the 2 groups. The study was designed as a non-inferiority trial with a predetermined margin of 10 points.RESULTS:There was no significant difference in the mean ± SD pretest scores between the web-based and the on-site groups (21.1 ± 12.6 and 26.9 ± 13.6 respectively; P = .11). The mean ± SD posttest scores were 45.6 ± 25.0 for the web-based simulator and 43.4 ± 16.5 for on-site simulator (mean difference 2.2; one-sided 95% CI –7.0 to ∞; Pnon-inferiority = .02 [non-inferiority confirmed]). Changes in mean ± SD scores (posttest – pretest) were 25.9 ± 20.9 for the web-based simulator and 16.5 ± 15.9 for the on-site simulator (mean difference 9.4, one-sided 95% CI 0.9 to ∞; Pnon-inferiority < .001 [non-inferiority confirmed]).CONCLUSIONS:In the education of first-year critical care fellows on mechanical ventilation waveform analysis, a web-based mechanical ventilation simulator was non-inferior to a traditional on-site mechanical ventilation simulator.

Purpose Low-income children experience disproportionately high rates of dental caries and challenges in accessing dental care compared to their higher-income peers. The purpose of this scoping review was to examine the prevalence of dental caries and dental service utilization among Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) enrolled children.Methods The literature search and review were conducted between September 2023 and February 2024. The review followed the PRISMA-ScR reporting guidelines and included three databases: PubMed, CINAHL, and Dentistry & Oral Sciences Source. The study focused on children aged one to five participating in WIC within the United States (US) and aimed to determine the prevalence of dental service utilization and dental caries in the targeted population.Results This review includes twelve articles that are quantitative observational studies conducted from February 2001 to February 2023. Most of the studies were conducted in WIC programs in the Southern and Midwest regions of the US. Dental caries rates decreased by 61.8% from 2004 to 2016, with the highest prevalence in 2004, and the lowest prevalence in 2016. Dental service utilization among WIC children increased by 56.9% from 1992 to 2020.Conclusion There has been an increase in dental service utilization among WIC-enrolled children, with an overall decrease in dental caries over the last two decades. However, the prevalence of dental caries remains disproportionately high for children enrolled in WIC when compared to non-participants. To develop effective dental interventions for children enrolled in WIC, it is fundamental to identify the unique determinants of dental caries in this population.

Introduction

Exacerbation of COPD complicated by respiratory acidaemia is the commonest indication for noninvasive ventilation (NIV). The NIV outcomes (NIVO) score offers the best estimate of survival for those ventilated. Unfortunately, two-thirds of cases of COPD are unrecognised, and patients may present without COPD having been confirmed by spirometry.

Non-invasive ventilation (NIV) is the mainstay to treat patients who need augmentation of ventilation for acute and chronic forms of respiratory failure. The last several decades have witnessed an extension of the indications for NIV to a variety of acute and chronic lung diseases. Evolving advancements in technology and personalised approaches to patient care make it feasible to prioritise patient-centred care models that deliver home-based management using telemonitoring and telemedicine systems support. These trends may improve patient outcomes, reduce healthcare costs and improve the quality of life for patients who suffer from chronic diseases that precipitate respiratory failure.

ABSTRACTWe document the effort over the last 30 years to respond to the call by women advocates at the International Conference on Population and Development for more woman-initiated single or dual-purpose contraceptive methods by developing the Caya contoured diaphragm, an innovative diaphragm designed to meet the needs of women and their partners and expand options for nonhormonal barrier contraception. We describe the complex and interrelated set of activities undertaken to develop the product using a human-centered design process and how we are working to create a corollary sustainable market. This review includes the evidence generated around improved acceptability among couples in low- and middle-income countries and depicts challenges and practical actions on how to dispel misconceptions about diaphragm use. Importantly, we share programmatic lessons learned on increasing universal access to this new sexual and reproductive health technology. Following our new model for increasing access to new and underutilized methods, Caya is now registered and being marketed in nearly 40 countries worldwide.

