Simultaneous gradient-echo/spin-echo EPI of graded ischemia in human skeletal muscle

The goal of this study was to evaluate the usefulness of blood oxygenation level-dependent (BOLD) methodologies to provide temporal and spatial information about skeletal muscle perfusion. A simultaneous gradient echo (GE) and spin-echo (SE) imaging sequence (GE/SE) with alternating TE was used to acquire images of leg skeletal muscle throughout a stepped reactive hyperemia paradigm. The change in both the GE and SE relaxation rates (ΔR2*, ΔR2) measured during ischemia and reactive hyperemia scaled with the duration of cuff inflation (the ischemic period) plateaued for cuff inflations lasting longer than 120 seconds and were greater in soleus muscle than in gastrocnemius. The ratio ΔR2*/ΔR2 was found to be less during the reactive hyperemia period relative to ischemia. Considering that a greater proportion of capillary vessels are perfused during reactive hyperemia than during ischemia, this finding suggests that magnetic susceptibility methodologies, with their dependence on compartment size, may provide a measure of the relative distribution of small and large vessels in skeletal muscle.     

The global potential for increased storage of carbon on land

Constraining the climate crisis requires urgent action to reduce anthropogenic emissions while simultaneously removing carbon dioxide from the atmosphere. Improved information about the maximum magnitude and spatial distribution of opportunities for additional land-based removals of CO₂ is needed to guide on-the-ground decision-making about where to implement climate change mitigation strategies. Here, we present a globally consistent spatial dataset (approximately 500-m resolution) of current, potential, and unrealized potential carbon storage in woody plant biomass and soil organic matter. We also provide a framework for prioritizing actions related to the restoration, management, and maintenance of woody carbon stocks and associated soils. By comparing current to potential carbon storage, while excluding areas critical to food production and human habitation, we find 287 petagrams (PgC) of unrealized potential storage opportunity, of which 78% (224 PgC) is in biomass and 22% (63 PgC) is in soil. Improved management of existing forests may offer nearly three-fourths (206 PgC) of the total unrealized potential, with the majority (71%) concentrated in tropical ecosystems. However, climate change is a source of considerable uncertainty. While additional research is needed to understand the impact of natural disturbances and biophysical feedbacks, we project that the potential for additional carbon storage in woody biomass will increase (+17%) by 2050 despite projected decreases (−12%) in the tropics. Our results establish an absolute reference point and conceptual framework for national and jurisdictional prioritization of locations and actions to increase land-based carbon storage.

