The seventh national communication of Malta under the United Nations framework convention on climate change

This is the fourth time that Malta is submitting a National Communication under the United Nations Framework Convention on Climate Change (UNFCCC), following the submission of a First National Communication in 2004 and a Second National Communication in 2010. This is also the second time that Malta is submitting such a Communication since its accession to Annex I status under the Convention, the first two submissions having been made as a non-Annex I Party. Emission reduction or limitation commitments applicable to Malta Malta’s status under the Convention up to the time it applied for accession to Annex I, and with that accession being conditional to not taking on quantified emission limitation or reduction targets for the first commitment period of the Kyoto Protocol, meant that until 2012 Malta was not subject to an economy-wide greenhouse gas related obligation under the Protocol. This however did not mean that Malta had no obligations to limit or reduce emissions from anthropogenic activities taking place in the country. In line with, Malta will be contributing its fair share of the EU’s unconditional commitment under the Convention to reduce emissions by 20% below 1990 levels by 2020. This is in line with the target inscribed in the amendments to the Kyoto Protocol (the Doha Amendments), that will be jointly fulfilling the second commitment period with the other Union member states; therefore, emissions from the aforementioned power plants remain subject to compliance with EU Emissions Trading Scheme provisions, while the Effort-Sharing Decision target is the principal emissions mitigation obligation that the country has until 2020, for all other greenhouse gas emissions. The major point sources of greenhouse gas emissions in Malta, namely the electricity generation plants have been, since of 2005, subject to the EU Emissions Trading Scheme, whereby they are required to surrender allowances in respect of emissions of carbon dioxide. Emissions of greenhouse gases not covered by the EU Emissions Trading Scheme, are subject to an overall limit under the so-called Effort-Sharing Decision. Under this decision, Malta must limit such greenhouse gases to not more than 5% over emission levels in 2005, by 2020. The EU is already looking towards the longer-term future, with the 2030 climate and energy framework providing for a 40% domestic reduction target for 2030. Legislative implementation of this goal is currently under discussion at EU level.peer-reviewe

Acupuncture for IVF and assisted reproduction : an integrated approach to treatment and management /

Incorporating orthodox medical theory and the existing evidenced-base for the use of acupuncture therapy, Acupuncture for IVF and Assisted Reproduction enables acupuncture practitioners to provide appropriate advice regarding diagnoses, orthodox tests and investigations, and tailor acupuncture treatment according to the stage of the fertility cycle, and associated underlying condition. An essential manual for all practitioners working in this area, or planning to do so.Includes bibliographical references and index.Incorporating orthodox medical theory and the existing evidenced-base for the use of acupuncture therapy, Acupuncture for IVF and Assisted Reproduction enables acupuncture practitioners to provide appropriate advice regarding diagnoses, orthodox tests and investigations, and tailor acupuncture treatment according to the stage of the fertility cycle, and associated underlying condition. An essential manual for all practitioners working in this area, or planning to do so.Print version record.Front Cover; Dedication ; Acupuncture for IVF and Assisted Reproduction: An Integrated Approach to Treatment and Management ; Copyright ; Contents ; Biographies ; IRINA SZMELSKYJ; LIANNE AQUILINA; ALAN SZMELSKYJ; Foreword ; Preface ; Acknowledgements ; Chapter 1: Subfertility overview; Introduction; Definition of Infertility Disorder; Definition of pregnancy; Definition of regular intercourse; Length of time to achieve pregnancy; Implications; Prevalence of Infertility; Infertility trends; Infertility treatment seeking; Major Causes of Subfertility from an Orthodox Medical Point of View.Common medical causes of subfertility presenting in acupuncture practiceImportance of treating both male and female partners; Contributory Subfertility Factors: The Orthodox Medical Perspective; Socioeconomic factors; Delayed parenthood; Education and financial status; Political policies; Healthcare spending; Traditions, culture, and family values; Environmental factors; Occupational factors; Overview of other factors; Increased stress levels; Nutrition, weight, and exercise; Early puberty; Sexual intercourse; Reproductive tract infections; Negative lifestyle habits.Causes of Subfertility from the TCM Point of ViewInternal causes of disease/injury through emotion; Anger; Contemplation or worry; Anxiety; Fear; Sadness and grief; Guilt; Interrelationship between the emotions, the body, and the Spirit; External causes of disease; Cold EPF; Heat/Fire EPF; Damp EPF; Miscellaneous causes of disease; Constitution; Inappropriate diet; Surgery; Social, recreational, and physical overexertion; Work and rest; Previous fertility treatment; Miscarriages; Coitus and family planning; Contraception; Summary of the causes of diseases in subfertility.Reproductive History and Development from an Orthodox Medical PerspectiveReproductive History and Development from a TCM Perspective; View and worship of fertility; Works of classical Chinese medicine physicians; Recognition by Chinese medicine of some of the fundamental concepts of fertility; Fertile window and intercourse timing; The effect of age on fertility; Importance of optimizing natural fertility; Integrated approach; Summary; References; Chapter 2: Anatomy and physiology of the reproductive system: Prerequirements for conception.Functional Anatomy of the Reproductive System from an Orthodox Medical PerspectiveFemale reproductive anatomy; The ovaries and follicles; The fallopian tubes; Uterus; Vagina; Abnormalities of the female reproductive anatomy; Ovarian factors; Tubal factors; Uterine factors; Male reproductive anatomy; Testes; Epididymides; Vas deferens; Seminal vesicles; Ejaculatory ducts, prostate gland, and prostatic urethra; Urethra; Penis; Abnormalities of the male reproductive anatomy; Sperm and Egg Production; Spermatogenesis and spermiogenesis; Structure of sperm; Oogenesis; Structure of the egg.Elsevie