ABSTRACTToxicological emergencies present a significant health challenge in Nepal. Despite the high burden, the country has inadequate formal toxicology training, medical toxicology expertise, and adequate poison control infrastructure. In recognition of this need, the Nepal Poison Information Center (PIC) was established as a collaborative effort involving local and international partners. Through a comprehensive partnership framework, the Nepal PIC provides 24 hours a day, 7 days a week expert guidance to health care workers, conducts educational webinars, and engages in research. Initial data from the pilot phase indicate successful consultation delivery. Challenges include bureaucratic hurdles and the need for sustainable funding. Despite these challenges, the Nepal PIC demonstrates early feasibility and potential for expansion into a comprehensive toxicology center, contributing to the advancement of clinical toxicology in Nepal. Long-term sustainability relies on governmental support and continued advocacy efforts.

ABSTRACTMore than half of births among Indigenous women in Guatemala are still being attended at home by providers with no formal training. We describe the incorporation of comadronas (traditional midwives) into casas maternas (birthing centers) in the rural highlands of western Guatemala. Although there was initial resistance to the casa, comadronas and clients have become increasingly enthusiastic about them. The casas provide the opportunity for comadronas to continue the cultural traditions of prayers, massages, and other practices that honor the vital spiritual dimension of childbirth close to home in a home-like environment with extended family support while at the same time providing a safer childbirth experience in which complications can be detected by trained personnel at the casa, managed locally, or promptly referred to a higher-level facility. Given the growing acceptance of this innovation in an environment in which geographical, financial, and cultural barriers to deliveries at higher-level facilities lead most women to deliver at home, casas maternas represent a feasible option for reducing the high level of maternal mortality in Guatemala.This article provides an update on the growing utilization of casas and provides new insights into the role of comadronas as birthing team members and enthusiastic promotors of casas maternas as a preferable alternative to home births. Through the end of 2023, these casas maternas had cared for 4,322 women giving birth. No maternal deaths occurred at a casa, but 4 died after referral.The Ministry of Health of Guatemala has recently adopted this approach and has begun to implement it in other rural areas where home births still predominate. This approach deserves consideration as a viable and feasible option for reducing maternal mortality throughout the world where home births are still common, while at the same time providing women with respectful and culturally appropriate care.

BACKGROUND AND PURPOSE:

World Health Organization (WHO) grade 2 and 3 diffuse gliomas account for approximately 5% of primary brain tumors. They are invasive and infiltrative tumors and have considerable morbidity, causing progressive neurologic deterioration. The mean survival time is <10 years from diagnosis. Surgical debulking represents first-line management. The extent of resection is associated with progression-free and overall survival. Radiologic assessment of the extent of resection is challenging. This can be underestimated on early postoperative MRI, meaning that accurate assessment may be achieved only on delayed follow-up imaging. We hypothesized that DWI may help facilitate more reliable estimates of the extent of resection on early postoperative MRI. This study aimed to assess the utility of DWI in early postoperative MRI to evaluate the extent of resection.

We primary care clinicians, scholars, and leaders ascribe value to Barbara Starfield’s core tenets of primary care—the 4 Cs: first contact, comprehensiveness, coordination, and continuity. In today’s era of rapid technological advancements and dwindling resources, what are the implications for face-to-face interactions of patient-clinician relationships? We propose adding a 5th C: "Contiguity." Contiguity—or physical proximity and presence—is a key dimension that not only enables the necessary technical aspects of a physical exam but also authenticates the most human aspects of a relationship and occurs specifically when we are physically vulnerable and responsible for the other before us. This, in turn, may best enable us to bridge difference and nurture trust with our patients. We measure what we value and, thus, naming Contiguity as a core tenet assures that we will not lose sight of this keystone in a patient’s relationship with their personal physician.

The Respiratory Intensive Care Assembly of the European Respiratory Society gathered in Berlin to organise the third Respiratory Failure and Mechanical Ventilation Conference in February 2024. The conference covered key points of acute and chronic respiratory failure in adults. During the 3-day conference ventilatory strategies, patient selection, diagnostic approaches, treatment and health-related quality of life topics were addressed by a panel of international experts. In this article, lectures delivered during the event have been summarised by early career members of the Assembly and take-home messages highlighted.

New research shows that levels of overall and heavy drinking among Americans are still higher than they were in 2018.

