Kentucky Law Survey: Environmental Law

Under the rubric of environmental law, this Survey addresses three separate topics: air quality control, water conservation and development, and zoning. In the exploration of these three topics, relevant decisions from the Kentucky courts and the Kentucky Department for Natural Resources and Environmental Protection, as well as opinions from the Kentucky Attorney General, are analyzed

Elevated plasma levels of TIMP-3 are associated with a higher risk of acute respiratory distress syndrome and death following severe isolated traumatic brain injury.

BackgroundComplications after injury, such as acute respiratory distress syndrome (ARDS), are common after traumatic brain injury (TBI) and associated with poor clinical outcomes. The mechanisms driving non-neurologic organ dysfunction after TBI are not well understood. Tissue inhibitor of matrix metalloproteinase-3 (TIMP-3) is a regulator of matrix metalloproteinase activity, inflammation, and vascular permeability, and hence has plausibility as a biomarker for the systemic response to TBI.MethodsIn a retrospective study of 182 patients with severe isolated TBI, we measured TIMP-3 in plasma obtained on emergency department arrival. We used non-parametric tests and logistic regression analyses to test the association of TIMP-3 with the incidence of ARDS within 8 days of admission and in-hospital mortality.ResultsTIMP-3 was significantly higher among subjects who developed ARDS compared with those who did not (median 2810 pg/mL vs. 2260 pg/mL, p=0.008), and significantly higher among subjects who died than among those who survived to discharge (median 2960 pg/mL vs. 2080 pg/mL, p<0.001). In an unadjusted logistic regression model, for each SD increase in plasma TIMP-3, the odds of ARDS increased significantly, OR 1.5 (95% CI 1.1 to 2.1). This association was only attenuated in multivariate models, OR 1.4 (95% CI 1.0 to 2.0). In an unadjusted logistic regression model, for each SD increase in plasma TIMP-3, the odds of death increased significantly, OR 1.7 (95% CI 1.2 to 2.3). The magnitude of this association was greater in a multivariate model adjusted for markers of injury severity, OR 1.9 (95% CI 1.2 to 2.8).DiscussionTIMP-3 may play an important role in the biology of the systemic response to brain injury in humans. Along with clinical and demographic data, early measurements of plasma biomarkers such as TIMP-3 may help identify patients at higher risk of ARDS and death after severe isolated TBI.Level of evidenceIII

Asteroid and comet flux in the neighborhood of the earth

Significant advances in the knowledge and understanding of the flux of large solid objects in the neighborhood of Earth have occurred. The best estimates of the collision rates with Earth of asteroids and comets and the corresponding production of impact craters are presented. Approximately 80 Earth-crossing asteroids were discovered through May 1988. Among 42 new Earth-crossing asteroids found in the last decade, two-thirds were discovered from observations at Palomar Observatory and 15 were discovered or independently detected in dedicated surveys with the Palomar Observatory and 15 were discovered or independently detected in dedicated surveys with the Palomar 46 cm Schmidt. Probabilities of collision with Earth have been calculated for about two-thirds of the known Earth-crossing asteroids. When multiplied by the estimated population of Earth-crossers, this yields an estimated present rate of collision about 65 pct higher than that previously reported. Spectrophotometric data obtained chiefly in the last decade show that the large majority of obvserved Earth-crossers are similar to asteroids found in the inner part of the main belt. The number of discovered Earth-crossing comets is more than 4 times greater than the number of known Earth-crossing asteroids, but reliable data on the sizes of comet nuclei are sparse. The flux of comets almost certainly was highly variable over late geologic time, owing to the random perturbation of the Oort comet cloud by stars in the solar neighborhood

Intermediate reading exercises for use with the Durrell Analysis of Reading Difficulty.

Thesis (Ed.M.)--Boston Universit

Animal Assisted Therapy in a Special Needs Dental Practice: An Interprofessional Model for Anxiety Reduction

Purpose: Individuals with intellectual and developmental disabilities (IDD) suffer from poor oral hygiene and periodontal disease that may predispose them to systemic diseases. In order to receive dental care, the assistance of a certified registered nurse anesthetist (CRNA) is often needed. The role of the CRNA is to provide sedation to reduce the high level of anxiety demonstrated by many individuals with intellectual disabilities in the dental suite. However, this can become a challenge with patients that are anxious when they arrive. The purpose of this paper is to describe an interprofessional dental team that added a certified therapy dog and handler to reduce anxiety of individuals with IDD when they arrive in the dental suite.Methods: A convenience sample of 30 individuals with intellectual disability seen for dental care in an outpatient setting met with a therapy dog prior to receiving preventative dental care. Comparisons were made between observed anxiety levels and behaviors measured by the ADAMS (anxiety scale) and a researcher-developed behavior tool prior to and after the interaction with the therapy dog.Results: This program suggested that the addition of the therapy dog to the interprofessional team prior to sedation decreased anxiety levels and improved the behavioral outcomes of the individual with intellectual disabilities.Conclusions: The incorporation of a certified therapy dog and handler as part of an interprofessional healthcare team in the dental suite may pay great dividends in improving the compliance and comfort of the individual with intellectual and developmental disabilities during dental care visits

Animal Assisted Therapy in a Special Needs Dental Practice: An Interprofessional Model for Anxiety Reduction

Purpose: Individuals with intellectual and developmental disabilities (IDD) suffer from poor oral hygiene and periodontal disease that may predispose them to systemic diseases. In order to receive dental care, the assistance of a certified registered nurse anesthetist (CRNA) is often needed. The role of the CRNA is to provide sedation to reduce the high level of anxiety demonstrated by many individuals with intellectual disabilities in the dental suite. However, this can become a challenge with patients that are anxious when they arrive. The purpose of this paper is to describe an interprofessional dental team that added a certified therapy dog and handler to reduce anxiety of individuals with IDD when they arrive in the dental suite. Methods: A convenience sample of 30 individuals with intellectual disability seen for dental care in an outpatient setting met with a therapy dog prior to receiving preventative dental care. Comparisons were made between observed anxiety levels and behaviors measured by the ADAMS (anxiety scale) and a researcher-developed behavior tool prior to and after the interaction with the therapy dog. Results:This program suggested that the addition of the therapy dog to the interprofessional team prior to sedation decreased anxiety levels and improved the behavioral outcomes of the individual with intellectual disabilities. Conclusions:The incorporation of a certified therapy dog and handler as part of an interprofessional healthcare team in the dental suite may pay great dividends in improving the compliance and comfort of the individual with intellectual and developmental disabilities during dental care visits