An Overview of Highway Funding In Missouri

http://www.truman.missouri.edu/ipp/publications/index.asp?ViewBy=DateEstablished in 1913, the Missouri Department of Transportation (MoDOT) is responsible for all modes of transportation including air, rail, water, and mass transit, as well as highway transportation. Unlike most other Missouri departments, the director of MoDOT is not appointed by the Governor. Rather, a group of six commissioners, appointed by the Governor and approved by the Senate, hire the director. The director then manages the day to day operations of the more than 6,650 full-time-equivalent employees. This report focuses on highway transportation, the largest, most controversial and most important of the department's transportation functions. The report provides a historical context for highway development and maintenance, an overview of the issues currently facing MoDOT and of the current funding mechanisms, a brief comparison of Missouri's highway funding rates with those of other states, and a description of the ways the revenues are distributed.Includes bibliographical referece

Implications of Water Supply for Indigenous Americans during Holocene Aridity Phases on the Southern High Plains, USA

Springs in the 40 to 50 large lake basins (\u3e15 km2) on the southern portion of the Southern High Plains (SHP) were active during periods of aridity in the Holocene when there may have been human habitation of the area. Eolian erosion of the lake floors and lunette accretion occurred as groundwater levels declined in response to decreased groundwater recharge. The declining lake floor associated with eolian erosion allowed groundwater evaporative discharge to continue, thus maintaining a groundwater gradient toward the lake. This hydrologic condition was favorable for a relatively continuous spring discharge to the lake, independent of the elevation of the lake floor. To evaluate the postulated dynamic equilibrium critical to this conclusion, 17 optically stimulated ages were determined from a 17.7-m deep core of a lunette adjacent to Double Lakes, Texas (33º 13′ 15″ N, 101º 54′ 08″ W). The core yielded sediment accumulation dates of 11,500 ± 1100, 6500 ± 700, and 4900 ± 500 yr B.P., corresponding broadly with periods of aridity known from other evidence. Based on analysis of this lunette, it is concluded that springs in Double Lakes basin probably existed throughout the Holocene with discharges similar to those observed historically. We assumed that similar dynamic equilibrium existed in the other large lake basins in the SHP and that these springs could have provided a continuous source of water for indigenous peoples during periods of prolonged aridity. The dynamic equilibrium that is proposed in this study is applicable not only to other arid and semiarid geographic areas with wind-erodible material but also over different geologic times

Implications of Water Supply for Indigenous Americans during Holocene Aridity Phases on the Southern High Plains, USA

Springs in the 40 to 50 large lake basins (\u3e15 km2) on the southern portion of the Southern High Plains (SHP) were active during periods of aridity in the Holocene when there may have been human habitation of the area. Eolian erosion of the lake floors and lunette accretion occurred as groundwater levels declined in response to decreased groundwater recharge. The declining lake floor associated with eolian erosion allowed groundwater evaporative discharge to continue, thus maintaining a groundwater gradient toward the lake. This hydrologic condition was favorable for a relatively continuous spring discharge to the lake, independent of the elevation of the lake floor. To evaluate the postulated dynamic equilibrium critical to this conclusion, 17 optically stimulated ages were determined from a 17.7-m deep core of a lunette adjacent to Double Lakes, Texas (33º 13′ 15″ N, 101º 54′ 08″ W). The core yielded sediment accumulation dates of 11,500 ± 1100, 6500 ± 700, and 4900 ± 500 yr B.P., corresponding broadly with periods of aridity known from other evidence. Based on analysis of this lunette, it is concluded that springs in Double Lakes basin probably existed throughout the Holocene with discharges similar to those observed historically. We assumed that similar dynamic equilibrium existed in the other large lake basins in the SHP and that these springs could have provided a continuous source of water for indigenous peoples during periods of prolonged aridity. The dynamic equilibrium that is proposed in this study is applicable not only to other arid and semiarid geographic areas with wind-erodible material but also over different geologic times

Rural Gambian women's reliance on health workers to deliver sulphadoxine – pyrimethamine as recommended intermittent preventive treatment for malaria in pregnancy

<p>Abstract</p> <p>Background</p> <p>The use of most anti-malarial medications is restricted during pregnancy, but two doses of sulphadoxine-pyrimethamine are recommended after the first trimester as intermittent preventive treatment in pregnancy (IPTp). In The Gambia, only 32% of women receive two doses and very little research has been conducted on women's awareness of drug safety during pregnancy. The objective of this paper was to assess whether rural Gambian women were aware of the importance of the timing of the two-dose IPT dose schedule and its relevance to drug safety.</p> <p>Methods</p> <p>This was a qualitative study in which 41 interviews and 16 focus group discussions with women, adolescents, men and traditional birth attendants were conducted. A generic qualitative approach was used to generate a theory as to why women might not participate in IPTp as recommended.</p> <p>Results</p> <p>Although most women used calendar months to count their stage of pregnancy, these months did not correlate with their concept of foetal development. Foetal growth was described following Islamic tradition as water, clot, piece of meat and human being, although there was little consensus about the order or timing in which these stages occurred. Common signs and conditions of malaria were known. Women were anxious about miscarriage and recognized that some medicines should not be taken in the first trimester, but were urged by men and traditional birth attendants to attend for antenatal care in the first trimester to "start treatment." General knowledge about the purpose of pregnancy medications and when they should be taken was poor among both men and women. One important result was that women relied entirely on health workers to provide safe drugs, at the correct time.</p> <p>Conclusion</p> <p>Women did not have relevant information to judge the safety and appropriate timing of pregnancy drugs, which made them over-reliant on health workers. They should be encouraged to date their own pregnancies in culturally relevant terms and to anticipate when and which medications they should receive.</p

