The Green Divider: A Discourse Analysis of the Kingdom Community Wind Project in Lowell, VT.

The debate around wind power in Vermont is extremely contentious and has ultimately led to a halt of new wind development. As human induced climate change poses a threat to modern society, the state of Vermont has adopted ambitious renewable energy goals that will require a large increase in renewable infrastructure across the state. Although wind power is generally supported by the population based on polling data, projects are faced with a strong opposition. The Kingdom Community Wind project, operational in 2012 in Lowell, VT, was especially contentious, and has left lasting marks on the future for wind energy development in Vermont. To understand how the issue of wind power is communicated in Vermont, I conducted a content analysis of articles published in the Caledonian Record, Burlington Free Press, and Associated Press in the year 2011 on the Kingdom Community Wind project to determine how the debate is being shaped and what frames are employed to contextualize it. This study seeks to answer the questions: Which actors are journalists prioritizing in their coverage? What frames do different actors present? How do different actors employ collective action frames? What are the greater environmental, political, and ethical meanings present in the content of the frames? In doing this research I discuss some of the core conflicts which operates under the surface of the media content, and provide recommendations for potential steps forward in Vermont’s renewable energy future

Should we use appetite stimulants for malnourished elderly patients?

Only 1 appetite stimulate, megestrol acetate oral suspension (Megace) at 400 mg or 800 mg daily, has been studied in this population. The data show only limited benefit, mixed outcomes, and potential harm (strength of recommendation: B, based on small, randomized, controlled trials)

Conceptual analysis of a lunar base transportation system

Important to the planning for a lunar base is the development of transportation requirements for the establishment and maintenance of that base. This was accomplished as part of a lunar base systems assessment study conducted by the NASA Langley Research Center in conjunction with the NASA Johnson Space Center. Lunar base parameters are presented using a baseline lunar facility concept and timeline of developmental phases. Masses for habitation and scientific modules, power systems, life support systems, and thermal control systems were generated, assuming space station technology as a starting point. The masses were manifested by grouping various systems into cargo missions and interspersing manned flights consistent with construction and base maintenance timelines. A computer program that sizes the orbital transfer vehicles (OTV's), lunar landers, lunar ascenders, and the manned capsules was developed. This program consists of an interative technique to solve the rocket equation successively for each velocity correction (delta V) in a mission. The delta V values reflect integrated trajectory values and include gravity losses. As the program computed fuel masses, it matched structural masses from General Dynamics' modular space-based OTV design. Variables in the study included the operation mode (i.e., expendable vs. reusable and single-stage vs. two-stage OTV's), cryogenic specific impulse, reflecting different levels of engine technology, and aerobraking vs. all-propulsive return to Earth orbit. The use of lunar-derived oxygen was also examined for its general impact. For each combination of factors, the low-Earth orbit (LEO) stack masses and Earth-to-orbit (ETO) lift requirements are summarized by individual mission and totaled for the developmental phase. In addition to these discrete data, trends in the variation of study parameters are presented

Childhood alopecia areata: What treatment works best?

There are no validated effective treatments for alopecia areata (AA). Topical immunotherapy (squaric acid dibutylester [SADBE] and diphenylcyclopropenone [DPCP]) induces the most significant short-term hair regrowth in children with severe AA (strength of recommendation [SOR]: C, 4 small individual cohort studies and 1 moderately sized retrospective case review). Intralesional steroids can induce hair regrowth greater than 50% in children with limited AA (SOR: C, 1 retrospective cohort study). Other commonly used treatments--topical and oral corticosteroids, topical cyclosporine, photodynamic therapy, and topical minoxidil--have no benefit over placebo (SOR: A, 14 randomized controlled trials [RCTs] and 3 within-patient studies)

What is the best way to manage phantom limb pain?

No single best therapy for phantom limb pain (PLP) exists. Treatment requires a co- ordinated application of conservative, pharmacologic, and adjuvant therapies. Evaluative management (including prosthesis adjustment, treatment of referred pain, and residual limb care) should be tried initially (strength of recommendation [SOR]: C, expert opinion). Other first-line treatments such as transcutaneous electrical nerve stimulation (TENS) (SOR: A, multiple high-quality randomized, control trials [RCTs]), and biofeedback (SOR: B, numerous case studies) can reduce PLP. Pharmaco- therapy, including opioids, anticonvulsants (gabapentin), and nonsteroidal anti- inflammatory drugs (NSAIDs), can also relieve pain (SOR: B, initial RCTs and inconsistent findings)

Chronic urticaria: What diagnostic evaluation is best?

A detailed history and 6-week trial of an H1 antihistamine are the best diagnostic evaluations for chronic urticaria. More extensive diagnostic work-up adds little, unless the patient's history specifically indicates a need for further evaluation (strength of recommendation: B, inconsistent or limited-quality evidence)

Does birth weight predict childhood obesity?

A birth weight greater than 4,000 g is associated with an increased risk of obesity in both childhood and adolescence (strength of recommendation [SOR]: B, systematic review and multiple cohort studies)

Does spinal manipulation relieve back pain?

Spinal manipulation therapy (SMT) reduces lower back pain and improves the ability to perform everyday activities more than sham therapies (strength of recommendation [SOR]: A, multiple randomized controlled trials [RCTs] and systematic reviews), but it�۪s no more or less effective than pain medication, physical therapy, exercise, back school, or care given by a general practitioner (SOR: A, meta-analysis)

Evaluation of Ovarian Cysts

Initial evaluation of an ovarian cyst is largely determined by its characteristics on ultrasonography, in addition to the presence of symptoms, laboratory evaluation, and patient history. Women with an ovarian cyst, but with no symptoms, family or personal history of cancer (e.g., ovarian, breast, colorectal), physical or laboratory evidence suggestive of infection, pregnancy, or systemic illness, are considered at low risk of ovarian cancer and may be followed with serial ultrasonography. (Strength of Recommendation [SOR]: B, based on a prospective cohort study.) A cyst identified on transvaginal ultrasonography is usually benign if it is thin-walled, unilocular, smooth-bordered, and less than 10 cm in diameter. Cyst aspiration and treatment with combined oral contraceptives do not hasten cyst resolution. (SOR: A, based on good-quality randomized controlled trials.) A complex cyst without benign features should be aggressively evaluated for ovarian cancer. (SOR: C, based on expert opinion.

What is the best nonsurgical therapy for pelvic organ prolapse?

Q. What is the best nonsurgical therapy for pelvic organ prolapse? Evidence-based answer: Pelvic floor muscle training (PFMT) and pessaries are equally effective in treating symptoms of pelvic organ prolapse (POP). PFMT transiently improves patient satisfaction and reduces urinary incontinence more than pessaries do (strength of recommendation [SOR]: B, a randomized controlled trial [RCT]). PFMT moderately improves prolapse symptoms and severity, especially following 6 months of supervised intervention (SOR: B, a systematic review of randomized trials with some methodologic flaws). Two pessaries (ring with support and Gellhorn) reduce symptoms in as many as 60% of patients (SOR: B, a systematic review of randomized trials). Untreated postmenopausal women with mild grades of uterine prolapse are unlikely to develop more severe prolapse; 25% to 50% improve spontaneously (SOR: C, a prospective cohort study with methodologic flaws)