Otologic safety of intratympanic N-acetylcysteine in an animal model.

OBJECTIVE: N-acetylcysteine (NAC) is an anti-oxidant and mucolytic effective against bacterial biofilms, making it useful in the treatment of chronically discharging ears that are unresponsive to traditional treatment methods. The objective of this study was to evaluate the otologic safety of intratympanic NAC combined with Ciprodex® in an animal model. METHODS: Baseline distortion product otoacoustic emissions (DPOAE) and auditory brainstem response (ABR) measurements were performed for both ears on thirteen guinea pigs from the animal care research facilities of the McGill University Health Center. This was followed by intratympanic administration of control solution (Ciprofloxacin 0.3%/Dexamethasone 0.1%) to the left ear and experimental solution (1.25% NAC/Ciprofloxacin 0.3%/Dexamethasone 0.1%) to the right ear. Three additional intratympanic injections were performed over the next fourteen days. DPOAE and ABR measurements were repeated 3-4 weeks after the initial procedure. Outcome measures included differences in DPOAE and ABR thresholds after intervention, clinical evidence of vestibular dysfunction and histological evidence of ototoxicity. RESULTS: There were no significant differences in the ABR thresholds and DPOAE results of the control and experimental ears at baseline and after intervention. There was neither clinical manifestation of vestibular dysfunction nor histological evidence of ototoxicity. CONCLUSION: Our study suggests that intratympanic 1.25% NAC with ciprofloxacin and dexamethasone is safe in guinea pigs and support its potential use in the treatment of chronically discharging ears. Further studies in humans are required to analyze its efficacy relative to conventional treatments. LEVEL OF EVIDENCE: Animal Research.

Comprehensive management of anterior drooling: An International Pediatric Otolaryngology Group (IPOG) consensus statement.

OBJECTIVE: To provide guidance for the comprehensive management of children referred for anterior drooling. The mission of the International Pediatric Otolaryngology Group (IPOG) is to develop expertise-based recommendations for the management of pediatric otolaryngologic disorders with the goal of improving patient care. METHODS: Survey of expert opinion by the members of the International Pediatric Otolaryngology Group (IPOG). The recommendations are derived from current expert consensus and critical review of the literature. RESULTS: Consensus recommendations include initial care and approach recommendations for health care providers who commonly evaluate children with drooling. This includes evaluation and treatment considerations for commonly debated issues in drooling management, initial work-up of children referred for anterior drooling, treatment recommendations, indications and contra-indications for rehabilitation, medical, and surgical management, as well as pros and cons of different surgical procedures in the hands of drooling management experts. CONCLUSION: Anterior drooling consensus recommendations are aimed at improving patient-centered care in children referred for sialorrhea.

Reconciling Multiple Methane Detection and Quantification Systems at Oil and Gas Tank Battery Sites.

Emission rates were estimated for >100 oil and gas production sites with significant liquid-handling equipment (tank battery sites) in the Permian Basin of west Texas. Emission estimates based on equipment counts and emission factors, but not accounting for large uninventoried emission events, led to ensemble average emission rates of 1.8-3.6 kg/h per site. None of the site-specific emission estimates for individual sites, based on equipment counts, exceeded 10 kg/h. On-site drone-based emission measurements led to similar emission estimates for inventoried sources. Multiple aircraft measurement platforms were deployed and reported emissions exceeding 10 kg/h at 14-27% of the sites, and these high-emission rate sites accounted for 80-90% of total emissions for the ensemble of sites. The aircraft measurement systems were deployed asynchronously but within a 5 day period. At least half of the sites with emission rates above 10 kg/h detected by aircraft had emissions that did not persist at a level above 10 kg/h for repeat measurements, suggesting typical high-emission rate durations of a few days or less for many events. The two aircraft systems differed in their estimates of total emissions from the ensembles of sites sampled by more than a factor of 2; however, the normalized distributions of emissions for sites with emission rates of >10 kg/h were comparable for the two aircraft-based methods. The differences between the two aircraft-based platforms are attributed to a combination of factors; however, both aircraft-based emission measurement systems attribute a large fraction of emissions to sites with an emission rate of >10 kg/h.

Screening for von Willebrand disease does not impact posttonsillectomy bleeding in a low-risk population.