WASHINGTON — Secretary of State Rex Tillerson says diplomatic efforts aimed at resolving the North Korean crisis “will continue until the first bomb drops.”

That statement comes despite President Donald Trump’s tweets a couple of weeks ago that his chief envoy was “wasting his time” trying to negotiate with “Little Rocket Man,” a mocking nickname Trump has given the nuclear-armed nation’s leader, Kim Jong Un.

“I think he does want to be clear with Kim Jong Un and that regime in North Korea that he has military preparations ready to go and he has those military options on the table. And we have spent substantial time actually perfecting those,” Tillerson told CNN’s “State of the Union” on Sunday. “But be clear: The president has also made clear to me that he wants this solved diplomatically. He’s not seeking to go to war.”

Recent mixed messaging from the top of the U.S. government has raised concerns about the potential for miscalculation amid the increasingly bellicose exchange of words by Trump and the North Korean leader.

Trump told the U.N. General Assembly last month that if the U.S. is “forced to defend itself or its allies, we will have no choice but to totally destroy North Korea.” Trump also tweeted that Korea’s leadership “won’t be around much longer” if it continued its provocations, a declaration that led the North’s foreign minister to assert that Trump had “declared war on our country.”

Tillerson acknowledged during a recent trip to Beijing that the Trump administration was keeping open direct channels of communications with North Korea and probing the North’s willingness to talk. He provided no elaboration about those channels or the substance of any discussions.

Soon after, Trump took to Twitter, saying he had told “our wonderful Secretary of State, that he is wasting his time trying to negotiate with Little Rocket Man … Save your energy Rex, we’ll do what has to be done!” Trump offered no further explanation, but he said all military options are on the table for dealing with North Korea’s nuclear and missile programs.

Analysts have speculated about whether the president and his top diplomat were playing “good cop, bad cop” with North Korea, and how China might interpret the confusing signals from Washington. Beijing is the North’s main trading partner, and the U.S. is counting on China to enforce U.N. sanctions.

“Rest assured that the Chinese are not confused in any way what the American policy towards North Korea (is) or what our actions and efforts are directed at,” Tillerson said.

Asked if Trump’s tweets undermined Tillerson, the secretary said: “I think what the president is doing is he’s trying to motivate action on a number of people’s part, in particular the regime in North Korea. I think he does want to be clear with Kim Jong Un and that regime in North Korea that he has military preparations ready to go and he has those military options on the table and we have spent substantial time perfecting those.”

He added that Trump “has made it clear to me to continue my diplomatic efforts, which we are, and I’ve told others those diplomatic efforts will continue until the first bomb drops.”

North Korea has launched missiles that potentially can strike the U.S. mainland and recently conducted its largest ever underground nuclear explosion. It has threatened to explode another nuclear bomb above the Pacific.

The post Rex Tillerson says continue diplomacy with North Korea ‘until first bomb drops’ appeared first on PBS NewsHour.

Secretary of State Rex Tillerson speaks at the Center for Strategic and International Studies on Wednesday.

WASHINGTON — Secretary of State Rex Tillerson is condemning reported atrocities committed against Rohingya Muslims in Myanmar, and he says those responsible — perhaps the country’s military — will be held accountable.

Tillerson says accounts of the suffering of the Rohingya are “heartbreaking” — and that if those reports are true, then “someone is going to be held to account for that.”

Tillerson — who’s set to visit South Asia next week — is urging the Myanmar government to improve humanitarian access to the population in western Rakhine state.

Amnesty International has accused Myanmar’s security forces of killing hundreds of men, women and children during a systematic campaign to expel the Rohingya. More than 580,000 refugees have fled to neighboring Bangladesh since late August.

“We really hold the military leadership accountable for what’s happening,” Tillerson said at the Center for Strategic and International Studies, a Washington think tank. “What’s most important to us is that the world can’t just stand idly by and be witness to the atrocities that are being reported in that area.”

He also called Wednesday for the U.S. and India to expand strategic ties. He pointedly criticized China, which he accused of challenging international norms needed for global stability.

