Nature-based climate solutions require a mix of socioeconomic and governance attributes.

Nature-based climate solutions (NCS) can play a crucial role in reducing climate change. There is, however, a lack of understanding of the biophysical, social, and political contexts surrounding NCS, which hampers its practical implementation. Here, we used estimates of carbon sink potential to identify socioeconomic and ecological factors that may stimulate NCS implementation in developing economies. We considered carbon sink potential for eight NCS, including reforestation, peatland restoration, natural forest management, improved rice cultivation, optimal grazing intensity, grazing (legumes), avoided peatland impacts, and avoided coastal impacts. Food insecurity hotspots, which currently receive the most development aid, have the lowest likelihood of realizing NCS' potential. Poor governance structures and food insecurity impede the implementation of NCS projects at the country level. By carefully assessing complementary food security, sustainable financing, and soil quality safeguards, NCS as a nationally determined contribution to climate mitigation can be made more effective.

Land-use and climate risk assessment for Earth's remaining wilderness.

Earth's wilderness areas are reservoirs of genetic information and carbon storage systems, and are vital to reducing extinction risks. Retaining the conservation value of these areas is fundamental to achieving global biodiversity conservation goals; however, climate and land-use risk can undermine their ability to provide these functions. The extent to which wilderness areas are likely to be impacted by these drivers has not previously been quantified. Using climate and land-use change during baseline (1971-2005) and future (2016-2050) periods, we estimate that these stressors within wilderness areas will increase by ca. 60% and 39%, respectively, under a scenario of high emission and land-use change (SSP5-RCP8.5). Nearly half (49%) of all wilderness areas could experience substantial climate change by 2050 under this scenario, potentially limiting their capacity to shelter biodiversity. Notable climate (>5 km year-1) and land-use (>0.25 km year-1) changes are expected to occur more rapidly in the unprotected wilderness, including the edges of the Amazonian wilderness, Northern Russia, and Central Africa, which support unique assemblages of species and are critical for the preservation of biodiversity. However, an alternative scenario of sustainable development (SSP1-RCP2.6) would attenuate the projected climate velocity and land-use instability by 54% and 6%, respectively. Mitigating greenhouse gas emissions and preserving the remaining intact natural ecosystems can help fortify these bastions of biodiversity.

Levothyroxine sodium oral solution to control thyroid function in a patient with hypothyroidism and celiac disease.

Implementing a gluten-free diet and switching to the levothyroxine oral solution significantly improved malabsorptive and hypothyroid symptoms in a patient with hypothyroidism, Addison's disease, and celiac disease without the need to increase levothyroxine dosage.

Nutraceutical Supplements in the Thyroid Setting: Health Benefits beyond Basic Nutrition.

In recent years, there has been a growing interest in nutraceuticals, which may be considered as an efficient, preventive, and therapeutic tool in facing different pathological conditions, including thyroid diseases. Although iodine remains the major nutrient required for the functioning of the thyroid gland, other dietary components play important roles in clinical thyroidology-these include selenium, l-carnitine, myo-inositol, melatonin, and resveratrol-some of which have antioxidant properties. The main concern regarding the appropriate and effective use of nutraceuticals in prevention and treatment is due to the lack of clinical data supporting their efficacy. Another limitation is the discrepancy between the concentration claimed by the label and the real concentration. This paper provides a detailed critical review on the health benefits, beyond basic nutrition, of some popular nutraceutical supplements, with a special focus on their effects on thyroid pathophysiology and aims to distinguish between the truths and myths surrounding the clinical use of such nutraceuticals.

Environmental sustainability assessment using dynamic Autoregressive-Distributed Lag simulations-Nexus between greenhouse gas emissions, biomass energy, food and economic growth.