BACKGROUND: Bleeding is an important complication in children following tonsillectomy. Screening with coagulation tests prior to procedure is common to assess bleeding risk in the perioperative period, although ASH/ASPHO Choosing Wisely guidelines recommend against routine PT/PTT testing. Our aim was to compare von Willebrand factor antigen (VWF:Ag) and activity levels among patients with postoperative bleeding following tonsillectomy to evaluate for potential risk for bleeding. PROCEDURE: Eligible subjects were aged 0-18 without significant personal or family history of major bleeding. Postoperative bleeding diaries were collected and symptoms measured using a postoperative bleeding score. Plasma VWF levels were drawn at time of anesthesia administration. RESULTS: Postoperative bleeding occurred in 248 cases out of 1399 total subjects. Median VWF:Ag was 86 in patients with postoperative bleeding scores of 1-2, 86 for scores 3-4, 84 for scores 5-6, and 83 for scores >6, with no significant difference among groups (p = .98). Additionally, no difference was observed for subjects with multiple days of postoperative bleeding as compared to those with only 1 day of postoperative bleeding. Finally, no difference in VWF:Ag was observed for subjects whose first reported bleed occurred early in the postoperative course compared to those whose first reported bleed occurred later. VWF:Ag does not correlate with severity of bleeding, time of onset of first bleeding event, or recurrence of bleeding in healthy children with no personal or family history of bleeding who have postoperative bleeding following tonsillectomy. CONCLUSIONS: This data does not support routine von Willebrand disease screening prior to tonsillectomy.

Temporal Variability of Emissions Revealed by Continuous, Long-Term Monitoring of an Underground Natural Gas Storage Facility.

Temporal variability contributes to uncertainty in inventories of methane emissions from the natural gas supply chain. Extrapolation of instantaneous, "snapshot-in-time" measurements, for example, can miss temporal intermittency and confound bottom-up/top-down comparisons. Importantly, no continuous long-term datasets record emission variability from underground natural gas storage facilities despite substantial contributions to sector-wide emissions. We present 11 months of continuous observations on a section of a storage site using dual-frequency comb spectroscopy (DCS observing system) and aircraft measurements. We find high emission variability and a skewed distribution in which the 10% highest 3 h emission periods observed by the continuous DCS observing system comprise 41% of the total observed 3-hourly emissions. Monthly emission rates differ by >12×, and 3-hourly rates vary by 17× in 24 h. We find links to the operating phase of the facility-emission rates, including as a percentage of the total gas flow rate, are significantly higher during periods of injection compared to those of withdrawal. We find that if a high frequency of aircraft flights can occur, then the ground- and aircraft-based approaches show excellent agreement in emission distributions. A better understanding of emission variability at underground natural gas storage sites will improve inventories and models of methane emissions and clarify pathways toward mitigation.

Assessment of Regional Methane Emission Inventories through Airborne Quantification in the San Francisco Bay Area.

This study derives methane emission rates from 92 airborne observations collected over 23 facilities including 5 refineries, 10 landfills, 4 wastewater treatment plants (POTWs), 2 composting operations, and 2 dairies in the San Francisco Bay Area. Emission rates are measured using an airborne mass-balance technique from a low-flying aircraft. Annual measurement-based sectorwide methane emissions are 19,000 ± 2300 Mg for refineries, 136,700 ± 25,900 Mg for landfills, 11,900 ± 1,500 Mg for POTWs, and 11,100 ± 3,400 Mg for composting. The average of measured emissions for each refinery ranges from 4 to 23 times larger than the corresponding emissions reported to regulatory agencies, while measurement-derived landfill and POTW estimates are approximately twice the current inventory estimates. Significant methane emissions at composting facilities indicate that a California mandate to divert organics from landfills to composting may not be an effective measure for mitigating methane emissions unless best management practices are instituted at composting facilities. Complementary evidence from airborne remote sensing imagery indicates atmospheric venting from refinery hydrogen plants, landfill working surfaces, composting stockpiles, etc., to be among the specific source types responsible for the observed discrepancies. This work highlights the value of multiple measurement approaches to accurately estimate facility-scale methane emissions and perform source attribution at subfacility scales to guide and verify effective mitigation policy and action.

Airborne Assessment of Methane Emissions from Offshore Platforms in the U.S. Gulf of Mexico.