He said the world needed the U.S. and India to have a strong partnership. The two nations share goals of security, free navigation, free trade and fighting terrorism in the Indo-Pacific, and serve as “the eastern and western beacons” for an international rules-based order which is increasingly under strain, he said.

Both India and China had benefited from that order, but Tillerson said India had done so while respecting rules and norms, while China had “at times” undermined them. To make his point, he alluded to China’s island building and expansive territorial claims in seas where Beijing has long-running disputes with Southeast Asian neighbors.

“China’s provocative actions in the South China Sea directly challenge the international law and norms that the United States and India both stand for,” Tillerson said in an address at the Center for Strategic and International Studies, a Washington think tank.

He added that the U.S. seeks constructive relations with China but “won’t shrink” from the challenges it poses when it “subverts the sovereignty of neighboring countries, and disadvantages the U.S. and our friends.”

U.S.-India relations have generally prospered in the past decade, in part because of their shared concerns about the rise of China. While President Donald Trump has looked to deepen cooperation with China on addressing the nuclear threat from North Korea, he’s also sought a closer relationship with India, which shares U.S. worries on Islamic extremism.

“In this period of uncertainty and angst, India needs a reliable partner on the world stage. I want to make clear: with our shared values and vision for global stability, peace and prosperity, the United States is that partner,” Tillerson said.

Tillerson said the U.S. wants to help improve India’s military capabilities, and also improve security cooperation among the region’s major democracies, which included Japan and Australia.

Tillerson said the U.S. and India were leading regional efforts on counterterrorism. He called for India’s archrival Pakistan “to take decisive action against terrorist groups based within their own borders that threaten its own people and the broader region.”

The post Tillerson: ‘Heartbreaking’ reports of suffering in Myanmar appeared first on PBS NewsHour.

The Scotch whisky distiller has announced a major change

A Scottish distillery has hailed the opening of a new 'dining destination' amid an expansion push.

Josh tells us another tale of the Mehss Effect. Sam poots. Anna Marie gets snuggles, not struggles. Kelley tells us about the big hole in her heart. And Chris disinfects himself with Atelier Lysol.

The post RPG Cast – Episode 579: “Bad Nugs Are Still Nugs” appeared first on RPGamer.

Kelley watches DVDs like a caveman. Josh chews on all the expensive things. Meanwhile, Chris stands by some barrels.

The post RPG Cast – Episode 609: “Throwing Corpses at the Door Till You Let Me In” appeared first on RPGamer.

Reverb features new works by Es Devlin and Theaster Gates, plus Devon Turnbull's Listening Room.

The post The Vinyl Factory: Reverb exhibition extended until 22 December appeared first on Fact Magazine.

Sony Interactive Entertainment in a new video posted to YouTube revealed the PlayStation 5 Slim Digital Edition has been discounted by $70 and will be available for $379.99. The deal runs until December 24 "while supplies last."

No word yet if the standard PlayStation 5 or the recently released PlayStation 5 Pro will be discounted. The standard PS5 is priced at $499.99 and the PS5 Pro is priced at $699.99.

As of the time of writing, the discount isn't available yet at retailers or through PlayStation Direct.

A life-long and avid gamer, William D'Angelo was first introduced to VGChartz in 2007. After years of supporting the site, he was brought on in 2010 as a junior analyst, working his way up to lead analyst in 2012 and taking over the hardware estimates in 2017. He has expanded his involvement in the gaming community by producing content on his own YouTube channel and Twitch channel. You can contact the author on Twitter @TrunksWD.

Full Article - https://www.vgchartz.com/article/463046/ps5-slim-digital-edition-discounted-to-379-in-the-us-until-december-24/

Remedy's Alan Wake 2 has now "recouped most of its development and marketing expenses", CEO Tero Virtala has announced in a business review for January-September 2024. Speaking as somebody who would quite like there to be more Alan Wake games - or at least, moderately weird and pretty decent blockbuster singleplayer horror games - I am both pleased by this news and a little troubled that Remedy's eldritch forest fable (which came out in October 2023) has yet to break even.

