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In this study, our goal was to adapt the moss layer transfer technique (MLTT), first developed to restore degraded Sphagnum‐dominated peatland explicitly with a bryophyte layer, to a former in‐situ oil sands well‐pad constructed with nearby mineral fill in northwestern Alberta, Canada. Mineral fill was either completely removed or partially removed with residual fill buried under excavated and decompacted peat, followed by the transfer of donor moss collected from nearby linear features with different plant communities in peatlands. Three years after MLTT, peatland vegetation covers 63% of the site. Carex spp. dominate with 36% coverage, followed by mosses at 12%, including 3% Sphagnum spp. and 8% fen mosses, and shrubs at 8%. Different substrate adjustment treatments and types of donor moss had negligible impact on vegetation development although areas without MLTT remained devoid of mosses and had the lowest peatland species cover. Instead, surface elevation, moisture conditions, and substrate chemistry played important roles in shaping the vegetation communities. The prompt introduction and establishment of peatland donor species through MLTT was crucial to the overall re‐establishment of peatland vegetation. This is the first full pad scale study to prove that a flat, moist peat surface created by the removal and/or burial of mineral fill can support peatland vegetation development, particularly ground layer bryophytes. Overall, the reclaimed well‐pad appears to be on trajectory toward becoming a functional peatland and our approaches should be considered and tested in future well‐pad reclamation trials. [ABSTRACT FROM AUTHOR]

Across Canada's boreal forest, disturbances from in situ oil sands mining, including well‐pads, significantly impact vast areas of the landscape. The creation of well‐pads requires removal of vegetation and placement of mineral fill, which essentially stops any carbon (C) sequestration on the once peatland ecosystem. It is important that, once no longer in use, these well‐pads are restored as long‐term C (peat) accumulation is what defines peatland ecosystem. However, little is known about the recovery of greenhouse gas exchange post‐restoration of these features. We studied a decommissioned well‐pad located in a treed poor fen that was restored using three soil adjustment treatments (SATs): (1) complete mineral fill removal (Peat‐Dec); (2) partial pad removal and burial under peat layer (BUPL); and (3) mixing mineral and peat by inversion (Mixed‐P‐M). The recreated peat surface was revegetated with donor peatland species using the moss layer transfer technique (MLTT). The objectives of this paper were to (1) quantify plot‐scale seasonal carbon dioxide (CO2) and methane (CH4) exchange of the SATs, 2–4 years post‐restoration compared to reference sites and (2) determine the influence of several environmental variables on CO2 and CH4 exchange. All SATs proved effective in recreating a soil surface needed to support peatland vegetation as shown by similar rates of net ecosystem exchange (NEE). Equally, both types of vegetation reintroduced led this site on a trajectory toward functioning as a net C sink. [ABSTRACT FROM AUTHOR]

Purpose: To review the evidence and provide clinical recommendations for the management of acute exacerbations of chronic obstructive pulmonary disease (COPD). Methods: This guideline is based on a systematic review of randomized controlled trials from database inception to January 2, 2019. The target audience for the guideline includes all primary care clinicians, and the target patient population includes adults who are experiencing acute exacerbations of COPD. This guideline was developed using a modified version of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system, a transparent approach to evaluating the certainty of the evidence and determining the strength of recommendations. Recommendation 1: The American Academy of Family Physicians (AAFP) recommends that clinicians prescribe systemic antibiotics for adults with acute exacerbations of COPD to improve clinical cure and reduce clinical failure (weak recommendation, moderate quality of evidence). Choice of antibiotic should be based on local resistance patterns, affordability, and patient history and preferences because there is insufficient evidence to support a preferential recommendation. Recommendation 2: The AAFP recommends that clinicians prescribe corticosteroids for adults with acute exacerbations of COPD to reduce clinical failure (weak recommendation, low quality of evidence). There is insufficient evidence to guide the dose, route of administration, or duration of treatment. [ABSTRACT FROM AUTHOR]

