Abstract. The Arctic Mediterranean (AM) is the collective name for the Arctic Ocean, the Nordic Seas, and their adjacent shelf seas. Into this region, water enters through the Bering Strait (Pacific inflow) and through the passages across the Greenland-Scotland Ridge (Atlantic inflow) and then modified within the AM. The modified waters leave the AM in several flow branches, which are grouped into two different categories: (1) overflow of dense water through the deep passages across the Greenland-Scotland Ridge, and (2) outflow of light water – here termed surface outflow – on both sides of Greenland. These exchanges transport heat, salt, and other substances into and out of the AM and are important for conditions in the AM. They are also part of the global ocean circulation and climate system. Attempts to quantify the transports by various methods have been made for many years, but only recently, has the observational coverage become sufficiently complete to allow an integrated assessment of the AM-exchanges based solely on observations. In this study, we focus on the transport of water and have collected data on volume transport for as many AM-exchange branches as possible between 1993–2015. The total AM-import (oceanic inflows plus freshwater) is found to be 9.1 ± 0.7 Sv (1 Sv = 106 m3 s−1) and has a seasonal variation of amplitude close to 1 Sv and maximum import in October. Roughly one third of the imported water leaves the AM as surface outflow with the remaining two thirds leaving as overflow. The overflow is mainly produced from modified Atlantic inflow and around 70 % of the total Atlantic inflow is converted into overflow, indicating a strong coupling between these two exchanges. The surface outflow is fed from the Pacific inflow and freshwater, but is still ~ 2/3rds from modified Atlantic water. For the inflow branches and the two main overflow branches (Denmark Strait and Faroe Bank Channel), systematic monitoring of volume transport has been established since the mid-1990s and this allows us to estimate trends for the AM-exchanges as a whole. At the 95 % level, only the inflow of Pacific water through the Bering Strait showed a statistically significant trend, which was positive. Both the total AM-inflow and the combined transport of the two main overflow branches also showed trends consistent with strengthening, but they were not statistically significant. They do suggest, however, that any significant weakening of these flows during the last two decades is unlikely and the overall message is that the AM-exchanges remained remarkably stable in the period from the mid-1990s to the mid-2010s. The overflows are the densest source water for the deep limb of the North Atlantic part of the Meridional Overturning Circulation (AMOC), and this conclusion argues that the reported weakening of the AMOC was not due to overflow weakening or reduced overturning in the AM. Although the combined data set has made it possible to establish a consistent budget for the AM-exchanges, the observational coverage for some of the branches is limited, which introduces considerable uncertainty. This lack of coverage is especially extreme for the surface outflows through the Denmark Strait, the overflow across the Iceland-Faroe Ridge, and the inflow over the Scottish shelf. We recommend that more effort is put into observing these flows as well as maintaining the monitoring systems established for the other exchange branches.

Mothers with learning disabilities face many challenges during the perinatal period including preparing for and establishing infant feeding. Evidence shows that women with learning disabilities are less likely to breastfeed than other mothers. A scoping review was undertaken using Arksey and O'Malley's methodology to understand what is known about how women with learning disabilities can be supported to make infant feeding decisions, particularly in relation to the use of appropriate and accessible images. An additional aim was to understand what further research is needed to achieve sustainable improvements to policy and practice in this area. A comprehensive search of fourteen electronic databases was undertaken to look for both published and grey literature. Initial searches, after removal of duplicates, resulted in 467 primary research articles plus 22 items of grey literature. Following a systematic process, three published papers and six items of grey literature were identified which met inclusion and exclusion criteria, five of which were resources. Little is known about the acceptability of existing resources, specifically in relation to the use of visual images. A synthesis of the grey literature and a thematic analysis of published literature was conducted and confirmed that women with learning disabilities need tailored support with infant feeding, including accessible resources and that there is a need for more in-depth research in this area.There is a high level of agreement about the importance of using easily read visual images within these resources, but little evaluation of the types of imagery used or their aesthetic histories.

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A disaster is a high-stakes, low-frequency event that health care providers need to be prepared for at a moment's notice. Disaster readiness is an expected essential competency for new graduates and nurses in practice. 1 Throughout the history of disasters, nurses have been involved in each phase of disaster management, including mitigation, preparedness, response, and recovery. 2 The impact of climate change, global terrorism, growing domestic civil unrest, and the emergence of new infectious disease pandemics suggests that the burden of caring for victims of disasters will continue to increase for health care systems. 3 The ability of the United States to appropriately respond to any disaster or public health emergency depends on the knowledge and skills of a national nursing workforce that can mobilize promptly. 4 The COVID-19 pandemic further highlighted the need for coordinated and efficient disaster response.The foundation of an effective disaster response starts in nursing education, making these skills critical components to incorporate into the curriculum. A tabletop simulation training strategy is an interactive, low-stress, no-fault strategy in which students have an assigned role and use their knowledge to solve problems. 5 This strategy provides nursing students with a classroom-based clinical experience that allows them to work through a problem instead of simply hearing and talking about it. Study results have indicated that tabletop exercises designed for senior nursing students provided good knowledge transfer from fundamental nursing courses to novel situations and promoted evidence-based judgments and critical thinking. 6 This finding emphasizes the significance of providing nursing students with realistic experiences that will better prepare them for clinical practice and potential mass casualty incidents after graduation. Conceptual FrameworkKolb's Experiential Learning Theory was the conceptual framework used to support tabletop simulation training as an effective learning strategy in nursing education. The theory consists of a 4-part learning cycle: concrete