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Psychological harm is a complex phenomenon which becomes even more complex and problematic in simulated clinical experiences (SCEs). Currently, there exists only one published protocol that addresses policies and procedures to mediate psychological harm during simulated clinical experiences. In this article, the phenomenon of psychological safety and psychological harm is explored. By synthesizing the results of a literature search, actions that could be taken before, during, and after the debrief are outlined. With the literature acting as a springboard for further discussion, suggestions are provided by a think tank of novice to expert facilitators that may assist simulation teams to mediate and intervene when psychological harm occurs with students. [ABSTRACT FROM AUTHOR]

The clinical presentation of neurosarcoidosis is varied as multiple levels of the neuraxis may be affected. When central nervous system involvement occurs, making an accurate diagnosis of the condition can be challenging, especially given the current definition for definite neurosarcoidosis requires histologic confirmation of the affected tissue (brain biopsy). This article will review our current knowledge and manifestations of neurosarcoidosis, discuss the current diagnostic approach as well as the challenges associated with a condition requiring histologic confirmation, discuss the current treatment approach, and highlight the challenges of this diagnosis with a few real-life clinical cases. We also highlight the selected differential diagnosis of neurosarcoidosis as well as multiple sclerosis which could mimic each other. [ABSTRACT FROM AUTHOR]

Multiple sclerosis (MS) is a CNS disorder characterized by inflammation, demyelination and neurodegeneration, and is the most common cause of acquired nontraumatic neurological disability in young adults. The course of the disease varies between individuals: some patients accumulate minimal disability over their lives, whereas others experience a rapidly disabling disease course. This latter subset of patients, whose MS is marked by the rampant progression of disability over a short time period, is often referred to as having 'aggressive' MS. Treatment of patients with aggressive MS is challenging, and optimal strategies have yet to be defined. It is important to identify patients who are at risk of aggressive MS as early as possible and implement an effective treatment strategy. Early intervention might protect patients from irreversible damage and disability, and prevent the development of a secondary progressive course, which thus far lacks effective therapy. [ABSTRACT FROM AUTHOR]

Forest bioenergy can contribute to climate change mitigation by reducing greenhouse gas ( GHG) emissions associated with energy production. We assessed changes in GHG emissions resulting from displacement of coal with wood pellets for the Atikokan Generating Station located in Northwestern Ontario, Canada. Two contrasting biomass sources were considered for continuous wood pellet production: harvest residue from current harvest operations (residue scenario) and fibre from expanded harvest of standing live trees (stemwood scenario). For the stemwood scenario, two metrics were used to assess the effects of displacing coal with forest biomass on GHG emissions: (i) time to carbon sequestration parity, defined as the time from the beginning of harvest to when the combined GHG benefit of displacing coal with biomass and the amount of carbon in regenerating forest equalled the amount of forest carbon without harvest for energy production; and (ii) time to carbon debt repayment, defined as the time from the beginning of harvest to when the combined GHG benefit of displacing coal with biomass and the amount of carbon in the regenerating forest equalled forest carbon at the time of harvest. Only time to carbon sequestration parity was used for the residue scenario. In the residue scenario, carbon sequestration parity was achieved within 1 year. In the stemwood scenario, times to carbon sequestration parity and carbon debt repayment were 91 and 112 years, respectively. Sensitivity analysis showed that estimates were robust when parameter values were varied. Modelling experiments showed that increasing growth rates for regenerating stands in the stemwood scenario could substantially reduce time to carbon sequestration parity. We discuss the use of the two metrics (time to carbon sequestration parity and time to carbon debt repayment) for assessing the effects of forest bioenergy projects on GHG emissions and make recommendations on terminology and methodologies for forest bioenergy studies. [ABSTRACT FROM AUTHOR]