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By: William A. Weiss, MD, PhD

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Objective Activity Outcome Progress/Milestone Focus Area #1: Strengthen the Academy’s Impact on Child Health through Policy order 10mg tapazole overnight delivery, Advocacy generic 5 mg tapazole free shipping, and Education Objective One: 1A generic 10mg tapazole amex. Coalition to purchase tapazole 10mg with visa Support Grieving Students education efforts to planning and care for 3. The final draft of the Infectious Diseases and technical report and policy statement are the Council on completed and will be shared with Environmental Health internal/external reviewers in July 2018. Webinars were children when conducted in September 2017, January 2018 responding to the Zika and March 2018. A draft Pediatric leverage ready-made Preparedness Tabletop Resource Kit was resources to promote prepared and circulated to select pediatricians state pediatric and and public health representatives for their public health planning input. Preparedness and Response Grant-Funded and strategies in public Deliverables 2017-2018. Since July 1, 2017, 8 forums (District abstract submissions were prepared (4 were meetings, conference approved, 1 was disapproved, 3 are pending). Focus Area #3: Broaden and Diversify Pathways for General Pediatricians, Pediatric Medical Subspecialists, Pediatric Surgical Subspecialists, and Trainees to Exercise Leadership within the Academy and the Broader Public Sphere beyond Pediatrics. Preparedness and Recovery, which was participation as needs and prepare and submitted in January 2018. Unfortunately, the leaders in evolving submit an application Section was not approved to move forward. Chapter Contacts were provided the opportunity to participate in the development of state preparedness funding applications. Focus Area #4: Enhance the Academy’s Communication with Members/Stakeholders Objective Five: 5A. Children and Disasters newsletter was launched stakeholder, and newsletters on a in June 2017. Outreach and Communication Activity August associations/groups 2017 meeting attendees, and Zika experts. It is and adding to the estimated that more than 50 individuals were newsletter distribution added to the listserv this past year. Webinars for clinicians and child educational outreach care providers were convened. A total of 7 to support health care What’s the Latest with the Flu messages for providers and child clinicians and child care providers were care professionals to developed. A call was achieve and maintain state-level models of held with project participants in January 2018 to financial stability to preparedness for offer and share updates on progress-to-date. PowerPoint presentation was attached to Emergency Medical encourage joint presentations on pediatric Services for Children preparedness. Activity 1A: Maintain a strong connection with federal advisory committees and entities to enhance planning and care for children in a disaster. The Academy also planned and convened 3 webinars for local providers using virtual meeting technology. This session familiarized pediatricians with the epidemiology, presentation, and diagnostic approaches for newborns and infants with a history and/or signs of Zika virus syndrome. During this session, an overview of who responds to disasters and their role was shared. Different types of disasters, including natural, chemical, biological, radiological, nuclear, and explosive disasters were discussed. The role of trainees and physicians in disasters was explained, and disaster preparedness techniques for patients and families at home and work/school were shared. A session titled, “Peds 21: Pediatricians Leading Change in Physician Health and Wellness”, st included a presentation by Dr Schonfeld. This “Pediatrics for the 21 Century” pre-conference program addressed the relationship among burnout, job satisfaction, quality care, and patient safety. Attendees left the session with the skills to implement wellness strategies for themselves, their practice, and their organizations. Opening Minds Conference: Two Pediatric Preparedness Ambassador members presented at the “Open Minds Early Education, Child Care, and School Age Conference and Expo”, in February 2018, in Chicago, Illinois. Activity 1C: Ensure children’s issues (and strategies for addressing them) are included in federal documents, regulations, and legislation. Objective 2: Strengthen formal processes to respond to child health emergencies and other pressing child health issues. Activity 2A: Produce a revised draft of the Pediatric Terrorism and Disaster Preparedness manual. Activity 2B: Address Issues specific to the Pediatric Anthrax Clinical Management. Progress: the intent form to request reaffirmation of the Pediatric Anthrax Clinical Management was submitted and approved. Activity 2C: Work with the Committee on Infectious Diseases and the Council on Environmental Health to produce a draft of the “Chemical-biological Terrorism and its Impact on Children” policy documents. Progress: Initial drafts of the technical report and policy statement were developed, and these materials will be circulated for review by internal and external stakeholders in July 2018. The webinar described the key elements of the new regulation and shared examples of activities that children’s hospitals can undertake to address the exercise requirements of this rule. The first webinar, “Planning for Hospital Pediatric Surge: Solutions Within Reach”, provided approaches for children’s hospitals to consider when planning to manage a surge of pediatric patients, including the development of a written plan and steps that can be taken to exercise the plan. Calls with Zika field assignees in 28+ departments of public health were convened. A draft Pediatric Preparedness Tabletop Resource Kit was prepared and circulated to select pediatricians and public health representatives for their input. Activity 3C: Present information, updates, and strategies in public forums (District meetings, conference sessions, etc.

