Changes in sea surface temperature (SST) during the Paleocene-Eocene Thermal Maximum (PETM) have been estimated primarily from oxygen isotope and Mg/Ca records generated from deep-sea cores. Here we present a record of sea surface temperature change across the Paleocene-Eocene boundary for a nearshore, shallow marine section located on the eastern margin of North America. The SST record, as inferred from TEX 86 data, indicates a minimum of 8 ؇C of warming, with peak temperatures in excess of 33 ؇C. Similar SSTs are estimated from planktonic foraminifer oxygen isotope records, although the excursion is slightly larger. The slight offset in the oxygen isotope record may reflect on seasonally higher runoff and lower salinity.

An abrupt climate warming of 5 to 10 degrees C during the Palaeocene/Eocene boundary thermal maximum (PETM) 55 Myr ago is linked to the catastrophic release of approximately 1,050-2,100 Gt of carbon from sea-floor methane hydrate reservoirs. Although atmospheric methane, and the carbon dioxide derived from its oxidation, probably contributed to PETM warming, neither the magnitude nor the timing of the climate change is consistent with direct greenhouse forcing by the carbon derived from methane hydrate. Here we demonstrate significant differences between marine and terrestrial carbon isotope records spanning the PETM. We use models of key carbon cycle processes to identify the cause of these differences. Our results provide evidence for a previously unrecognized discrete shift in the state of the climate system during the PETM, characterized by large increases in mid-latitude tropospheric humidity and enhanced cycling of carbon through terrestrial ecosystems. A more humid atmosphere helps to explain PETM temperatures, but the ultimate mechanisms underlying the shift remain unknown.

Context: The COVID-19 pandemic has severely affected medical training with social distancing requirements posing a barrier to in-person teaching and face-to-face interaction between medical students, residents, and attendings. It remains unknown whether a virtual learning format can effectively improve medical knowledge and decrease social isolation. In March 2020, the University of Hawaii Family Medicine Residency Program created a residency-wide Virtual Morning Report (VMR) as a regular gathering space to address clinical training and social needs for both learners and educators. Objective: To evaluate whether a VMR improved training and decreased isolation. Study Design: Cross-sectional anonymous online survey. Setting: Community-based family medicine residency program Population: All 21 residents, 5 clinical attendings, and 10 medical students interested in family medicine. Intervention: A VMR held online 3 times weekly with interactive, clinical case-based presentations (30 minutes) by students, residents, and attendings including community physicians. Attendance was voluntary.Main and Secondary Outcome Measures: Self-report of whether VMR improved medical knowledge and well-being.Results: Of the 37 participants (90% response), 87% reported that improving medical knowledge was a moderately or extremely important reason for attending VMR. Most reported that attending VMR improved their medical knowledge moderately or a great deal overall (78%), specifically for generating differential diagnoses (88%) and work-up (88%), and less so for history/exam (47%). With respect to social isolation, 62% reported improving well-being was an extremely or moderately important reason for attending VMR. Effect of VMR participation on social isolation was mixed with many but not all reporting that VMR improved their overall well-being moderately or a great deal (30%) by increasing morale (38%), enjoyment of medicine (54%), connecting with residents (57%), or connecting with faculty (44%).Conclusions: Virtual Morning Reports proved to be an effective clinical training tool to improve medical knowledge when COVID-19 restrictions reduced in-person teaching. While participating in Virtual Morning Reports helped to improve well-being and increase a sense of connection through regular online socialization, more intentional efforts are needed to address the social isolation of students, residents, and attendings due to the COVID-19 pandemic.

Context: Long-acting reversible contraception (LARC) such as implants and IUDs are highly effective birth control methods. Physicians' ability to offer LARCs is important for patient access and LARC training is recommended by the ACGME. At the University of Hawaii Family Medicine Residency Program, we explored residents' interest in LARCs and difficulties experienced with LARC training. Our goal is to design a better curriculum to train family physicians who are competent and confident to insert LARCs in their future practice. Objectives: To evaluate residents' interest in providing LARCs and barriers to LARC training. Study Design: Residents received general contraceptive and LARC training in their continuity clinics, OB/GYN rotations, and electives at Planned Parenthood. Evaluation of their LARC training experience consisted of a cross-sectional online survey conducted in May 2021. Setting: Communitybased family medicine residency program. Population Studied: Family medicine residents. Results: Of the 21 residents (100% response), nearly all considered it "very important" for family medicine training to include general contraceptive counseling (95%) though this was lower for implant (76%) and IUD training (76%). The most common barrier ("moderate" or "significant") to LARC training was lack of time (81%). Most residents reported 30 minute or less was sufficient for general contraceptive counseling (95%) but not for same-day implant (24%) or same-day IUD placement (14%). Other barriers included too few patients requiring LARCs (76%), doing initial contraceptive counseling but follow-up LARC placement done by different clinician (58%), and attending not available (38%). Regarding intentions after training, female versus male residents reported much higher rates of being "very likely" to provide general contraceptive counseling (100% vs 40%), implant (90% vs 30%) and IUDs (90% vs 20%) in their future practice. Conclusions: Most residents considered LARC training to be very important for family physicians but interest in providing LARCs in future practice was significantly higher amongst female versus male residents. Major barriers which need to be addressed with LARC training are that LARC placement takes time (scheduling into a procedure clinic may help), needs required volume (may need specific electives with opportunity to place LARCs), and gender differences with regards to interest in contraceptive counseling after training.