Methane (CH4) emissions from oil and gas activities are large and poorly quantified, with onshore studies showing systematic inventory underestimates. We present aircraft measurements of CH4 emissions from offshore oil and gas platforms collected over the U.S. Gulf of Mexico in January 2018. Flights sampled individual facilities as well as regions of 5-70 facilities. We combine facility-level samples, production data, and inventory estimates to generate an aerial measurement-based inventory of CH4 emissions for the U.S. Gulf of Mexico. We compare our inventory and the Environmental Protection Agency Greenhouse Gas Inventory (GHGI) with regional airborne estimates. The new inventory and regional airborne estimates are consistent with the GHGI in deep water but appear higher for shallow water. For the full U.S. Gulf of Mexico our inventory estimates total emissions of 0.53 Tg CH4/yr [0.40-0.71 Tg CH4/yr, 95% CI] and corresponds to a loss rate of 2.9% [2.2-3.8%] of natural gas production. Our estimate is a factor of 2 higher than the GHGI updated with 2018 platform counts. We attribute this disagreement to incomplete platform counts and emission factors that both underestimate emissions for shallow water platforms and do not account for disproportionately high emissions from large shallow water facilities.

Low VWF levels in children and lack of association with bleeding in children undergoing tonsillectomy.

von Willebrand disease is a common bleeding disorder, but diagnosis can be difficult in young children who have not had bleeding challenges. We sought to evaluate the correlation between bleeding and von Willebrand factor (VWF) levels in children undergoing surgical challenge with tonsillectomy. Children ages 0 to 18 undergoing tonsillectomy without a personal or family history of bleeding were enrolled prospectively following informed consent and institutional review board approval. VWF levels were obtained at the time of surgery. VWF antigen (VWF:Ag) and VWF activity (VWF:GPIbM) were tested via enzyme-linked immunosorbent assay. Bleeding score was calculated using the International Society of Hematology bleeding assessment tool (BAT). Surgical and postoperative bleeding were determined using questionnaires filled out by the surgeon and patient/family. A total of 1399 subjects were enrolled with evaluable data, with a median age of 5 years. The median VWF:Ag was 85 IU/dL and the median VWF:GPIbM was 100 U/dL. Median BAT for the entire population was 0, including those with postoperative bleeding. There was no difference in VWF level between those who experienced postoperative bleeding and those who did not, with median VWF:Ag 85 vs 85 (P = .89) and mean VWF:GPIbM 98 vs 100 (P = .5). Interestingly, there was a difference in VWF levels with age, with median VWF:Ag 81 for those younger than 3 years, 82 for those 3 to 6 years, 90 for those 7 to 10 years, and 100 for those 11 to 18 years. A similar trend was noted for VWF:GPIbM. Of the 2 to 6 year olds, 5% had VWF:Ag <50, which would meet criteria for low VWF, but only 1.8% had an abnormal BAT at study entry and only 2.5% bled after surgery. Only 1 subject with low VWF had an elevated postoperative BAT >2. These data suggest that low VWF levels do not correlate with bleeding in children undergoing tonsillectomy. In addition, VWF levels outside the adult normal range in young children may be more common than previously thought and do not necessarily predict surgical bleeding.

Top-Down Constraints on Methane Point Source Emissions From Animal Agriculture and Waste Based on New Airborne Measurements in the U.S. Upper Midwest.

Agriculture and waste are thought to account for half or more of the U.S. anthropogenic methane source. However, current bottom-up inventories contain inherent uncertainties from extrapolating limited in situ measurements to larger scales. Here, we employ new airborne methane measurements over the U.S. Corn Belt and Upper Midwest, among the most intensive agricultural regions in the world, to quantify emissions from an array of key agriculture and waste point sources. Nine of the largest concentrated animal feeding operations in the region and two sugar processing plants were measured, with multiple revisits during summer (August 2017), winter (January 2018), and spring (May-June 2018). We compare the top-down fluxes with state-of-science bottom-up estimates informed by U.S. Environmental Protection Agency methodology and site-level animal population and management practices. Top-down point source emissions are consistent with bottom-up estimates for beef concentrated animal feeding operations but moderately lower for dairies (by 37% on average) and significantly lower for sugar plants (by 80% on average). Swine facility results are more variable. The assumed bottom-up seasonality for manure methane emissions is not apparent in the aircraft measurements, which may be due to on-site management factors that are difficult to capture accurately in national-scale inventories. If not properly accounted for, such seasonal disparities could lead to source misattribution in top-down assessments of methane fluxes.

California's methane super-emitters.