Some memory difficulties can be caused by the bruises purchase 10 mg tapazole free shipping, which is why you may not remember the accident very well purchase tapazole 5 mg with visa. Like a black and blue mark on your arm or leg generic tapazole 10 mg with mastercard, these bruises will recover with time buy cheap tapazole 5 mg online. Most of the memory problems that patients notice after a head injury are not caused by bruising. If you don’t concentrate long enough, the information is never stored in your memory. Concentration problems are a normal part of recovering from a head injury and some memory trouble is a normal side effect of this. You will probably be able to concentrate and remember better when you get enough rest. Writing important things down, using a pocket tape recorder, and asking for reminders are other excellent ways of coping with temporary memory difficulties. After a head injury, it can be easy to forget that we sometimes had trouble remembering things even before the accident. Some of the symptoms you notice may actually have nothing to do with your head injury. A list of common memory “problems” is shown below along with the percentage of people who experience each “symptom” even though they didn’t have a head injury. Things We Normally Forget “Symptom” Percentage Forgets telephone numbers 58% Forgets people’s names 48% Forgets where car was parked 32% Loses car keys 31% Forgets groceries 28% Forgets reason for entering room 27% Forgets directions 24% Forgets appointment dates 20% Forgets store locations in mall 20% Loses items around the house 17% Loses wallet or pocketbook 17% Forgets content of daily conversations 17% Worrying about remembering things that you would normally forget can make your memory seem worse to you. If you can remember your memory problems, you probably don’t have Traumatic Brain Injury: A guide for patients 9 much of a memory problem! Headaches Headaches are part of the normal recovery process, but that doesn’t make them any less bothersome. Not only are they painful to experience, but frequent headaches can take a toll on you mentally and emotionally, and are a common cause of irritability and concentration problems following a head injury. This guide cannot replace the medical advice that you should get if you are bothered by headaches. Headaches can have many causes, and your doctor will want to diagnose the problem and prescribe medication that can help if you need it. One of the most common causes of headaches after a head injury is stress or tension. This is usually the cause when the headaches start for the first time several weeks after the injury. Your workday, class schedule, or daily routine should be temporarily shortened if you continue to have headaches. Stress or worry cause tension headaches by increasing muscle tension in your neck or forehead. These muscles become tense and can stay tight without you realizing it, out of habit. They can become even tighter once a headache starts, because muscles automatically tense in reaction to pain. Now clench both your hands as hard as you can and hold them that way for a moment or two before letting them relax completely. Now continue to tense and relax more muscles groups by adding a different set each time: hands, arms, face, chest, stomach, buttocks, legs, feet. Finally, tense all the muscles in your body at once as hard as you can, and then let them relax. Progressive muscle relaxation can help prevent tension headaches by relaxing your muscles. This works best if you practice it each day at about the same time for 5 minutes or so. Anxiety Worry about symptoms and problems at work is the main cause of anxiety for many patients. Anxiety should not be a problem for you if you understand that your symptoms are a normal part of recovery, get enough rest, and gradually increase your responsibilities at work. If you are anxious, chances are that you are telling yourself things that are making you that way. Usually, when people worry all the time it is out of habit, not because the things that they are telling themselves are really true. The steps you need to take to solve a problem will be the Traumatic Brain Injury: A guide for patients 10 same when you are calm as they would be if you were anxious. Confusion and trouble thinking Many people feel uncertain, perplexed, or confused after a head injury. Concentration problems, being tired, headaches, and anxiety can all make it hard to think clearly. Like these other symptoms, trouble thinking is probably a sign that you are doing too much too soon. Dizziness, visual difficulties, and light sensitivity Dizziness and visual difficulties should be checked by your doctor. These symptoms usually go away by themselves in 3-6 months or less in most patients. If you find these symptoms troublesome, your doctor may want to prescribe medication for motion sickness, or eyeglasses. Some motion sickness medications are very effective for dizziness, but can make you drowsy or reduce your attention span as side effects.

