Life Cycle Assessment of Coastal Enhanced Weathering for Carbon Dioxide Removal from Air.

Coastal enhanced weathering (CEW) is a carbon dioxide removal (CDR) approach whereby crushed silicate minerals are spread in coastal zones to be naturally weathered by waves and tidal currents, releasing alkalinity and removing atmospheric carbon dioxide (CO2). Olivine has been proposed as a candidate mineral due to its abundance and high CO2 uptake potential. A life cycle assessment (LCA) of silt-sized (10 µm) olivine revealed that CEW's life-cycle carbon emissions and total environmental footprint, i.e., carbon and environmental penalty, amount to around 51 kg CO2eq and 3.2 Ecopoint (Pt) units per tonne of captured atmospheric CO2, respectively, and these will be recaptured within a few months. Smaller particle sizes dissolve and uptake atmospheric CO2 even faster; however, their high carbon and environmental footprints (e.g., 223 kg CO2eq and 10.6 Pt tCO2-1, respectively, for 1 µm olivine), engineering challenges in comminution and transportation, and possible environmental stresses (e.g., airborne and/or silt pollution) might restrict their applicability. Alternatively, larger particle sizes exhibit lower footprints (e.g., 14.2 kg CO2eq tCO2-1 and 1.6 Pt tCO2-1, respectively, for 1000 µm olivine) and could be incorporated in coastal zone management schemes, thus possibly crediting CEW with avoided emissions. However, they dissolve much slower, requiring 5 and 37 years before the 1000 µm olivine becomes carbon and environmental net negative, respectively. The differences between the carbon and environmental penalties highlight the need for using multi-issue life cycle impact assessment methods rather than focusing on carbon balances alone. When CEW's full environmental profile was considered, it was identified that fossil fuel-dependent electricity for olivine comminution is the main environmental hotspot, followed by nickel releases, which may have a large impact on marine ecotoxicity. Results were also sensitive to transportation means and distance. Renewable energy and low-nickel olivine can minimize CEW's carbon and environmental profile.

Osteoporosis Diagnosis and Management in Long-Term Care Facility.

BACKGROUND: Contemporary estimates of the prevalence of diagnosed osteoporosis among long-term care facility residents are limited. METHODS: This chart review collected data between April 1, 2012 and August 31, 2013 for adult (age ≥ 30 years) residents of 11 long-term care facilities affiliated with the Louisiana State University Health Sciences Center in the New Orleans metropolitan area. Data (demographics; comorbidities; osteoporosis diagnosis, risk factors, diagnostic assessments, treatments; fracture history; fall risk; activities of daily living) were summarized. Data for residents with and without diagnosed osteoporosis were compared using χ tests and t tests. RESULTS: The study included 746 residents (69% women, mean [SD] age: 76.3 [13.9] years, median length of stay approximately 18.5 months). An osteoporosis diagnosis was recorded for 132 residents (18%), 30% of whom received a pharmacologic osteoporosis therapy. Fewer than 2% of residents had bone mineral density assessments; 10% had previous fracture. Calcium and vitamin D use was more prevalent in residents with diagnosed osteoporosis compared with other residents (calcium: 49% versus 12%, vitamin D: 52% versus 28%; both P < 0.001). Over half (304/545) of assessed residents had a high fall risk. Activities of daily living were similarly limited regardless of osteoporosis status. CONCLUSIONS: The prevalence of diagnosed osteoporosis was higher than previously reported for long-term care residents, but lower than epidemiologic estimates of osteoporosis prevalence for the noninstitutional U.S. POPULATION: In our sample, osteoporosis diagnostic testing was rare and treatment rates were low. Our results suggest that osteoporosis may be underdiagnosed and undertreated in long-term care settings.

Behavioral interventions for office-based care: stress and anxiety disorders.

Numerous behavioral therapies have been investigated in the management of anxiety- and stress-related disorders. There is strong evidence to support cognitive behavioral therapy (CBT) in the management of generalized anxiety disorder (GAD), posttraumatic stress disorder, obsessive-compulsive disorder, panic disorder, and social phobias. Adjunctive behavioral sleep intervention may enhance results for GAD, and initiation of a selective serotonin reuptake inhibitor for GAD before CBT also may enhance response. Several randomized clinical trials showed benefit of Internet-based CBT for GAD, but additional studies are needed before conclusions can be drawn regarding its effectiveness for posttraumatic stress disorder. Although outcome data are limited, family physicians can offer patients screening for anxiety disorders, psychological first aid (ie, listening to and comforting patients, teaching about emotional and physiologic responses to traumatic incidents, and encouraging engagement with social supports and coping) after trauma, education about anxiety disorders, and referral to evidence-based self-help resources. Family physicians also can ensure linkage with behavioral health care physicians and encourage adherence to self-help protocols.

Complementary and alternative medicine usage for behavioral health indications.

Evidence on the use of complementary and alternative medicine (CAM) modalities in the treatment of depression, anxiety, sleep disorders, and attention-deficit/hyperactivity disorder (ADHD) is reviewed. There is strong evidence to support the use of St. John's wort (SJW) in depression, and growing support for the use of omega-3 fatty acids and S-adenosyl-l-methionine as potential adjuncts to conventional therapies. Evidence is insufficient to support the antidepressant benefit of dehydroepiandrosterone, inositol, folate, and saffron. Only kava has high-quality evidence for use in the treatment of anxiety disorders, and its use is discouraged because of safety concerns. There is preliminary supportive evidence for valerian and inositol treatment of anxiety, but SJW and passionflower have achieved little research support. Melatonin is likely to be useful in treating delayed sleep phase, jet lag, or shift work, but there is little evidence for the benefit of valerian compared with placebo. There are currently no evidence-supported CAM treatments for ADHD (zinc and omega-3 fatty acids are reviewed).

Acute dyspnea in the office.

Respiratory difficulty is a common presenting complaint in the outpatient primary care setting. Because patients may first seek care by calling their physician's office, telephone triage plays a role in the early management of dyspnea. Once the patient is in the office, the initial goal of assessment is to determine the severity of the dyspnea with respect to the need for oxygenation and intubation. Unstable patients typically present with abnormal vital signs, altered mental status, hypoxia, or unstable arrhythmia, and require supplemental oxygen, intravenous access and, possibly, intubation. Subsequent management depends on the differential diagnosis established by a proper history, physical examination, and ancillary studies. Dyspnea is most commonly caused by respiratory and cardiac disorders. Other causes may be upper airway obstruction, metabolic acidosis, a psychogenic disorder, or a neuromuscular condition. Differential diagnoses in children include bronchiolitis, croup, epiglottitis, and foreign body aspiration. Pertinent history findings include cough, sore throat, chest pain, edema, and orthopnea. The physical examination should focus on vital signs and the heart, lungs, neck, and lower extremities. Significant physical signs are fever, rales, wheezing, cyanosis, stridor, or absent breath sounds. Diagnostic work-up includes pulse oximetry, complete blood count, electrocardiography, and chest radiography. If the patient is admitted to the emergency department or hospital, blood gases, ventilation-perfusion scan, D-dimer tests, and spiral computed tomography can help clarify the diagnosis. In a stable patient, management depends on the underlying etiology of the dyspnea.