Methane is a powerful greenhouse gas and is targeted for emissions mitigation by the US state of California and other jurisdictions worldwide1,2. Unique opportunities for mitigation are presented by point-source emitters-surface features or infrastructure components that are typically less than 10 metres in diameter and emit plumes of highly concentrated methane3. However, data on point-source emissions are sparse and typically lack sufficient spatial and temporal resolution to guide their mitigation and to accurately assess their magnitude4. Here we survey more than 272,000 infrastructure elements in California using an airborne imaging spectrometer that can rapidly map methane plumes5-7. We conduct five campaigns over several months from 2016 to 2018, spanning the oil and gas, manure-management and waste-management sectors, resulting in the detection, geolocation and quantification of emissions from 564 strong methane point sources. Our remote sensing approach enables the rapid and repeated assessment of large areas at high spatial resolution for a poorly characterized population of methane emitters that often appear intermittently and stochastically. We estimate net methane point-source emissions in California to be 0.618 teragrams per year (95 per cent confidence interval 0.523-0.725), equivalent to 34-46 per cent of the state's methane inventory8 for 2016. Methane 'super-emitter' activity occurs in every sector surveyed, with 10 per cent of point sources contributing roughly 60 per cent of point-source emissions-consistent with a study of the US Four Corners region that had a different sectoral mix9. The largest methane emitters in California are a subset of landfills, which exhibit persistent anomalous activity. Methane point-source emissions in California are dominated by landfills (41 per cent), followed by dairies (26 per cent) and the oil and gas sector (26 per cent). Our data have enabled the identification of the 0.2 per cent of California's infrastructure that is responsible for these emissions. Sharing these data with collaborating infrastructure operators has led to the mitigation of anomalous methane-emission activity10.

Observations of Methane Emissions from Natural Gas-Fired Power Plants.

Current research efforts on the atmospheric impacts of natural gas (NG) have focused heavily on the production, storage/transmission, and processing sectors, with less attention paid to the distribution and end use sectors. This work discusses 23 flights at 14 natural gas-fired power plants (NGPPs) using an aircraft-based mass balance technique and methane/carbon dioxide enhancement ratios (ΔCH4/ΔCO2) measured from stack plumes to quantify the unburned fuel. By comparing the ΔCH4/ΔCO2 ratio measured in stack plumes to that measured downwind, we determined that, within uncertainty of the measurement, all observed CH4 emissions were stack-based, that is, uncombusted NG from the stack rather than fugitive sources. Measured CH4 emission rates (ER) ranged from 8 (±5) to 135 (±27) kg CH4/h (±1σ), with the fractional CH4 throughput lost (loss rate) ranging from -0.039% (±0.076%) to 0.204% (±0.054%). We attribute negative values to partial combustion of ambient CH4 in the power plant. The average calculated emission factor (EF) of 5.4 (+10/-5.4) g CH4/million British thermal units (MMBTU) is within uncertainty of the Environmental Protection Agency (EPA) EFs. However, one facility measured during startup exhibited substantially larger stack emissions with an EF of 440 (+660/-440) g CH4/MMBTU and a loss rate of 2.5% (+3.8/-2.5%).

Age at diagnosis, but not HPV type, is strongly associated with clinical course in recurrent respiratory papillomatosis.

BACKGROUND: Recurrent Respiratory Papillomatosis (RRP) is a rare disease characterized by the growth of papillomas in the airway and especially the larynx. The clinical course is highly variable among individuals and there is poor understanding of the factors that drive an aggressive vs an indolent course. METHODS: A convenience cohort of 339 affected subjects with papillomas positive for only HPV6 or HPV11 and clinical course data available for 1 year or more, from a large multicenter international study were included. Exploratory data analysis was conducted followed by inferential analyses with frequentist and Bayesian statistics. RESULTS: We examined 339 subjects: 82% were diagnosed prior to the age of 18 years, 65% were infected with HPV6, and 69% had an aggressive clinical course. When comparing age at diagnosis with clinical course, the probability of aggressiveness is high for children under five years of age then drops rapidly. For patients diagnosed after the age of 10 years, an indolent course is more common. After accounting for confounding between HPV11 and young age, HPV type was minimally associated with aggressiveness. Fast and Frugal Trees (FFTs) were utilized to determine which algorithms yield the highest accuracy to classify patients as having an indolent or aggressive clinical course and consistently created a branch for diagnostic age at ~5 years old. There was no reliable strong association between clinical course and socioeconomic or parental factors. CONCLUSION: In the largest cohort of its type, we have identified a critical age at diagnosis which demarcates a more aggressive from less aggressive clinical course.