Interventions for treating cholestasis in pregnancy (Review)

BACKGROUND: Obstetric cholestasis has been linked to adverse maternal and fetal/neonatal outcomes. As the pathophysiology is poorly understood, therapies have been empiric. The first version of this review, published in 2001, and including nine randomised controlled trials involving 227 women, concluded that there was insufficient evidence to recommend any of the interventions alone or in combination. This is the first update. OBJECTIVES: To evaluate the effectiveness and safety of therapeutic and delivery interventions in women with cholestasis of pregnancy. SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (20 February 2013) and reference lists of identified studies. SELECTION CRITERIA: Randomised controlled trials that compared two intervention strategies for women with a clinical diagnosis of obstetric cholestasis. DATA COLLECTION AND ANALYSIS: The review authors independently assessed trials for eligibility and risk of bias. We independently extracted data and checked these for accuracy. MAIN RESULTS: We included 21 trials with a total of 1197 women. They were mostly at moderate to high risk of bias. They assessed 11 different interventions resulting in 15 different comparisons.Compared with placebo, ursodeoxycholic acid (UDCA) showed improvement in pruritus in five (228 women) out of seven trials. There were no significant differences in instances of fetal distress in the UDCA groups compared with placebo (average risk ratio (RR) 0.67; 95% confidence interval (CI) 0.22 to 2.02; five trials, 304 women; random-effects analysis: T² = 0.74; I² = 48%). There were significantly fewer total preterm births with UDCA (RR 0.46; 95% CI 0.28 to 0.73; two trials, 179 women). The difference for spontaneous preterm births was not significant (RR 0.99; 95% CI 0.41 to 2.36, two trials, 109 women).Two trials (48 women) reported lower (better) pruritus scores for S-adenosylmethionine (SAMe) compared with placebo, while two other trials of 34 women reported no significant differences between groups.UDCA was more effective in improving pruritus than either SAMe (four trials; 133 women) or cholestyramine (one trial; 84 women), as was combined UDCA+SAMe when compared with placebo (one trial; 16 women) and SAMe alone (two trials; 68 women). However, combined UDCA+SAMe was no more effective than UDCA alone in regard to pruritus improvement (one trial; 53 women) and two trials (80 women) reported data were insufficient to draw any conclusions from. In one trial comparing UDCA and dexamethasone (83 women), a significant improvement with UDCA was seen only in a subgroup of women with severe obstetric cholestasis (23 women).Danxiaoling significantly improved pruritus in comparison to Yiganling. No significant differences were seen in pruritus improvement with other interventions.Eight trials reported fetal or neonatal deaths, with two deaths reported overall (both in the placebo groups).Women receiving UDCA and cholestyramine experienced nausea, vomiting and diarrhoea. Guar gum caused mild abdominal distress, diarrhoea and flatulence during the first days of treatment. Women found charcoal suspension unpleasant to swallow. Dexamethasone caused nausea, dizziness and stomach pain in one woman.One trial (62 women) looked at the timing of delivery intervention. There were no stillbirths or neonatal deaths in 'early delivery' or the 'await spontaneous labour' group. There were no significant differences in the rates of caesarean section, meconium passage or admission to neonatal intensive care unit between the two groups. AUTHORS' CONCLUSIONS: Different approaches to assessing and reporting pruritus precluded pooling of trials comparing the effects of UDCA versus placebo on pruritus, but examination of individual trials suggests that UDCA significantly improves pruritus, albeit by a small amount. Fewer instances of fetal distress/asphyxial events were seen in the UDCA groups when compared with placebo but the difference was not statistically significant. Large trials of UDCA to determine fetal benefits or risks are needed.A single trial was too small to rule in or out a clinically important effect of early term delivery on caesarean section.There is insufficient evidence to indicate that SAMe, guar gum, activated charcoal, dexamethasone, cholestyramine, Salvia, Yinchenghao decoction (YCHD), Danxioling and Yiganling, or Yiganling alone or in combination are effective in treating women with cholestasis of pregnancy

Conceptualisation and development of the Leg Activity Measure (LegA) for patient and carer reported assessment of activity (function) in the paretic leg in people with acquired brain injury

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