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The efficacy of these measures is best monitored with site-specific plaque samples cheap tapazole 5 mg line, as a reduction of the bacteria in the susceptible interdental region is not always adequately shown in saliva samples [31] cheap tapazole 10 mg overnight delivery. Moreover buy tapazole 10 mg cheap, they should be motivated to 10mg tapazole free shipping use and be instructed in early oral hygiene procedures and informed about further preventive measures. In various studies it could be shown that the application of Cervitec can have a preventive effect on the development and progression of early childhood caries. Two studies revealed that the preventive treatment of pregnant women reduced the transmission of mutans streptococci and caries incidence in infants. The objective of this study was to investigate the caries-preventive effect of Cervitec in pregnant women and their babies. Cervitec was applied every six months in 97 women until their children were 36 months old (control group: 60 untreated women). The caries prevalence in the children of the mothers who were treated was significantly lower than in the children of the control group (see Figure 10) [34]. The children of the mothers that were treated showed a significantly lower caries incidence (dmft) compared to the children of the control group. Adapted from Dubielecka et al, 2005 Duskova J, Broukal Z, Kratky M (2000): Inhibition of the oral Steptococcus mutans transfer in the mother and child care: results in mothers and infants in the 3rd year of study. The mothers treated with Cervitec demonstrated a lower increase in caries and plaque and a healthier gingiva compared to the control group. In addition, the prenatal and postnatal antimicrobial prophylaxis with Cervitec prevented the transmission of measurable amounts of mutans streptococci from mothers to their children [35]. The fast and easy handling of the Cervitec varnish represents an advantage, as the compliance of children is naturally limited. Plotzitza B, Kneist S, Berger J, Hetzer G (2005): Efficacy of chlorhexidine varnish applications in prevention of early childhood caries. In this study, the caries-preventive effect of Cervitec was evaluated in one-year-old children 5 at high caries risk (> mutans streptococci level of 10 cfu/ml of saliva) and compared to an untreated control group. Cervitec was applied every three months for a period of one year and the caries status evaluated in the two-year olds. It was shown that, compared to the control group, caries was significantly reduced in this risk group due to the application of Cervitec (p=0. However, the study also revealed that poor dietary habits cannot be compensated by the use of Cervitec [36]. This study, which involved 181 six-to-seven-year-old school children, investigated the caries preventive effect of Cervitec in comparison with a placebo in deciduous molars. It was shown that, after two years, the caries incidence could be reduced by 46% (p=0. No improvement of the situation could be achieved in children who already had caries [37]. When removable orthodontic appliances are worn, and in particular during orthodontic treatment with fixed orthodontic appliances, plaque is capable of adhering to the tooth surfaces more easily. If oral hygiene is insufficient, the increased accumulation of plaque and the microorganisms associated with plaque accretion may lead to enamel lesions, caries and inflammation of the gums. Several studies investigated and confirmed the caries-preventive effect of Cervitec in patients undergoing orthodontic treatment [7; 38-46]. Twenty patients with fixed orthodontic appliances and poor oral hygiene were recruited into this split mouth study. The four quadrants of each patient were either treated with ozone (which has a toxic effect on bacteria) or with a combination of Cervitec and Fluor Protector or they served as control. White spot formation was significantly lower in these quadrants than in the quadrants treated with ozone (3. Consequently, caries protection is higher after the treatment with Cervitec/Fluor Protector compared to ozone or no treatment at all [40]. Young orthodontic patients wearing removable appliances were treated with Cervitec at an interval of two to three days. Adapted from Kneist et al, 2008 the authors rated the properties of Cervitec particularly high because it does not cause discoloration. During the observation period of twelve weeks, the discoloration of teeth was evaluated. The caries risk was assessed on the basis of the mutans streptococci count in the plaque. For this purpose, the bacteria contained in the plaque samples were grown on a selective agar medium, which only allowed the growth of mutans streptococci. A follow-up examination of 60 patients revealed that the mutans streptococci counts were lower in the cases treated with the 40-% varnish compared to Cervitec. However, a difference in the efficacy of the two varnishes was no longer detectable after two months [47]. Two hundred and twenty adolescents were treated either with Cervitec and Fluor Protector or only with Fluor Protector every twelve weeks for the duration of wearing fixed orthodontic appliances (72 weeks). Another 100 adolescents who did not receive any varnish treatment served as a control group. Nagy (2000): Effect of chlorhexidine varnish on bacterial levels in plaque and saliva during orthodontic treatment. Twenty-four patients aged between 14 and 18 were treated with Cervitec or a placebo varnish after the brackets had been placed. The bacterial counts were evaluated in the saliva and plaque at baseline und after one, three, six, nine and twelve months using Dentocult.