Source Apportionment of Ambient Methane Enhancements in Los Angeles, California, To Evaluate Emission Inventory Estimates.

Rapid increase in atmospheric methane (CH4) mixing ratios over the past century is attributable to the intensification of human activities. Information on spatially explicit source contributions is needed to develop efficient and cost-effective CH4 emission reduction and mitigation strategies to addresses near-term climate change. This study collected long-term ambient CH4 measurements at Mount Wilson Observatory (MWO) in Los Angeles, California, to estimate the annual CH4 emissions from the portion of Los Angeles County that is within the South Coast Air Basin (SCLA). The measurement-based CH4 emission estimates for SCLA ranged from 3.95 to 4.89 million metric tons (MMT) carbon dioxide equivalent (CO2e) per year between 2012 and 2016. Source apportionment of CH4, CO, CO2, and volatile organic compounds (VOCs) measurements were used to evaluate source categories that contributed to ambient CH4 mixing ratio enhancements (ΔCH4) at SCLA between 2014 and 2016. Results suggested ΔCH4 contributions of 56-79% from natural gas sources, 7-31% from landfills, and 4-15% from transportation sources. The SCLA-specific CH4 emission estimate made using a research grade gridded CH4 emission inventory suggested contributions of 47% from natural gas sources and 50% from landfills. Subsequent airborne measurements determined that CH4 emissions from two major CH4 sources in SCLA were significantly smaller in magnitude than previously thought. This study highlights the importance of studying the variabilities of CH4 emissions across California for policy makers and stakeholders alike.

Aerially guided leak detection and repair: A pilot field study for evaluating the potential of methane emission detection and cost-effectiveness.

Novel aerial methane (CH4) detection technologies were used in this study to identify anomalously high-emitting oil and gas (O&G) facilities and to guide ground-based "leak detection and repair" (LDAR) teams. This approach has the potential to enable a rapid and effective inspection of O&G facilities under voluntary or regulatory LDAR programs to identify and mitigate anomalously large CH4 emissions from a disproportionately small number of facilities. This is the first study of which the authors are aware to deploy, evaluate, and compare the CH4 detection volumes and cost-effectiveness of aerially guided and purely ground-based LDAR techniques. Two aerial methods, the Kairos Aerospace infrared CH4 column imaging and the Scientific Aviation in situ aircraft CH4 mole fraction measurements, were tested during a 2-week period in the Fayetteville Shale region contemporaneously with conventional ground-based LDAR. We show that aerially guided LDAR can be at least as cost-effective as ground-based LDAR, but several variable parameters were identified that strongly affect cost-effectiveness and which require field research and improvements beyond this pilot study. These parameters include (i) CH4 minimum dectectable limit of aerial technologies, (ii) emission rate size distributions of sources, (iii) remote distinction of fixable versus nonfixable CH4 sources ("leaks" vs. CH4 emissions occurring by design), and (iv) the fraction of fixable sources to total CH4 emissions. Suggestions for future study design are provided. Implications: Mitigation of methane leaks from existing oil and gas operations currently relies on on-site inspections of all applicable facilities at a prescribed frequency. This approach is labor- and cost-intensive, especially because a majority of oil and gas-related methane emissions originate from a disproportionately small number of facilities and components. We show for the first time in real-world conditions how aerial methane measurements can identify anomalously high-emitting facilities to enable a rapid, focused, and directed ground inspection of these facilities. The aerially guided approach can be more cost-effective than current practices, especially when implementing the aircraft deployment improvements discussed here.

Extrapolation of point measurements and fertilizer-only emission factors cannot capture statewide soil NO x emissions.

Maaz et al. argue that inconsistencies across scales of observation undermine our working hypothesis that soil NO x emissions have been substantially overlooked in California; however, the core issues they raise are already discussed in our manuscript. We agree that point measurements cannot be reliably used to estimate statewide soil NO x emissions-the principal motivation behind our new modeling/airplane approach. Maaz et al.'s presentation of fertilizer-based emission factors (a nonmechanistic scaling of point measures to regions based solely on estimated nitrogen fertilizer application rates) includes no data from California or other semiarid sites, and does not explicitly account for widely known controls of climate, soil, and moisture on soil NO x fluxes. In contrast, our model includes all of these factors. Finally, the fertilizer sales data that Maaz et al. highlight are known to suffer from serious errors and do not offer a logically more robust pathway for spatial analysis of NO x emissions from soil.