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Early reactions to Call Of Duty: Black Ops 6 multiplayer range from frothing dislike through omnimovement hype to our own Ed Thorn's dead-eyed appraisal that it's "a good one, I think. Not a bad one. If you like Call Of Duty, you will like this. If you don't like Call Of Duty, you will not like this." I feel like we need to emergency-deploy a supply crate of smelling salts, because the sheer OK-ness of Black Ops 6 appears to have tumbled Ed into a stupor.

Perhaps it would be a different story if he'd encountered some of the spawning issues and glitches people are talking about, with players joining games and materialising right into a hail of fire. The players in question include Black Ops 6's developers, who comically note in the latest Black Ops 6 patch notes that "Yes, we saw ourselves in a Killcam before selecting a Loadout too." The latest patch seeks to address this, naturally. As regards the campaign side of things, it also resets your safehouse currency to 5000, if you've had your single player funds stolen (or multiplied) by technical gremlins.

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JUDY WOODRUFF: It’s been almost a month since Hurricane Maria destroyed much of Puerto Rico and killed at least 48 people. The island and its residents are still coming to grips with the scale of the devastation.

William Brangham brings us the latest.

WILLIAM BRANGHAM: Many Puerto Ricans are still in the dark, without electrical power. Hundreds of thousands still have no access to running water, and the rebuilding of the countless damaged homes, roads and facilities is just beginning.

The Associated Press reported yesterday that almost half the sewage treatment plants on the island are still out of service, increasing the risk of contamination and disease.

I’m joined now by David Begnaud. He’s a correspondent from CBS News who’s been doing some very strong reporting there from since when the storm hit, and is just back from his latest trip to the island.

David, welcome to the NewsHour.

I wonder. We saw many of your reports and others of people still three weeks out from the storm who are still drinking from streams and creeks. You heard — I mentioned this AP report about fears of contamination.

Can you just tell us what is going on there? How are people getting water now?

DAVID BEGNAUD, CBS News: Well, let me tell you this.

The governor of Puerto Rico said this morning that he’s aware of those reports and that they’re looking into it. What’s concerning, William, is that three weeks after the storm and at least a week after the allegations first surfaced that people might be trying to drink from toxic wells at what’s known as Superfund sites, the governor of Puerto Rico is still saying, we’re looking into it and telling people to stay out of rivers where sewage may be spilling into the river.

And, he said, we want them to stay away from the coastal areas.

How are people doing? They’re still desperate to get water. No one seems to be able to figure out how to get enough water to every single person on that island who needs it. And as long as people need water, it’s still an emergency phase.

Nearly four weeks later, no one seems to be able to move from the emergency to the recovery.

WILLIAM BRANGHAM: So, people who are — we see them drinking out of these PVC pipes that they have kind of rigged and sort of poked into the side of a creek.

People are just drinking that water straight, without purification, without boiling it; is that right?

DAVID BEGNAUD: Absolutely.

Look, they have got the PVC pipes tapped into the mountains so that it’s coming out of the stream that way. And they literally are — I saw a woman walk up to a potable water tank that the military had brought in, and she had a Clorox bottle.

And I said, “Ma’am, you’re putting drinkable water in a Clorox bottle?”

And she said, “It’s all I have got.”

Now, that was a good scenario. The other scenarios are people right now who are drinking from streams and creeks and rivers who have no water filters, who have nothing, right? They’re just taking this water.

Now, listen, the government got a million water-purifying tablets within the last week. It took almost three weeks to get those. Now there’s a large push to bring in water filters.

I have got to tell you, most of the water filters I’m seeing brought in are coming from the private sector, and civilian samaritans who are getting 1,000 or more from the mainland and flying them over to Puerto Rico and personally hand-delivering them.

WILLIAM BRANGHAM: That’s really incredible.

Medical facilities were another big — just a huge devastation on the island. I know you have been doing a lot of reporting on the USS Comfort.

DAVID BEGNAUD: Yes.

WILLIAM BRANGHAM: This is the huge Naval hospital that is now just offshore Puerto Rico.

But I understand it hasn’t been fully utilized. Can you tell us what your reporting has found there?

DAVID BEGNAUD: The two men running the ship told us that nearly 87 percent of the ship is empty. Sounds alarming, right? They have 200 beds, and 87 percent are empty.