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About 10 per cent of global water withdrawals was ducing many benefts in community health buy cheap tapazole 5 mg on line, food produc used for producing energy in 2014 (excluding hydropower) discount tapazole 10mg with amex. Water withdrawals in the energy sector cheap tapazole 10mg fast delivery, 2014 Two thirds of global water withdrawals are from sur face water and one third is from groundwater purchase tapazole 5mg free shipping. Pumping groundwater is about seven times more energy intensive than surface water abstraction. One growing concern is the increasing use of groundwater for irrigation and the impact this will have on energy demand. This source is popular among the many millions of impoverished smallholder farmers across sub-Saharan Africa and South Asia because of easy ac cess, reliability and flexibility (Shah, 2012). The link between energy requirements and groundwater pumping is direct and strong in India. India’s energy policy Growing economies will consume more energy, which is used to stimulate or control groundwater abstraction means more water will be needed for generation. However, the International Energy Agency suggests the Although 86 per cent of the world’s population has ac increase will be lower (30 per cent), with demand declin cess to electricity, there are still 1. Access to electricity is poor and population growth is overtaking progress in electrifcation (World Projections to 2040 based on 2005 fgures show less Bank, 2017e). Signifcantly more people lack access than a 2 per cent rise in water withdrawals for energy. There are no data on how many the water withdrawn for energy generation returns to the people lack both water and electricity. Beyond Sustainable Development Goal 6 Introducing electricity for pumping and water wastewater treatment are not to be constrained by treatment would increase access to water with a lack of electricity. This also applies in reverse, if the potential to improve health and well-being increasing access to energy is not to be constrained and increase growth in agricultural and industrial by the lack of water. Providing much-needed electricity in A special case that illustrates the connection be water-stressed areas may lead to conflicts among tween energy and water supply is desalination (box competing water users, with trade-offs needed to 41), which is evolving into a viable alternative water resolve them. It will be important for the water and source to combat water scarcity and water stress. Some 44 per cent of this capacity (37 million m3/day) was in the Middle East (mainly Saudi Arabia, Kuwait, United Arab Emirates, Qatar and Bahrain) and North Africa (mainly Libya and Algeria). Other countries using large desalination plants include Australia, Israel, Spain and United States. Desalinated water is produced from brackish water (salt content less than 10,000 mg/l) and seawater with a salinity in the range 30,000–44,000 mg/l. Brackish water is limited in volume, and so most desalination will be from seawater, which is abundant. This offers a logical solution for sustainable, long-term management as water demand grows in arid regions (Voutchkov, 2016). However, desalination is costly and energy intensive, requiring signifcant investments in infrastructure. Desalination also has an environmental impact that must be understood and managed. Modern reverse-osmosis de salination plants take in large volumes of seawater and discharge highly concentrated brine back into the sea. This is potentially harmful to fsh and other marine organisms such as plankton, eggs and larvae. Brine has twice the salinity of seawater and it is much denser, so the two do not mix easily. There are methods for dispersing concentrated brine that involve diluting with wastewater and encouraging mixing, but further research is needed, especially to understand the long-term impact (Cooley and others, 2013). The International Energy Agency estimates that 120 40 per cent for abstraction, 25 per cent for wastewa million tons of oil equivalent of energy was consumed ter treatment and 20 per cent for water distribution. Wastewater treatment plants can be the water sector consumed 4 per cent of the world’s designed to generate energy due to heat content and total electricity production in the same year (fgure 49): organic material. Renewables are expected to contrib the water sector is already used to treat wastewa ute nearly 60 per cent of all new electricity genera ter in developed countries. This is almost Wastewater collection and treatment will require 60 40 per cent of the total renewables increase for per cent more electricity by 2040 (figure 48). Most of this will be required matching downstream demands, often from ag in low-income countries where only 8 per cent of the riculture, and mitigating ecosystem and other industrial and municipal wastewater receives any effects do not always fit with the demands for en kind of treatment (Sato and others, 2013). A potential bonus is that the energy contained in the water consumed for irrigating biofuels is a wastewater is about 5–10 times greater than the concern. A small saving in energy use or an increase in effciency can make a big difference to water accessible for people. A saving of 1 per cent (4 billion m3) would provide enough water annually for 219 million people based on 50 litres per day as a basic access service level. This offers the prospect that solutions to water scarcity are within reach, especially if similar reductions are made in other water-using sectors such as agriculture and industry, although it is affected by location and many other factors. Achieving sustainable management reviews the opportunities and challenges for progress to of water and sanitation for all will require profound wards achievement of the goal and highlights the follow evolution of actions among policymakers and deci ing key messages. Actions need to be taken now to move towards a more sustainable and resilient path, leaving the 2030 Agenda is universal and transformative for all no one behind, if the 2030 Agenda targets are to be Member States. The global targets are relevant to poverty reduction, inequality elimination, peace and jus all countries, but their relative importance is highly tice, and the environment. Integrating Sustainable • More and better data are required for national, regional and global monitoring. It will Further work is required to standardize and harmonize ensure appropriate timing and sequencing of policy and indicators used in national and global monitoring, as institutional reforms and public investments, so that lim well as to increase understanding on how to assess ited resources are used more effciently and sustainably. Sustainable management of water and sanitation for all underpins wider efforts to end poverty and advance sustainable development.