Emissions of carbon to the atmosphere must remain below ∼250 petagrams (PgC) (918 PgCO₂) from 2021 onward to achieve the Paris Agreement’s goal of limiting global temperature rise to well below 2 °C (1–3). At present rates, that amount of carbon will be emitted by 2045. It follows that even necessary and drastic cuts in emissions (i.e., a rapid transition from fossil fuels to renewable energy sources) must be accompanied by carbon dioxide removal (CDR) or negative emissions strategies (4). Promising options for large-scale CDR include improved land stewardship (5), commonly referred to as natural climate solutions (NCS) (6–8). In particular, increasing carbon storage in woody biomass (e.g., forest ecosystems) is widely recognized as having high climate mitigation potential while also affording an array of environmental and socio-economic cobenefits (6–9). While a growing body of research has estimated the near-term potential for land-based climate mitigation (6, 8, 10), these studies emphasize the climate benefit over short, 10- to 30-y planning horizons. They do not include estimates of the upper limit for additional land-based carbon storage or its spatial distribution. This information is essential for landscape-level planning and targeted implementation of NCS, given that the potential for additional carbon storage is necessarily defined by both the rate at which carbon can be sequestered and the magnitude of the available reservoir. Therefore, we provide 500-m-resolution global maps to quantify the maximum potential for additional carbon storage in ecosystems dominated by woody vegetation (i.e., trees and shrubs), under baseline (1960 to 1990) and future (representative concentration pathway scenario 8.5 [RCP8.5]) climate conditions. This information can be used to help direct NCS toward areas with the greatest maximum opportunity, inform when NCS will saturate, and identify the types of NCS actions that are best suited to a given location.One approach to estimating maximum additional carbon storage—or the difference between current and potential carbon, which we term “unrealized potential” carbon—is a bookkeeping approach that tracks carbon fluxes through time. Under this approach, net land-based emissions since 1850 are estimated to have been 108 to 188 PgC, including both biomass (above and below ground) and soil organic matter (13–17). Estimates that account for preindustrial (i.e., pre-1850) land use are more varied and increase post-1850 estimates by as much as 325 to 357 PgC (18) or as little as 48 to 153 PgC (11–13, 15). This high uncertainty limits the practical utility of this approach.Other investigators have sought instead to quantify unrealized potential by comparing estimates of current and potential land carbon storage. Sanderman et al. (6), considering only soil organic carbon (SOC), estimated net losses in the upper 2 m of soil from agricultural land use to be 116 PgC since 10,000 BC. Erb et al. (19), focusing on changes in vegetation biomass, found losses in carbon due to human land use to be significantly larger (447 PgC) than the studies cited above that consider only the postindustrial period, but generally consistent with some of those that account for preindustrial human disturbance (18). Bastin et al. (20), in a study focused on the restoration of global tree cover, identified an additional reservoir of 206 PgC when considering all carbon pools (aboveground and belowground biomass, soil, litter, and dead wood) after excluding cropland and urban areas.However, all of these global analyses fall short in delivering the robust spatially explicit information needed for targeted planning and implementation of landscape-level NCS. While the global dataset produced by Bastin et al. (20) has a reasonably high spatial resolution (30 arc seconds; approximately 900 m) and considers all land carbon pools, the product is limited to the storage potential afforded by the expansion of tree cover. Moreover, the result is subject to the uncertainty inherent in indirect estimates of carbon stock from area-based metrics of tree/forest cover (21). In comparison, the data product created by Erb et al. (19), which is based on several disparate yet direct estimates of terrestrial carbon storage, is limited by its treatment of only the biomass carbon pool and coarse spatial resolution (5 arc min; approximately 9.3 km). The authors themselves remark that “the uncertainty range could be narrowed if a single robust, validated method would be applied continuously in the stocktaking efforts” (19).Here, we apply a consistent suite of methods to generate spatially explicit global estimates of current (ca. 2016) and climate-constrained potential land carbon storage in aboveground woody biomass (AGB), belowground woody biomass (BGB), and SOC pools at a spatial resolution of approximately 500 m. The difference between current and potential land carbon storage represents the unrealized potential for additional carbon accumulation in global woody biomass and soils. We then disaggregate this global estimate of unrealized potential carbon storage using a conceptual framework we term the NCS opportunity space: seven discrete, internally consistent, and spatially explicit categories of broad NCS action (Fig. 1). Categories are defined quantitatively in terms of woody carbon density, thereby avoiding the uncertainty associated with derivative approximations of potential carbon storage based on forest area or canopy cover. After applying safeguards to lands currently utilized for food production, human habitation (e.g., urban areas), and sensitive biodiversity (nonwoody grasslands), we demonstrate the utility of the opportunity space framework for landscape-level NCS planning by analyzing the global, regional, and national potential for additional land carbon storage attributable to restoration (e.g., reforestation), management (e.g., improved natural forest stewardship), and maintenance (i.e., the sequestration benefit accrued through avoided forest conversion) of woody carbon stocks and associated soils. Finally, we evaluate the uncertainty that climate change poses to the magnitude and spatial distribution of the unrealized potential for additional carbon storage through 2050.Open in a separate windowFig. 1.The NCS opportunity space, consisting of seven categories defined by the ratio of current (x axis) to potential (y axis) carbon storage as well as carbon-based thresholds delineating NCS-relevant systems. Categories include: Restore/High suitability for forestry-based NCS (R/H; red), Maintain and manage/High suitability for forestry-based NCS (MM/H; dark green), Maintain/High suitability for forestry-based NCS (M/H; dark blue), Restore/Low suitability for forestry-based NCS (R/L; orange), Maintain and manage/Low suitability for forestry-based NCS (MM/L; light green), Maintain/Low suitability for forestry-based NCS (M/L; light blue), and Nonwoody (yellow). † denotes associated grassland/savanna biodiversity considerations.     