Now, here’s what they said: We stand ready for whatever the government wants to do. We are waiting to be told by the government.

So, I went to the governor, and said exactly what’s happening. And he said: “Look, I’m not satisfied with what the protocol was from the beginning.”

He said, initially, they were prioritizing only the most critically ill patients go to the Comfort. And he said there was a layered process that was complicating things.

So, the governor, Ricardo Rossello, said: “I started to take out some of those layers, and I, said, listen, take people on the ship who may not be critically ill, but need good medical care and can’t get it at the hospital, where the lights are flickering and the A.C. is not running.”

That’s what the governor said.

Within a matter of hours, I got a tweet from a third-year medical student who said: “Let me tell you what a nightmare it has been to reach the Comfort.”

He said: “We have got a pediatric patient who desperately needs to get off this island, either to a hospital on the mainland or to the Comfort.”

And he said: “I went through Google and the local newspaper to find the number. I couldn’t find it.”

Now, here is how things work. Within about 30 minutes of that tweet going out and that medical student’s story being posted, the governor’s spokesperson responded with numbers that should be able to help.

The bottom line here, William, is that asking relentless questions and the good work of journalism is what’s making a difference there. It’s no one person. There’s no heroic work that’s being done by any journalist, other than people who are going back to the same officials and asking some of the same questions, relentlessly seeking the right answer that will make a difference.

WILLIAM BRANGHAM: One of the other pieces of reporting that you did that was very early in the story was this backlog of supplies trapped in container ships on the ports in Puerto Rico.

I understand some of that — some of those supplies are now moving. Can you tell us, are they getting to where they need to be throughout the island?

DAVID BEGNAUD: So, the shipping containers you’re talking about, about 3,000 sitting in the Port of San Juan, have been moved out, not all of them, but a majority of them.

And they were intended for grocery stores around the island. Right? So, those were private companies that had brought in these shipping containers, paid for the supplies, but couldn’t move them because their truck drivers were either at home, because the home had been destroyed, or the road was impassable.

More and more supplies are getting out. But let me tell you, the grocery stores around the island, they have a lot of nonperishables, Pringles, candy, cookies, all on the shelf.

But when you go to the meat section, it’s nearly 75 percent empty at the stores we have been to, the produce section 90 percent empty. And finding bottled water there is almost like playing a game.

WILLIAM BRANGHAM: David Begnaud, CBS News, thank you so much for your reporting. Thanks for your time.

DAVID BEGNAUD: You bet.

The post Puerto Ricans still don’t have reliable drinking water, and fears of contamination are rising appeared first on PBS NewsHour.

Boeing’s Starliner spacecraft had so many problems during its first crewed launch to the International Space Station that NASA officials aren’t sure whether it will be able to bring its crew back home as planned

A simulator for the process of scientific discovery shows that AI models still fall short of human scientists and engineers in coming up with hypotheses and carrying out experiments on their own

Even though that perception is partly the creation of right-wing media, the Democrats surely need to hone their identity.

Meta had huge success last year with its flagship Quest 3 VR headset and it is back with a significantly cheaper 3S device that compromises on visuals but still delivers a great experience

The Federal Emergency Management Agency supervisor who was fired after she told her staff to skip hurricane-damaged homes with Trump signs in their yards says it wasn't an isolated incident and is a "colossal event."

According to a report Tuesday, the league deliberately decided not to impose an immediate fine on San Francisco 49ers defensive end Nick Bosa for wearing a "Make America Great Again" hat during a postgame television interview.

And the Epic Games Achievements system will start to roll out next week.

A single dose of a smallpox vaccine seems to lower the risk of catching mpox by around 60 per cent, and two doses would probably be even better

Politics and pinball do sometimes have a lot in common. Both can produce surprising and unexpected results. Those lights and metal balls that pinball was known for before the digital age sometimes would make you an unexpected winner. Politics may do that for all those who want to revive the Farm Bill. Politics... Continue Reading

Tactile controls are back in vogue. Apple added two new buttons to the iPhone 16, home appliances like stoves and washing machines are returning to knobs, and several car manufacturers are reintroducing buttons and dials to dashboards and steering wheels.

