Air Quality and Transportation on Colorado\u27s Front Range: Taking Responsibility for Difficult Choices

15 pages. Collection of 3 papers presented at the Hot Topics in Natural Resources Law program held on March 12, 1996. Includes biographical information for Wade Buchanan, David A. Pampu, and Christine Lipaj Shaver. With communities along Colorado\u27s Front Range continuing to grow at a rapid rate, government, private businesses and citizens are faced with difficult choices concerning air quality and transportation. Can we control the brown cloud and increasing congestion on our roads and freeways? What decisions and sacrifices must be made, and who will take responsibility for them? Wade Buchanan, Chairman of the Regional Air Quality Council (RAQC), will moderate a panel addressing these issues including David Pampu, Deputy Executive Director of the Denver Regional Council of Governments (DRCOG); Christine Shaver, Environmental Defense Fund attorney; and Ken Hotard, Senior Vice-President of the Boulder Area Board of Realtors

Air Quality and Transportation on Colorado\u27s Front Range: Taking Responsibility for Difficult Choices

15 pages. Collection of 3 papers presented at the Hot Topics in Natural Resources Law program held on March 12, 1996. Includes biographical information for Wade Buchanan, David A. Pampu, and Christine Lipaj Shaver. With communities along Colorado\u27s Front Range continuing to grow at a rapid rate, government, private businesses and citizens are faced with difficult choices concerning air quality and transportation. Can we control the brown cloud and increasing congestion on our roads and freeways? What decisions and sacrifices must be made, and who will take responsibility for them? Wade Buchanan, Chairman of the Regional Air Quality Council (RAQC), will moderate a panel addressing these issues including David Pampu, Deputy Executive Director of the Denver Regional Council of Governments (DRCOG); Christine Shaver, Environmental Defense Fund attorney; and Ken Hotard, Senior Vice-President of the Boulder Area Board of Realtors

Support for healthy breastfeeding mothers with healthy term babies

BACKGROUND: There is extensive evidence of important health risks for infants and mothers related to not breastfeeding. In 2003, the World Health Organization recommended that infants be breastfed exclusively until six months of age, with breastfeeding continuing as an important part of the infant's diet until at least two years of age. However, current breastfeeding rates in many countries do not reflect this recommendation. OBJECTIVES: To describe forms of breastfeeding support which have been evaluated in controlled studies, the timing of the interventions and the settings in which they have been used.To examine the effectiveness of different modes of offering similar supportive interventions (for example, whether the support offered was proactive or reactive, face-to-face or over the telephone), and whether interventions containing both antenatal and postnatal elements were more effective than those taking place in the postnatal period alone.To examine the effectiveness of different care providers and (where information was available) training.To explore the interaction between background breastfeeding rates and effectiveness of support. SEARCH METHODS: We searched Cochrane Pregnancy and Childbirth's Trials Register (29 February 2016) and reference lists of retrieved studies. SELECTION CRITERIA: Randomised or quasi-randomised controlled trials comparing extra support for healthy breastfeeding mothers of healthy term babies with usual maternity care. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. The quality of the evidence was assessed using the GRADE approach. MAIN RESULTS: This updated review includes 100 trials involving more than 83,246 mother-infant pairs of which 73 studies contribute data (58 individually-randomised trials and 15 cluster-randomised trials). We considered that the overall risk of bias of trials included in the review was mixed. Of the 31 new studies included in this update, 21 provided data for one or more of the primary outcomes. The total number of mother-infant pairs in the 73 studies that contributed data to this review is 74,656 (this total was 56,451 in the previous version of this review). The 73 studies were conducted in 29 countries. Results of the analyses continue to confirm that all forms of extra support analyzed together showed a decrease in cessation of 'any breastfeeding', which includes partial and exclusive breastfeeding (average risk ratio (RR) for stopping any breastfeeding before six months 0.91, 95% confidence interval (CI) 0.88 to 0.95; moderate-quality evidence, 51 studies) and for stopping breastfeeding before four to six weeks (average RR 0.87, 95% CI 0.80 to 0.95; moderate-quality evidence, 33 studies). All forms of extra support together also showed a decrease in cessation of exclusive breastfeeding at six months (average RR 0.88, 95% CI 0.85 to 0.92; moderate-quality evidence, 46 studies) and at four to six weeks (average RR 0.79, 95% CI 0.71 to 0.89; moderate quality, 32 studies). We downgraded evidence to moderate-quality due to very high heterogeneity.We investigated substantial heterogeneity for all four outcomes with subgroup analyses for the following covariates: who delivered care, type of support, timing of support, background breastfeeding rate and number of postnatal contacts. Covariates were not able to explain heterogeneity in general. Though the interaction tests were significant for some analyses, we advise caution in the interpretation of results for subgroups due to the heterogeneity. Extra support by both lay and professionals had a positive impact on breastfeeding outcomes. Several factors may have also improved results for women practising exclusive breastfeeding, such as interventions delivered with a face-to-face component, high background initiation rates of breastfeeding, lay support, and a specific schedule of four to eight contacts. However, because within-group heterogeneity remained high for all of these analyses, we advise caution when making specific conclusions based on subgroup results. We noted no evidence for subgroup differences for the any breastfeeding outcomes. AUTHORS' CONCLUSIONS: When breastfeeding support is offered to women, the duration and exclusivity of breastfeeding is increased. Characteristics of effective support include: that it is offered as standard by trained personnel during antenatal or postnatal care, that it includes ongoing scheduled visits so that women can predict when support will be available, and that it is tailored to the setting and the needs of the population group. Support is likely to be more effective in settings with high initiation rates. Support may be offered either by professional or lay/peer supporters, or a combination of both. Strategies that rely mainly on face-to-face support are more likely to succeed with women practising exclusive breastfeeding