Diabetic retinopathy screening in a Canadian community pediatric diabetes clinic

Objective

To evaluate the screening rates for diabetic pediatric patients in a regional center according to the Canadian Diabetes Association guidelines.

The incidence of giant cell arteritis in Ontario,Canada

Objective

The incidence of giant cell arteritis (GCA) is insufficiently documented for Canada, but important to ascertain for public health planning. We estimate the incidence of biopsy-proven GCA (BPGCA) in Kingston, Ontario, and for the province of Ontario.

Kentucky Health Access Nurturing Development Services Home Visiting Program Improves Maternal and Child Health

Maternal and Child Health Journal - Background and Objectives: Home visitation programs are one of the numerous efforts to help reduce the rates of preterm birth and low birth weight as well as...     

Functional MRI of brain activation induced by scanner acoustic noise

A method is introduced by which brain activation caused by the acoustic noise associated with echo planar imaging (EPI) is mapped. Two types of time series were compared. The first time series, considered the “task,” involved applying only EPI gradients for 20 s without the application of RF pulses, then, without pause, starting image collection. The second, considered the “control,” involved typical sequential image acquisition without the prior gradient pulses. Subtraction of the first 5 s of the two time series revealed signal enhancement mainly in the primary auditory cortex. The technique was validated using a motor cortex task that mimicked the hypothesized scanner noise induced activation.     

Student feedback in problem based learning: a survey of 103 final year students across five Ontario medical schools

CONTEXT: Problem based learning (PBL) has become an integral component of medical curricula around the world. In Ontario, Canada, PBL has been implemented in all five Ontario medical schools for several years. Although proper and timely feedback is an essential component of medical education, the types of feedback that students receive in PBL have not been systematically investigated. OBJECTIVES: In the first multischool study of PBL in Canada, we sought to determine the types of feedback (grades, written comments, group feedback from tutor, individual feedback from tutor, peer feedback, self-assessment, no feedback) that students receive as well as their satisfaction with these different feedback modalities. SUBJECTS AND METHODS: We surveyed a sample of 103 final year medical students at the five Ontario schools (University of Toronto, McMaster University, Queens University, University of Ottawa and University of Western Ontario). Subjects were recruited via E-mail and were asked to fill out a questionnaire. RESULTS: Many students felt that the most helpful type of feedback in PBL was individual feedback from the tutor, and indeed, individual feedback was one of the more common types of feedback provided. However, although students also indicated a strong preference for peer and group feedback, these forms of feedback were not widely reported. There were significant differences between schools in the use of grades, written comments, self-assessment and peer feedback, as well as the immediacy of the feedback given. CONCLUSIONS: Across Ontario, students do receive frequent feedback in PBL. However, significant differences exist in the types of feedback students receive, as well as the timing. Although rated highly by students at all schools, the use of peer feedback and self-assessment is limited at most, but not all, medical schools.     

Chronic inflammatory reaction to bone wax in cochlear implantation: A case report and literature review

Background: Cochlear implantation is a well-established treatment for severe-to-profound sensorineural hearing loss. While bone wax is used commonly during mastoidectomy and other bony surgeries as a hemostatic agent, there have been reports of bone wax triggering foreign body reactions, months to years after surgery. This report describes the first known foreign body reaction to bone wax used in cochlear implantation surgery.

Case Presentation: A 6-year-old male presented with an unusual post-auricular inflammation two years after cochlear implantation. Extended treatment with oral and intravenous antibiotics failed to resolve the presumed infection. Upon exploration of the mastoid cavity, fragments of bone wax were discovered within the granulation tissue. Excision of bone wax fragments and local flap reconstruction resulted in complete resolution of the inflammatory process.

Conclusions: Bone wax has been implicated in foreign body reactions in many different surgical specialties. This is the first reported case of an adverse reaction to bone wax after cochlear implantation. Clinically, the bone wax reaction was misinterpreted as an implant infection, which resulted in extended antibiotic use and delay of appropriate treatment. As a result, bone wax should be used judiciously during mastoidectomy, and particularly in the area of the electrode and soft tissue closure.