Oil sands exploration activities across the Alberta boreal peatlands requires tree clearing and results in sites being left compressed and with altered understory vegetation. Restoration techniques, including planting trees, mechanical mounding with tree planting, and spreading coarse woody debris have been tested across abandoned oil sands exploration sites. In this study two oil sands exploration sites were monitored 6- and 9-years post-treatment, along with two control areas disturbed 20 years ago with no active restoration treatment. Results were compared to a natural reference site to understand how various restoration techniques influenced carbon flux and growing season carbon balance. Tree ingress was observed across all parts of the restored oil sands exploration sites except a wet control area disturbed 20 years ago. The creation of dry microsites through the mechanical mounding technique substantially increased tree productivity, and we found that 9 years post-restoration the mounded area of an oil sands exploration site had a tree net primary productivity similar to the natural site. This carbon uptake, however, was partially offset by large emissions of methane from pools adjacent to mounds. We found that planting trees only could result in a growing season carbon balance that is within the range of a natural peatland 9 years following restoration. However, our estimates indicate that the mounding treatment 9 years following restoration released less carbon to the atmosphere overall compared to all other restoration treatments and control areas. This restoration technique may be useful if the restoration goal is focused on returning the carbon storage function at disturbed sites. As well as understanding attainability of restoration goals, evaluating ecohydrologic conditions of oil sands exploration sites pre-restoration is critical for informing the most appropriate restoration technique. [ABSTRACT FROM AUTHOR]

Purpose: To review the evidence and provide clinical recommendations for the screening and treatment of depression in patients who have had a recent acute coronary syndrome event. Methods: This guideline is based on a systematic review of randomized controlled trials and observational studies from January 1, 2003, to August 15, 2017. It is an update to a previous systematic review published in May 2005, which included studies up to March 2004. The target audience for the guideline includes all primary care clinicians, and the target patient population includes adults who are within the three months following an acute coronary syndrome event (unstable angina or myocardial infarction). This guideline was developed using a modified version of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system, a transparent approach to evaluating the certainty of the evidence and determining the strength of recommendations. Recommendation 1: The American Academy of Family Physicians recommends that clinicians screen for depression, using a standardized depression screening tool, in patients who have recently experienced an acute coronary syndrome event (weak recommendation, low-quality evidence). Individuals should undergo further assessment to confirm the diagnosis of depression (good practice point). Recommendation 2: The American Academy of Family Physicians strongly recommends that clinicians prescribe antidepressant medication, preferably selective serotonin reuptake inhibitors or serotonin-norepinephrine reuptake inhibitors, and/or cognitive behavior therapy to improve symptoms of depression in patients who have a history of acute coronary syndrome and have been diagnosed with depression (strong recommendation, moderate-quality evidence). [ABSTRACT FROM AUTHOR]

Across Canada's boreal forest, linear disturbances, including cutlines such as seismic lines and roads, crisscross the landscape to facilitate resource exploration and extraction; many of these linear disturbances cross peatland ecosystems. Changes in tree canopy cover and the compression of the peat by heavy equipment alter local thermal, hydrological, and ecological conditions, likely changing carbon exchange on the disturbance, and possibly in the adjacent peatland. We measured bulk density, water table, soil temperature, plant cover, and CO2 and CH4 flux along triplicate transects crossing a winter road through a wooded fen near Peace River, Alberta, Canada. Sample plots were located 1, 5, and 10 m from the road on both sides with an additional three plots on the road. Productivity of the overstory trees, when present, was also determined. The winter road had higher bulk density, shallower water table, higher graminoid cover, and thawed earlier than the adjacent peatland. Tree productivity and CO2 flux varied between the plots, and there was no clear pattern in relation to distance from the road. The plots on the winter road acted as a greater CO2 sink and greater CH4 source compared to the adjacent peatland with plots on the winter road emitting on average (standard error) 479 (138) compared to 41 (10) mg CH4 m−2 day−1 in the adjacent peatland. Considering both gases, global warming potential increased from 70 to 250 g CO2e m−2 year−1 in the undisturbed area to 2100 g CO2e m−2 year−1 on the winter road. Although carbon fluxes on any given cutline through peatland will vary depending on level of compaction, line width and vegetation community shifts, the large number of linear disturbances in Canada's boreal forest and slow recovery on peatland ecosites suggest they could represent an important anthropogenic greenhouse gas source. [ABSTRACT FROM AUTHOR]

