text:
Vitamin A (retinol)
Original Article: http://www.mayoclinic.com/health/vitamin-a/NS_patient-vitamina
Vitamin A (retinol)
Natural Standard® Patient Monograph, Copyright © 2013 (www.naturalstandard.com). All Rights Reserved. Commercial distribution prohibited. This monograph is intended for informational purposes only, and should not be interpreted as specific medical advice. You should consult with a qualified healthcare provider before making decisions about therapies and/or health conditions.
Vitamin A is a fat-soluble vitamin that is derived from two sources: preformed retinoids and provitamin carotenoids. Retinoids, such as retinal and retinoic acid, are found in animal sources such as liver, kidney, eggs, and dairy produce. Carotenoids, such as beta-carotene (which has the highest vitamin A activity), are found in plants such as dark or yellow vegetables and carrots.
Natural retinoids are present in all living organisms, either as preformed vitamin A or as carotenoids, and are required for biological processes such as vision and cellular growth. A major biologic function of vitamin A (as the metabolite retinal) is in the visual cycle. Research also suggests that vitamin A may reduce the mortality rate from measles, prevent some types of cancer, aid in growth and development, and improve immune function.
Recommended dietary allowance (RDA) levels for vitamin A oral intake have been established by the U.S. Institute for Medicine of the National Academy of Sciences to prevent deficiencies in vitamin A. At recommended doses, vitamin A is generally considered nontoxic. Excess dosing may lead to acute or chronic toxicity.
Vitamin A deficiency is rare in industrialized nations but remains a concern in developing countries, particularly in areas where malnutrition is common. Prolonged deficiency can lead to xerophthalmia (dry eye) and ultimately to night blindness or total blindness, as well as to skin disorders, infections (such as measles), diarrhea, and respiratory disorders.
Related terms
3,7-Dimethyl-9-(2,6,6,trimethyl-1-cyclohexen-1-yl)-2,4,6,8-natetraen-1-ol, 3-dehydroretinol, Accutane®, acitretin, adapalene, all- trans retinoic acid, Altinac®, Amnesteem®, antixerophthalmic vitamin, Aquasol A®, Avita®, axerophtholum, beta-carotene, beta-carotene oleovitamin A, bexarotene, Differin®, etretinate, isotretinoin, Palmitate-A®, Renova®, Retin-A®, Retin-A Micro®, retinaldehyde (RAL), retinyl acetate, retinyl N-formyl aspartamate, retinyl palmitate, retinoic acid, retinol, Solatene®, Soriatane®, SourceCF®, Targretin®, tazarotene, Tazorac®, Tegison®, topical retinoids, tretinoin, Vesabiod®, Vesanoid®, Vitamax®, vitamin A USP, vitamin A1, vitaminum A.
These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.
AcneTopical retinoids are considered among the best treatments for acne. Tretinoin (all- trans retinoic acid) Avita®, Renova®, Retin-A®, Retin-A Micro®) and derivatives of vitamin A, retinoids, and oral prescription medications, such as isotretinoin (Accutane®), are available for treatment. Isotretinoin may cause severe side effects, such as burning, erythema, and pruritus, and should be used only for severe resistant acne. Adapalene (Differin®), a naphthoic acid derivative and retinoid, is also effective and reported to have fewer side effects. Another retinoid, tazarotene (Tazorac®), has shown superior either tretinoin or adapalene. In general, supplementation with any retinoid (including tretinoin) must not be used in women who are pregnant, plan to become pregnant, or have a chance of being pregnant, due to a risk of severe birth defects. These medications should be prescribed and coordinated by a qualified licensed healthcare professional. Retinoids should not be used simultaneously, due to a risk of increased toxicity. | A |
Acute promyelocytic leukemia (treatment, all-trans retinoic acid)The prescription drug all- trans retinoic acid (ATRA, Vesanoid®) is a vitamin A derivative that is an established treatment for acute promyelocytic leukemia that improves median survival in this disease. Treatment should be under strict medical supervision. Vitamin A supplements should not be used simultaneously with ATRA, due to a risk of increased toxicity. | A |
AnemiaVitamin A deficiency has been shown to impair the mobilization of iron status, impair erythropoiesis, and increase susceptibility to infection. Vitamin A supplementation has been shown to raise hemoglobin levels and serum iron concentrations, particularly in children and pregnant women. It has also been shown to enhance the efficacy of iron supplementation in patients with vitamin A deficiency and iron deficiency anemia. | A |
Malaria (supportive agent)Limited research suggests that vitamin A may reduce fever, morbidity, and parasite blood levels in patients with malaria ( