Riverkeeper

The rich capacity of scene setting involves the five senses and an exploration of the nuances of place. Scene setting readies the protagonist for action and connects them to others through the sociometric matrix and contains them in a safe, profound space. The power of setting a scene is often truncated in deference to moving quickly into the full action phase of the drama. Attention to the rich capacity contained within the building of a scene, involving the senses and exploring the nuances of place, can often not only ready the protagonist for action, but connect them to others through the sociometric matrix of surplus reality. Through the re-storying of memories and the opening of new neuro network pathways, protagonists come to a richer understanding of the surplus reality of place being co-created in the socio-matrix within the group.

Abstract Stemming biodiversity loss requires greater investment in conservation and more efficient use of available resources. Prioritizing conservation actions that yield the most biodiversity benefit for the least cost can help maximize return on investment. Actions that have co‐benefits for other objectives, such as climate change mitigation, can also help mobilize additional funds for conservation. We used Priority Threat Management to identify actions to secure the greatest number of species groups of conservation concern for the least cost in the Lake Simcoe‐Rideau ecoregion, Ontario—one of Canada's biodiversity crisis ecoregions. We also estimated the carbon sequestration benefits of actions related to land protection and restoration. We found that without additional investment in conservation, 13 of 16 species groups were expected to have <50% probability of persistence in this ecoregion by 2050. Implementing all proposed strategies would yield the greatest biodiversity benefits and secure 12 of the 16 species groups with ≥60% probability of persistence, at a cost of CA$113 million per year over 27 years. In comparison, investing CA$97 million per year in landowner stewardship, habitat protection and restoration and regeneration strategies could secure 10 species groups and improve the probability of persistence of one additional group from 39% to 55%. The habitat protection and restoration strategies also deliver direct carbon benefits of around 11.2 Mt in total avoided CO 2 emissions and 137.6 Mt CO 2 in total potential sequestration, respectively, over the long‐term, thus supporting alignment with climate change mitigation targets and delivering co‐benefits that may further justify investment. Practical implication. By estimating the costs and demonstrating the expected benefits and potential carbon co‐benefits of conservation actions, Priority Threat Management can help maximize return on investment and identify actions that address multiple environmental crises.

Abstract The tokenization of the voluntary carbon market offers an innovative solution to address current problems like fragmentation, inefficiency, and lack of transparency in global emissions trading. While regulated carbon markets are subject to strict regulations, the voluntary CO₂ market remains characterized by a lack of trust, inconsistency, and price volatility, making participation challenging for businesses and communities—especially in developing countries. Blockchain technology can create a more transparent, efficient, and tamper-proof platform by tokenizing CO₂ certificates. Through smart contracts and decentralized ledgers, issues such as double counting and “zombie credits” can be mitigated, while also enabling verifiable carbon accounting. A tokenized CO₂ market also has the potential to promote financial inclusion. It allows local communities and small businesses to participate in CO₂ reduction projects and generate revenue from certificate trading. Additionally, automating transactions and reducing bureaucratic hurdles facilitate market access for new participants. Despite these benefits, challenges such as blockchain interoperability, regulatory uncertainty, and the need for standardized certification persist. Advancing this market requires international collaboration and clear guidelines to ensure the credibility and effectiveness of tokenization.

We describe hitherto unreported physiological low-grade 68Ga-PSMA-11 uptake in dural sinuses of patients who underwent 68Ga-PSMA-11 PET/CT for evaluation of prostate carcinoma. A strong positive correlation was found between SUVmax of tracer uptake in dural sinuses and SUVmax of blood pool activity in superior vena cava. Low-grade 68Ga-PSMA-11 uptake seen in dural sinuses is physiological and is most likely result of venous blood pool activity. Such uptake should not be interpreted as pathological. Knowledge of such physiological uptake is essential for optimal interpretation of PSMA PET/CT images and differentiating physiological versus pathological uptake.

This case study emerged from the necessity to reschedule an in-person long case examination to an online platform for physician assistant students' final clinical examination during COVID-19 restrictions. The aim of this study was to evaluate the experiences of students and examiners for a high stakes' clinical examination online. This was an evaluation research study using the Context, Input, Process, Product model, which provided a framework to establish the effectiveness and/or success of an online format for a high stakes' clinical examination. All students and examiners were invited to take part in virtual interviews. The results suggest that both students (n = 5) and examiners (n = 7) agree that, although the stress of a face-to-face examination was lessened for the student, this was balanced by a new stressor of potential Internet problems. All agreed that a virtual setting for a high stakes' assessment is not transferable, with both groups citing the lack of opportunities to "read the patient" and "showcase their physical examination skills" as challenging. Our study suggests that, in the context of balancing the risks of the pandemic with graduating health care professionals, the online clinical examination format met the required assessment criteria. Recommendations suggest that the long case could be planned so that students and patients are in the same setting to perform a physical examination, confirming the finding that questions on "how to" examine a patient are no substitute for "doing."

The COVID-19 pandemic prevented centers from providing in-person interactive training programs such as the Rural Trauma Team Development Course. Adapting the course to a virtual platform is an option, yet little is known regarding the feasibility of using this format. This study aimed to evaluate the feasibility of providing a virtual rural trauma development course during COVID-19. This is a descriptive study of emergency medical technicians, nurses, emergency department technicians, and physicians from four rural community health care facilities and local emergency medical services who participated in a virtual Rural Trauma Team Development Course held in November 2021 which was transformed into a virtual platform using live remote interactive lectures, recorded case-based scenarios, and interactive virtual-based questions. The course was evaluated by the changes instituted at the centers based on program recommendations and a participant survey. A total of 41 participants were studied, of whom 31 (75%) returned the emailed postprogram survey. The majority (>75%) of respondents rated the activity as very good, with course objectives met. All four facilities instituted changes following the program, including enhancing policy and procedures, guidelines, advancing performance improvement triggers, and equipment acquisition. Individual-reported participant satisfaction was very high. The Rural Trauma Team Development Course can be provided virtually and is a feasible option for trauma centers to provide initial trauma management in the rural community in a safe pandemic-restrictive atmosphere.

Organization change (OC) is increasingly important in today's volatile world. Understanding OC is a growing emphasis of management and organization (M&O) research and the singular focus of OC scholarship and practice. We show how selected M&O theories inform OC at the organization level. These theoretical perspectives diverge on issues central to OC. We explore what these conceptual differences mean for OC study and practice going forward.

There is a clinical necessity for dry eye disease treatments that perform across a broad range of presenting patient severities. Varenicline solution nasal spray (VNS), a unique cholinergic agonist ocular surface-sparing nasal spray therapy, demonstrated significant improvement in both signs and symptoms of dry eye disease in subjects with mild, moderate, and severe symptoms as the clinical studies enrolled a more real-world patient population. This study evaluated efficacy outcomes for VNS in patients with mild-moderate and severe dry eye disease. An analysis of integrated data from two randomized clinical trials, ONSET-1 (NCT03636061) and ONSET-2 (NCT04036292) (vehicle control [VC], n = 294; VNS 0.03 mg, n = 308), was performed. Adults 22 years or older with dry eye disease, Ocular Surface Disease Index score of ≥23, corneal fluorescein staining score of ≥2 in ≥1 regions/≥4 all regions, and Schirmer Test Score (STS) of ≤10 mm (no restrictions on Eye Dryness Score [EDS]) were included in this study. Efficacy was evaluated using analysis of covariance among pre-specified subgroups of mild-moderate and severe baseline disease severity defined by STS (≤5 vs. >5) and EDS (<60 vs. ≥60). Consistency of effect was evaluated by interaction tests. No treatment-subgroup interactions were observed for all end points ( P > .05). The odds of achieving a ≥10-mm improvement in STS for VNS versus VC for patients with baseline STS ≤5 and >5 were 3.4(95% confidence interval, 2.0 to 5.6) and 2.3(1.3 to 4.0) and for EDS of <60 and ≥60 were 3.4(1.9 to 6.1) and 2.5(1.5 to 4.0). Least-squares mean treatment/VC differences in change from baseline in EDS for patients with baseline STS ≤5 or >5 were -7.4(95% confidence interval, -12.5 to -2.4) and -2.8(-8.7 to 3.1); EDS of <60 and ≥60 were -2.9(-8.3 to 2.5) and -8.1(-13.6 to -2.6). Compared with VC, VNS improved tear production and patient-reported symptoms in patients with dry eye disease, demonstrating consistency of effect regardless of initial presenting severity.

The Naming of Bones The hardest part of separating another human being into teachable pieces? Not the chemicaled skin that dulls scalpels. Not the stare of warped pupils as your hacksaw catches and jerks in the skull. Not dicing genitals, bringing the dark parts of sex to light. Not scraping tendon from glistening femur to find cartilage cradled in joints at either end the greater and lesser trochanters who wrap the neck like scarves the tuberosities which anchor muscle the arc of the linea aspera towards the knee. None of that. It’s the smell. Embalming solutions are chosen to capture the texture of tissues to hold the hues of purple lung and crimson liver to plump arteries. The scent overpowers what we pretend not to see. Formaldehyde ethanol glycerine they cradle each cell whisper death is long in coming convince the bodies nothing has changed. The ammonia and pickle scent dulls your attention as you dissect the dead. Sometimes, years later, your nose remembers— on your thumb as you clear sleep from your eye or below the clavicle of your lover— and you recall the bones below, their names, and how we all are joined.