With this “re-buttonization,” as The Wall Street Journal describes it, demand for Rachel Plotnick’s expertise has grown. Plotnick, an associate professor of cinema and media studies at Indiana University in Bloomington, is the leading expert on buttons and how people interact with them. She studies the relationship between technology and society with a focus on everyday or overlooked technologies, and wrote the 2018 book Power Button: A History of Pleasure, Panic, and the Politics of Pushing (The MIT Press). Now, companies are reaching out to her to help improve their tactile controls.

Rachel Plotnick on...

• Researching the history of buttons
• The renaissance of physical controls
• Working with companies on “re-buttoning”

You wrote a book a few years ago about the history of buttons. What inspired that book?

Rachel Plotnick: Around 2009, I noticed there was a lot of discourse in the news about the death of the button. This was a couple years after the first iPhone had come out, and a lot of people were saying that, as touchscreens were becoming more popular, eventually we weren’t going to have any more physical buttons to push. This started to happen across a range of devices like the Microsoft Kinect, and after films like Minority Report had come out in the early 2000s, everyone thought we were moving to this kind of gesture or speech interface. I was fascinated by this idea that an entire interface could die, and that led me down this big wormhole, to try to understand how we came to be a society that pushed buttons everywhere we went.

Rachel Plotnick studies the ways we use everyday technologies and how they shape our relationships with each other and the world.Rachel Plotnick

The more that I looked around, the more that I saw not only were we pressing digital buttons on social media and to order things from Amazon, but also to start our coffee makers and go up and down in elevators and operate our televisions. The pervasiveness of the button as a technology pitted against this idea of buttons disappearing seemed like such an interesting dichotomy to me. And so I wanted to understand an origin story, if I could come up with it, of where buttons came from.

What did you find in your research?

Plotnick: One of the biggest observations I made was that a lot of fears and fantasies around pushing buttons were the same 100 years ago as they are today. I expected to see this society that wildly transformed and used buttons in such a different way, but I saw these persistent anxieties over time about control and who gets to push the button, and also these pleasures around button pushing that we can use for advertising and to make technology simpler. That pendulum swing between fantasy and fear, pleasure and panic, and how those themes persisted over more than a century was what really interested me. I liked seeing the connections between the past and the present.

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We’ve experienced the rise of touchscreens, but now we might be seeing another shift—a renaissance in buttons and physical controls. What’s prompting the trend?

Plotnick: There was this kind of touchscreen mania, where all of a sudden everything became a touchscreen. Your car was a touchscreen, your refrigerator was a touchscreen. Over time, people became somewhat fatigued with that. That’s not to say touchscreens aren’t a really useful interface, I think they are. But on the other hand, people seem to have a hunger for physical buttons, both because you don’t always have to look at them—you can feel your way around for them when you don’t want to directly pay attention to them—but also because they offer a greater range of tactility and feedback.

If you look at gamers playing video games, they want to push a lot of buttons on those controls. And if you look at DJs and digital musicians, they have endless amounts of buttons and joysticks and dials to make music. There seems to be this kind of richness of the tactile experience that’s afforded by pushing buttons. They’re not perfect for every situation, but I think increasingly, we’re realizing the merit that the interface offers.

What else is motivating the re-buttoning of consumer devices?

Plotnick: Maybe screen fatigue. We spend all our days and nights on these devices, scrolling or constantly flipping through pages and videos, and there’s something tiring about that. The button may be a way to almost de-technologize our everyday existence, to a certain extent. That’s not to say buttons don’t work with screens very nicely—they’re often partners. But in a way, it’s taking away the priority of vision as a sense, and recognizing that a screen isn’t always the best way to interact with something.

When I’m driving, it’s actually unsafe for my car to be operated in that way. It’s hard to generalize and say, buttons are always easy and good, and touchscreens are difficult and bad, or vice versa. Buttons tend to offer you a really limited range of possibilities in terms of what you can do. Maybe that simplicity of limiting our field of choices offers more safety in certain situations.

It also seems like there’s an accessibility issue when prioritizing vision in device interfaces, right?