Management of tooth resorption

The document attached has been archived with permission from the Australian Dental Association. An external link to the publisher’s copy is included.A correct diagnosis and an understanding of the aetiology and dynamics of the processes involved in tooth resorption is critical to effective management. Tooth resorptions can be classified as: (1) trauma induced; (2) infection induced; or (3) hyperplastic invasive. Some transient trauma induced resorptions require no treatment but must be carefully monitored to check that there are no complicating issues such as infection. In cases of trauma induced replacement resorption, a multidisciplinary approach is usually necessary to ensure an optimal long-term solution. Infection induced tooth resorptions require the removal of the invading micro-organisms by endodontic therapy including intra-canal medication which can also facilitate repair of the resorbed tooth structure. The hyperplastic invasive tooth resorptions pose considerable challenges in management due to the complexity and aggressive nature of the resorptive process. With careful case selection and complete inactivation of resorptive tissue successful management can be achieved.GS Heithersa

Lessons for the UK on implementation and evaluation of breastfeeding support: evidence syntheses and stakeholder engagement

Background Breastfeeding impacts multiple health outcomes but less than 50% of UK women breastfeed at 8 weeks. Women with long-term conditions face additional challenges in breastfeeding. Objectives To synthesise global and UK evidence to co-create an implementation and evaluation toolkit for cost-effective breastfeeding support in the NHS. Design Evidence syntheses with stakeholder engagement. Review methods Systematic reviews examined effectiveness of breastfeeding support for i) healthy women, and ii) women with long-term conditions using Cochrane Pregnancy and Childbirth group methods. Mixed methods systematic reviews synthesised process evaluations of effective breastfeeding support interventions for healthy women, and experiences of receiving/providing support for breastfeeding women. Cross-study synthesis integrated qualitative and quantitative findings. Systematic reviews synthesised evidence on the incremental costs and cost-effectiveness of breastfeeding support following NICE guidance. All searches were conducted May 2021 to October 2022. Stakeholder engagement and toolkit development comprised online discussions, a modified Delphi study, focus groups and four workshops. Participants were: 23 stakeholders, 16 parents in the parents panels, 15 women in the focus groups, and 87 stakeholders attended the workshops. Results We found considerably more interventions that were designed for healthy women (Review 1) compared to those aimed at women with long-term conditions (Reviews 1 and 4, approximately half the studies were targeted at groups at higher risk of poor breastfeeding outcomes, and possibly the impact of support may be different in these populations. Despite this, studies from Review 2 found that women perceived the provision of support as positive, important and needed. Studies from Review 5 echoed a range of suggestions from participants regarding potential strategies to improve breastfeeding support, with the most widely reported being the need to acknowledge the role and influence of other sources of support (e.g., partners, family, friends, peers, external professionals, web-based resources) and involving them in the provision of breastfeeding support for women with long-term conditions. In Reviews 3 and 6, there was uncertainty in the cost-effectiveness of breastfeeding support interventions due to the limited number of studies and lack of good quality evidence. Limitations There is lack of evidence for effectiveness and cost-effectiveness of breastfeeding interventions in the UK. There was often insufficient information about intervention characteristics reported. Conclusions ‘Breastfeeding only’ support probably reduces the number of women stopping any or exclusive breastfeeding. The evidence for ‘breastfeeding plus’ interventions is less consistent but may reduce the number of women stopping exclusive breastfeeding at 4-6 weeks and 6 months. We found no evidence of differential intervention effects regarding mode of provision or provider. Cost-effectiveness is uncertain due to the lack of good quality evidence. Key enablers of successful implementation were responsiveness and tailoring of interventions to both women’s and supporters’ needs. Breastfeeding support as delivered in the included studies probably has little to no effect on breastfeeding outcomes for women with long-term conditions. The mixed-methods synthesis and stakeholder work identified that existing interventions may not address the complex needs of these women. The main study output is a co-produced toolkit to guide implementation and evaluation of breastfeeding support services in the UK. Future work Evaluation of breastfeeding support for all women, in particular those at risk of poor breastfeeding outcomes (e.g., long-term conditions, deprivation). This could involve tailoring the toolkit to local contexts via implementation and effectiveness studies or using quality improvement studies