Background and Aims: Peatland methane (CH) fluxes may vary between plant types; however, in mixed communities, the specific role of each species is difficult to distinguish. The goal of this study was to determine the individual and interacting effect of moss, graminoid and shrub plant functional types on CH dynamics of experimentally planted plots in a rewetted minerotrophic peatland. Methods: We measured CH flux, pore water CH concentration and CH production and oxidation potential in pure stands of reintroduced Tomenthypnum nitens (Hedw.) Loeske, Carex aquatilis Wahlenb, or Myrica gale L., as well as mixtures of T. nitens + C. aquatilis and T. nitens + M. gale. Methane flux was also measured on bare peat plots. Results: The presence of both the graminoid C. aquatilis and the shrub M. gale resulted in the highest CH production potential in near surface peat (10 cm). The presence of moss ( T. nitens) and C. aquatilis significantly increased CH oxidation potential. Water table position was a significant control on CH flux, but the presence of C. aquatilis maintained higher flux even at dry plots. Plots including C. aquatilis had significantly lower pore water CH concentration at 30 cm depth, likely reflecting CH oxidation and transport. Conclusions: Management of restored sites aiming to reduce CH flux should focus on hydrology, i.e. water table position. The presence of graminoids enhances CH flux, while moss presence may result in lower CH emission. [ABSTRACT FROM AUTHOR]

The article comments on the U.S. Preventive Services Task Force's (USPSTF) recently updated recommendation statement, lowering the starting age for colorectal cancer screening. It notes that the American Academy of Family Physicians (AAFP) disagrees with USPSTF for lack of evidence to assess its benefits and harms. Also discussed is the potential cost to patients and the health care system of lowering the screening age to 45.

The article comments on the U.S. Preventive Services Task Force's (USPSTF) updated recommendation statement, lowering the starting age for colorectal cancer screening. It notes that the American Academy of Family Physicians (AAFP) disagrees with USPSTF for lack of evidence to assess its benefits and harms. Also discussed is the potential cost to patients and the health care system of lowering the screening age to 45.

Purpose: To review the evidence and provide clinical recommendations for appropriate blood pressure treatment targets for adults with hypertension. [ABSTRACT FROM AUTHOR]

Background Ethanol ( Et OH) exposure prior to traumatic injury, such as a burn, elevates systemic and local inflammatory responses and increases morbidity and mortality. Adipose is a large tissue mass that is often inflamed during obesity or other stresses, which disturbs metabolic homeostasis. To date, there has been little investigation into the inflammatory response of adipose tissue after combined Et OH exposure and burn injury. Methods Two Et OH exposure regimens were utilized to examine the role of inflammation in adipose tissue after Et OH and burn injury. Mice were either given a single or episodic binge exposure to Et OH or saline followed by scald (burn) or sham injury 30 minutes later. Twenty-four hours post injury, serum and adipose tissue were collected for assessment of inflammatory mediators. Results Single binge Et OH alone induced no inflammation in adipose when compared with sham vehicle-treated mice. However, single binge Et OH followed by burn injury induced significant elevations in m RNA and protein concentrations of pro-inflammatory mediators interleukin-6 ( IL-6), KC, and monocyte chemoattractant protein 1 compared with either insult alone or sham vehicle group. Additionally, Et OH exposure and burn injury significantly blunted inducible nitric oxide synthase (i NOS), indicating a complex inflammatory response. Episodic binge Et OH exposure followed by burn injury exacerbated the postburn adipose inflammatory response. The magnitude of the episodic binge-induced inflammatory parameters postburn were 2- to 5-fold greater than the response detected after a single exposure of Et OH, indicating Et OH-induced potentiation of burn-induced inflammatory response. Finally, inflammatory loci and crown-like structures in adipose were significantly increased by episodic binge Et OH and burn injury. Conclusions This is the first report of binge and burn-induced crown-like structure formation. Evidence presented herein suggests an important role for alcohol and burn as an additional mediator of adipose inflammation in postburn injury, a common complication in burn patients. [ABSTRACT FROM AUTHOR]

An editorial is presented on the management of acute pain from musculoskeletal injuries has guidance for family physicians. Topics include the family physicians commonly encounter patients with pain from acute musculoskeletal injuries that do not involve the lower back, and the management of chronic pain and the appropriate prescribing of opioids with less emphasis on the treatment of acute pain.