Selective dorsal rhizotomy in non-ambulant children with cerebral palsy: a multi-center prospective study

PurposeAssess the effects of selective dorsal rhizotomy (SDR) on motor function and quality of life in children with a Gross Motor Function Classification System (GMFCS) level of IV or V (non-ambulatory).MethodsThis is a prospective, observational study in three tertiary neurosurgery units in England, UK, performing SDR on children aged 3-18 with spastic diplegic cerebral palsy, and a GMFCS level of IV or V, between 2012 and 2019. The primary outcome measure was the change in the 66-item Gross Motor Function Measure (GMFM-66) from baseline to 24 months after SDR, using a linear mixed effects model. Secondary outcomes included spasticity, bladder function, quality of life, and pain scores.ResultsBetween 2012 and 2019, 144 children who satisfied these inclusion criteria underwent SDR. The mean age was 8.2 years. Fifty-two percent were female. Mean GMFM-66 score was available in 77 patients (53.5%) and in 39 patients (27.1%) at 24 months after SDR. The mean increase between baseline and 24 months post-SDR was 2.4 units (95% CI 1.7-3.1, p ConclusionsSDR improved gross motor function and reduced pain in most patients at 24 months after surgery, although the improvement is less pronounced than in children with GMFCS levels II and III. SDR should be considered in non-ambulant patients

Selective dorsal rhizotomy in non-ambulant children with cerebral palsy: a multi-center prospective study.

Acknowledgements: We would like to thank Christine Sneade, Carol Lever, Beata Bigas, Morag Sangster, and Colm MacEoin (Alder Hey Physiotherapy group) for their kind assistance with the study implementation, measurement of patient outcomes during the study, and the drafting and submission of the manuscript. CSG is supported by a grant from the Wolfson Foundation.PURPOSE: Assess the effects of selective dorsal rhizotomy (SDR) on motor function and quality of life in children with a Gross Motor Function Classification System (GMFCS) level of IV or V (non-ambulatory). METHODS: This is a prospective, observational study in three tertiary neurosurgery units in England, UK, performing SDR on children aged 3-18 with spastic diplegic cerebral palsy, and a GMFCS level of IV or V, between 2012 and 2019. The primary outcome measure was the change in the 66-item Gross Motor Function Measure (GMFM-66) from baseline to 24 months after SDR, using a linear mixed effects model. Secondary outcomes included spasticity, bladder function, quality of life, and pain scores. RESULTS: Between 2012 and 2019, 144 children who satisfied these inclusion criteria underwent SDR. The mean age was 8.2 years. Fifty-two percent were female. Mean GMFM-66 score was available in 77 patients (53.5%) and in 39 patients (27.1%) at 24 months after SDR. The mean increase between baseline and 24 months post-SDR was 2.4 units (95% CI 1.7-3.1, p < 0.001, annual change 1.2 units). Of the 67 patients with a GMFM-66 measurement available, a documented increase in gross motor function was seen in 77.6% (n = 52). Of 101 patients with spasticity data available, mean Ashworth scale decreased after surgery (2.74 to 0.30). Of patients' pain scores, 60.7% (n = 34) improved, and 96.4% (n = 56) of patients' pain scores remained the same or improved. Bladder function improved in 30.9% of patients. CONCLUSIONS: SDR improved gross motor function and reduced pain in most patients at 24 months after surgery, although the improvement is less pronounced than in children with GMFCS levels II and III. SDR should be considered in non-ambulant patients