Aerial Interyear Comparison and Quantification of Methane Emissions Persistence in the Bakken Formation of North Dakota, USA.

We performed an infrared optical gas imaging (OGI) survey by helicopter of hydrocarbon emissions in the Bakken formation of North Dakota. One year after an earlier survey of 682 well pads in September of 2014, the same helicopter crew resurveyed 353 well pads in 2015 to examine the persistence of emissions. Twenty-one newly producing well pads were added in the same sampling blocks. An instrumented aircraft was also used to quantify emissions from 33 plumes identified by aerial OGI. Well pads emitting methane and ethane in 2014 were far more likely to be emitting in 2015 than would be expected by chance; Monte Carlo simulations suggest >5σ deviation ( p < 0.0001) from random assignment of detectable emissions between survey years. Scaled up using basin-wide leakage estimates, the emissions quantified by aircraft are sufficient to explain previously observed basin-wide emissions of methane and ethane.

Agriculture is a major source of NO x pollution in California.

Nitrogen oxides (NO x = NO + NO2) are a primary component of air pollution-a leading cause of premature death in humans and biodiversity declines worldwide. Although regulatory policies in California have successfully limited transportation sources of NO x pollution, several of the United States' worst-air quality districts remain in rural regions of the state. Site-based findings suggest that NO x emissions from California's agricultural soils could contribute to air quality issues; however, a statewide estimate is hitherto lacking. We show that agricultural soils are a dominant source of NO x pollution in California, with especially high soil NO x emissions from the state's Central Valley region. We base our conclusion on two independent approaches: (i) a bottom-up spatial model of soil NO x emissions and (ii) top-down airborne observations of atmospheric NO x concentrations over the San Joaquin Valley. These approaches point to a large, overlooked NO x source from cropland soil, which is estimated to increase the NO x budget by 20 to 51%. These estimates are consistent with previous studies of point-scale measurements of NO x emissions from the soil. Our results highlight opportunities to limit NO x emissions from agriculture by investing in management practices that will bring co-benefits to the economy, ecosystems, and human health in rural areas of California.

Airborne Methane Emission Measurements for Selected Oil and Gas Facilities Across California.

We report 65 individual measurements of methane emissions from 24 oil and gas facilities across California. Methane emission rates were estimated using in situ methane and wind velocity measurements from a small aircraft by a novel Gauss' Theorem flux integral approach. The estimates are compared with annual mean emissions reported to the U.S. Environmental Protection Agency (USEPA) and the California Air Resources Board (CARB) through their respective greenhouse gas reporting programs. The average emissions from 36 measurements of 10 gas storage facilities were within a factor of 2 of emissions reported to USEPA or CARB, though large variance was observed and the reporting database did not contain all of the facilities. In contrast, average emissions from 15 measurements of the three refineries were roughly an order of magnitude more than reported to the USEPA or CARB. The remaining measurements suggest compressor emissions are variable and perhaps slightly larger than reported, and emissions from one oil production facility were roughly concordant with a separate (not GHG reporting) bottom-up estimate from other work. Together, these results provide an initial facility-specific survey of methane emissions from California oil and natural gas infrastructure with observed variability suggesting the need for expanded measurements in the future.

Comparisons of Airborne Measurements and Inventory Estimates of Methane Emissions in the Alberta Upstream Oil and Gas Sector.

Airborne measurements of methane emissions from oil and gas infrastructure were completed over two regions of Alberta, Canada. These top-down measurements were directly compared with region-specific bottom-up inventories that utilized current industry-reported flaring and venting volumes (reported data) and quantitative estimates of unreported venting and fugitive sources. For the 50 × 50 km measurement region near Red Deer, characterized by natural gas and light oil production, measured methane fluxes were more than 17 times greater than that derived from directly reported data but consistent with our region-specific bottom-up inventory-based estimate. For the 60 × 60 km measurement region near Lloydminster, characterized by significant cold heavy oil production with sand (CHOPS), airborne measured methane fluxes were five times greater than directly reported emissions from venting and flaring and four times greater than our region-specific bottom up inventory-based estimate. Extended across Alberta, our results suggest that reported venting emissions in Alberta should be 2.5 ± 0.5 times higher, and total methane emissions from the upstream oil and gas sector (excluding mined oil sands) are likely at least 25-50% greater than current government estimates. Successful mitigation efforts in the Red Deer region will need to focus on the >90% of methane emissions currently unmeasured or unreported.