Events such as a nuclear meltdown accident or nuclear attack have potential for severe radiation injuries. Radiation injury frequently occurs in combination with other forms of trauma, most often burns. Thus far, combined injury studies have focused mainly on skin wound healing and damage to the gut. Since both radiation exposure and remote burn have pulmonary consequences, we examined the early effects of combined injury on the lung. C57BL/6 male mice were irradiated with 5 Gy of total body irradiation followed by a 15% total body surface area scald burn. Lungs from surviving animals were examined for evidence of inflammation and pneumonitis. At 48 h post-injury, pathology of the lungs from combined injury mice showed greater inflammation compared to all other treatment groups, with marked red blood cell and leukocyte congestion of the pulmonary vasculature. There was excessive leukocyte accumulation, primarily neutrophils, in the vasculature and interstitium, with occasional cells in the alveolar space. At 24 and 48 h post-injury, myeloperoxidase levels in lungs of combined injury mice were elevated compared to all other treatment groups (P, 0.01), confirming histological evidence of neutrophil accumulation. Pulmonary levels of the neutrophil chemoattractant KC (CXCL1) were 3 times above that of either injury alone (P, 0.05). Further, monocyte chemotactic protein-1 (MCP-1, CCL2) was increased two- and threefold compared to burn injury or radiation injury, respectively (P, 0.05). Together, these data suggest that combined radiation and burn injury augments early pulmonary congestion and inflammation. Currently, countermeasures for this unique type of injury are extremely limited. Further research is needed to elucidate the mechanisms behind the synergistic effects of combined injury in order to develop appropriate treatments. [ABSTRACT FROM AUTHOR]

Laboratory evidence suggests that intestinal permeability is elevated following either binge ethanol exposure or burn injury alone, and this barrier dysfunction is further perturbed when these insults are combined. We and others have previously reported a rise in both systemic and local proinflammatory cytokine production in mice after the combined insult. Knowing that long myosin light-chain kinase (MLCK) is important for epithelial barrier maintenance and can be activated by proinflammatory cytokines, we examined whether inhibition of MLCK alleviated detrimental intestinal responses seen after ethanol exposure and burn injury. To accomplish this, mice were given vehicle or a single binge ethanol exposure followed by a sham or dorsal scald burn injury. Following injury, one group of mice received membrane permeant inhibitor of MLCK (PIK). At 6 and 24 h postinjury, bacterial translocation and intestinal levels of proinflammatory cytokines were measured, and changes in tight junction protein localization and total intestinal morphology were analyzed. Elevated morphological damage, ileal IL-1β and IL-6 levels, and bacterial translocation were seen in mice exposed to ethanol and burn injury relative to either insult alone. This increase was not seen in mice receiving PIK after injury. Ethanol-exposed and burn-injured mice had reduced zonula occludens protein-1 and occludin localization to the tight junction relative to sham-injured mice. However, the observed changes in junctional complexes were not seen in our PIK-treated mice following the combined insult. These data suggest that MLCK activity may promote morphological and inflammatory responses in the ileum following ethanol exposure and burn injury. [ABSTRACT FROM AUTHOR]

Background: Clinical and laboratory evidence suggests that alcohol consumption prior to burn injury leads to dysregulated immune function and subsequent higher rates of morbidity and mortality. Our laboratory previously observed higher levels of pro-inflammatory cytokines and leukocyte infiltration in the lungs of mice following ethanol and burn injury. To understand the mechanism of the increased inflammatory response, we looked at different signaling initiators of inflammation including toll-like receptors 2 and 4 (TLR2 and 4) pathways. Methods: Wild-type, TLR2, and TLR4 knockout mice were treated with vehicle or a single binge dose of ethanol (1.11 g/kg) and subsequently given a sham or burn injury. Twenty-four hours postinjury, systemic and pulmonary levels of pro-inflammatory cytokines were quantified, and differences in neutrophil infiltration were determined by histological examination. Results: Higher numbers of neutrophils were observed in the lungs of wild-type mice following the combined insult of ethanol and burn injury relative to either injury alone. This increase in leukocyte accumulation was absent in the TLR4 knockout mice. Circulating levels of IL-6 and tumor necrosis factor-α were also elevated in wild-type mice but not in TLR4 knockout mice. Consistent with these findings, pulmonary levels of KC and IL-6 were increased in wild-type mice following burn and ethanol compared to burn injury alone as well as to their TLR4 knockout counterparts. In contrast, TLR2 knockout mice displayed similar levels, to wild-type mice, of neutrophil infiltration as well as IL-6 and KC in the lung. Conclusions: These data suggest that TLR4 signaling is a crucial contributory component in the exuberant inflammation after ethanol and burn injury. However, TLR2 does not appear to play a vital role in the aberrant pulmonary inflammation. [ABSTRACT FROM AUTHOR]

The article discusses the clinical practice guidelines issued by the American Academy of Family Physicians (AAFP) on atrial fibrillation (AF) diagnosis and management. Topics explored include the presentation of AF symptoms such as irregular heart rate and extreme fatigue, the need for primary care physicians to educate AF patients about medication cost and possible side effects of anticoagulants, and the use of lenient rate control instead of strict rate control in patients with AF.