First narrow-band search for continuous gravitational waves from known pulsars in advanced detector data

Spinning neutron stars asymmetric with respect to their rotation axis are potential sources of continuous gravitational waves for ground-based interferometric detectors. In the case of known pulsars a fully coherent search, based on matched filtering, which uses the position and rotational parameters obtained from electromagnetic observations, can be carried out. Matched filtering maximizes the signalto- noise (SNR) ratio, but a large sensitivity loss is expected in case of even a very small mismatch between the assumed and the true signal parameters. For this reason, narrow-band analysis methods have been developed, allowing a fully coherent search for gravitational waves from known pulsars over a fraction of a hertz and several spin-down values. In this paper we describe a narrow-band search of 11 pulsars using data from Advanced LIGO’s first observing run. Although we have found several initial outliers, further studies show no significant evidence for the presence of a gravitational wave signal. Finally, we have placed upper limits on the signal strain amplitude lower than the spin-down limit for 5 of the 11 targets over the bands searched; in the case of J1813-1749 the spin-down limit has been beaten for the first time. For an additional 3 targets, the median upper limit across the search bands is below the spin-down limit. This is the most sensitive narrow-band search for continuous gravitational waves carried out so far

Intergenerational Justice Today

UID/FIL/00183/2013A theory of intergenerational justice consists in the study of the moral and political status of the relations between present and past or future people, more specifically, of the obligations and entitlements they can potentially generate. The challenges that justify talking about responsibilities between generations are myriad (e.g., the amount of public debt that is fair to incur; the funding of future pensions; reparations for past wrongs; climate change). And the disputes they prompt can focus on the past just as much as on the present, even though the fact that the human species has reached a state of technological progress that enables it to have an irredeemable impact on the planet and perhaps even endanger future human existence tends to make concerns about the future more pressing. Debates on intergenerational justice are twofold. The first revolves around the issue of whether claims of justice across generations whose members' lifetimes do not necessarily overlap could be justified. And the second revolves around the specific conception of justice in play, that is, around the nature of the standard that must be applied as well as around the identification of the contents of the duties that present generations supposedly have vis‐à‐vis past or future generations. This survey article depicts the conceptual and argumentative framework in which these debates are set. It aims to outline certain of the main features shared by the most influential contemporary theories of intergenerational justice, and the problems inherent in them. It concludes by suggesting that, even though the idea of succeeding generations is merely an abstraction, there are specific empirical states of affairs that require different theoretical responses to intergenerational justice.authorsversionpublishe

Self-medication for infants with colic in Lagos, Nigeria

<p>Abstract</p> <p>Background</p> <p>Infantile colic is a self-limiting condition that is distributed worldwide. It is often misdiagnosed as an organic disease for which an infant is admitted to the hospital. Many studies have described the aetiopathogenesis, pharmacologic and non-pharmacologic management of colic but none has evaluated self-medication for infants with colic. The aim of this study was therefore to determine the knowledge of Nigerian mothers about colic, their home-based management, extent of self-medication for the infants with colic and the types of medicines involved.</p> <p>Methods</p> <p>It is a prospective study conducted at the vaccination clinics of 20 primary health care centres, each from different Local Government Areas in Lagos, Nigeria. Eight hundred mothers that brought their infants for vaccination between April and September, 2006 were interviewed with open-and close-ended questionnaire.</p> <p>Results</p> <p>Six hundred and eighty three (85.4%) mothers claimed they had a good knowledge of colic. Incessant and excessive cry was the main clinical feature of colic identified by 430(62.9%) mothers. Three hundred and seventy eight (67.7%) infants were treated by self-medication, 157 (28.1%) sought medical intervention and 17 (3.1%) were treated at a traditional birth attendant home. Herbal medicines constituted 51.8% of the self-medicated medicines, of which 48 (26.2%) were "Ororo Ogiri". Nospamin^®(49.5%) and Gripe water^®(43.0%) were the two frequently prescribed and self-medicated medicines for infants with colic.</p> <p>Conclusion</p> <p>Nigerian mothers are deficient in their knowledge of colic. Self-medication was the most frequently used home-based intervention. Health education would appear necessary to improve parental management of this self-limiting condition.</p