The carbon sequestration response of aboveground biomass and soils to nutrient enrichment in boreal forests depends on baseline site productivity.

Nutrient enrichment can alleviate productivity limitations and thus substantially increase carbon (C) uptake in northern coniferous forests. Yet, factors controlling stand-to-stand variation of forest ecosystem responses to nutrient enrichment remain unclear. We used five long-term (13 years) nutrient-enrichment experiments across Sweden, where nitrogen (N), phosphorus, and potassium were applied annually to young Norway spruce forests that varied in their baseline ecosystem properties. We measured tree biomass and soil C and N stocks, litterfall C inputs, soil CO2 efflux, and shifts in composition and biomass of soil microbial communities to understand the links between above and belowground responses to nutrient enrichment. We found that the strongest responses in tree biomass occurred when baseline site productivity was lowest. High increases in tree biomass C stocks were generally balanced by weaker responses in organic soil C stocks. The average ecosystem C-N response rate was 35 kg C kg-1 N added, with a nearly five-fold greater response rate in tree biomass than in soil. The positive nutrient enrichment effects on ecosystem C sinks were driven by a 95% increase in tree biomass C stocks, 150% increase in litter production, 67% increase in organic layer C stocks, and a 46% reduction in soil CO2 efflux accompanied by compositional changes in soil microbial communities. Our results show that ecosystem C uptake in spruce forests in northern Europe can be substantially enhanced by nutrient enrichment; however, the strength of the responses and whether the enhancement occurs mainly in tree biomass or soils are dependent on baseline forest productivity.

Using Quality Improvement Methods to Improve Patient Experience.

Patient experience is an important component of the overall medical encounter. This paper explores how patient experience is measured and its role in radiology, including its impact on clinical outcomes and reimbursement. Although typically applied to safety and clinical outcomes, quality improvement methodology can also be used to drive improvement efforts centered on patient experience. Applying an established framework for patient-centered care to radiology, this paper provides a number of examples of projects that are likely to yield significant improvement in patient satisfaction measures.

CT scan parameters and radiation dose: practical advice for radiologists.

Although there has been increasing recognition of the importance of reducing radiation dose when performing multidetector CT examinations, the increasing complexity of CT scanner technology, as well as confusion about the importance of many different CT scan parameters, has served as an impediment to radiologists seeking to create lower dose protocols. The authors seek to guide radiologists through the manipulation of 8 fundamental CT scan parameters that can be altered or optimized to reduce patient radiation dose, including detector configuration, tube current, tube potential, reconstruction algorithm, patient positioning, scan range, reconstructed slice thickness, and pitch. Although there is always an inherent trade-off between image quality or noise and patient radiation dose, in many cases, a reasoned manipulation of these 8 parameters can allow the safer imaging of patients (with lower dose) while preserving diagnostic image quality.