Plotnick: The blind community had to fight for years to make touchscreens more accessible. It’s always been funny to me that we call them touchscreens. We think about them as a touch modality, but a touchscreen prioritizes the visual. Over the last few years, we’re seeing Alexa and Siri and a lot of these other voice-activated systems that are making things a little bit more auditory as a way to deal with that. But the touchscreen is oriented around visuality.

It sounds like, in general, having multiple interface options is the best way to move forward—not that touchscreens are going to become completely passé, just like the button never actually died.

Plotnick: I think that’s accurate. We see paradigm shifts over time with technologies, but for the most part, we often recycle old ideas. It’s striking that if we look at the 1800s, people were sending messages via telegraph about what the future would look like if we all had this dashboard of buttons at our command where we could communicate with anyone and shop for anything. And that’s essentially what our smartphones became. We still have this dashboard menu approach. I think it means carefully considering what the right interface is for each situation.

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Several companies have reached out to you to learn from your expertise. What do they want to know?

Plotnick: I think there is a hunger out there from companies designing buttons or consumer technologies to try to understand the history of how we used to do things, how we might bring that to bear on the present, and what the future looks like with these interfaces. I’ve had a number of interesting discussions with companies, including one that manufactures push-button interfaces. I had a conversation with them about medical devices like CT machines and X-ray machines, trying to imagine the easiest way to push a button in that situation, to save people time and improve the patient encounter.

I’ve also talked to people about what will make someone use a defibrillator or not. Even though it’s really simple to go up to these automatic machines, if you see someone going into cardiac arrest in a mall or out on the street, a lot of people are terrified to actually push the button that would get this machine started. We had a really fascinating discussion about why someone wouldn’t push a button, and what would it take to get them to feel okay about doing that.

In all of these cases, these are design questions, but they’re also social and cultural questions. I like the idea that people who are in the humanities studying these things from a long-term perspective can also speak to engineers trying to build these devices.

So these companies also want to know about the history of buttons?

Plotnick: I’ve had some fascinating conversations around history. We all want to learn what mistakes not to make and what worked well in the past. There’s often this narrative of progress, that things are only getting better with technology over time. But if we look at these lessons, I think we can see that sometimes things were simpler or better in a past moment, and sometimes they were harder. Often with new technologies, we think we’re completely reinventing the wheel. But maybe these concepts existed a long time ago, and we haven’t paid attention to that. There’s a lot to be learned from the past.

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Amazon is reportedly developing smart glasses for its delivery drivers, according to sources who spoke to Reuters. These glasses are intended to cut “seconds” from each delivery because, well, productivity or whatever. Sources say that they are an extension of the pre-existing Echo Frames smart glasses and are known by the internal code Amelia.

These seconds will be shaved off in a couple of ways. First of all, the glasses reportedly include an embedded display to guide delivery drivers around and within buildings. They will allegedly also provide drivers with “turn-by-turn navigation” instructions while driving. Finally, wearing AR glasses means that drivers won’t have to carry a handheld GPS device. You know what that means. They’ll be able to carry more packages at once. It’s a real mitzvah.

I’m being snarky, and for good reason, but there could be some actual benefit here. I’ve been a delivery driver before and often the biggest time-sink is wandering around labyrinthine building complexes like a lost puppy. I wouldn’t have minded a device that told me where the elevator was. However, I would not have liked being forced to wear cumbersome AR glasses to make that happen.

To that end, the sources tell Reuters that this project is not an absolute certainty. The glasses could be shelved if they don’t live up to the initial promise or if they’re too expensive to manufacture. Even if things go smoothly, it’ll likely be years before Amazon drivers are mandated to wear the glasses. The company is reportedly having trouble integrating a battery that can last a full eight-hour shift and settling on a design that doesn’t cause fatigue during use. There’s also the matter of collecting all of that building and neighborhood data, which is no small feat.

Amazon told Reuters that it is “continuously innovating to create an even safer and better delivery experience for drivers” but refused to comment on the existence of these AR glasses. "We otherwise don’t comment on our product roadmap,” a spokesperson said.

The Echo Frames have turned out to be a pretty big misfire for Amazon. The same report indicates that the company has sold only 10,000 units since the third-gen glasses came out last year.

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