Increasing population demand has triggered the enhancement of food production, energy consumption and economic development, however, its impact on climate change has become a global concern. This study applied a novel environmental sustainability assessment tool using dynamic Autoregressive-Distributed Lag (ARDL) simulations for model estimation of the relationships between greenhouse gas (GHG) emissions, energy, biomass, food and economic growth for Australia using data spanning from 1970 to 2017. The study found an inversed-U shaped relationship between energy consumption and income level, showing a decarbonized and services economy, hence, improved energy efficiency. While energy consumption increases emissions by 0.4 to 2.8%, biomass consumption supports Australia's transition to a decarbonized economy by reducing GHG emissions by 0.13% and shifts the demand for fossil fuel. Food and energy consumption underpin socio-economic development and vice versa. However, food waste from production and consumption increases ecological footprint, implying a lost opportunity to improve food security and reduce environmental pressure from agricultural production. There is no single path to achieving environmental sustainability, nonetheless, the integrated approach applied in this study reveals conceptual tools which are applicable for decision making.

Radiation safety in the treatment of patients with thyroid diseases by radioiodine 131I : practice recommendations of the American Thyroid Association.

BACKGROUND: Radiation safety is an essential component in the treatment of patients with thyroid diseases by ¹³¹I. The American Thyroid Association created a task force to develop recommendations that would inform medical professionals about attainment of radiation safety for patients, family members, and the public. The task force was constituted so as to obtain advice, experience, and methods from relevant medical specialties and disciplines. METHODS: Reviews of Nuclear Regulatory Commission regulations and International Commission on Radiological Protection [corrected] recommendations formed the basic structure of the recommendations. Members of the task force contributed both ideas and methods that are used at their respective institutions to aid groups responsible for treatments and that instruct patients and caregivers in the attainment of radiation safety. There are insufficient data on long-term outcomes to create evidence-based guidelines. RESULTS: The information was used to compile delineations of radiation safety. Factors and situations that govern implementation of safety practices are cited and discussed. Examples of the development of tables to ascertain the number of hours or days (24-hour cycles) of radiation precaution appropriate for individual patients treated with ¹³¹I for hyperthyroidism and thyroid cancer have been provided. Reminders in the form of a checklist are presented to assist in assessing patients while taking into account individual circumstances that would bear on radiation safety. Information is presented to supplement the treating physician's advice to patients and caregivers on precautions to be adopted within and outside the home. CONCLUSION: Recommendations, complying with Nuclear Regulatory Commission regulations and consistent with guidelines promulgated by the National Council on Radiation Protection and Measurement (NCRP-155), can help physicians and patients maintain radiation safety after treatment with ¹³¹I of patients with thyroid diseases. Both treating physicians and patients must be informed if radiation safety, an integral part of therapy with ¹³¹I, is to be attained. Based on current regulations and understanding of radiation exposures, recommendations have been made to guide physicians and patients in safe practices after treatment with radioactive iodine.

Insulin pen-the "iPod" for insulin delivery (why pen wins over syringe).

Diabetes affects most aspects of everyday life and places considerable responsibility on the patient; therefore, without patient acceptance of what we offer, the therapy is unlikely to be adhered to especially when that therapy happens to be insulin injection. In 2008, almost every physician/health care provider carries new and sleek cell phones (because the newer ones are well designed and function better). Why these same providers continue to prescribe insulin via syringes in 2008 is something that I cannot fathom. Previously, some insurance companies only paid for vials and there was no other choice, but today almost all insurance pay for pens and so the "insurance reason" is no longer tenable. Since Banting and Best discovered insulin in 1921, scientists have continued to improve the types of insulin (making them mimic physiology more closely in order to minimize hypoglycemia and improve glycemic control as seen with the latest analog insulins). In the same manner, the delivery process of insulin has also continued to evolve to make it easier and more acceptable to patients. Studies have shown that patients prefer device use over traditional vials/syringes. Pen devices used to inject insulin lead to better compliance, are quicker to inject, dosing is much more accurate, and, surprisingly, are more cost effective. I challenge my colleagues to take full responsibility for what their patients use. If a provider believes in pen devices, most of his/her patients will use them. The products your patients use is a direct reflection of what you practice. Educating providers to change their beliefs and practices is key to moving American diabetic patients from syringes to pen devices.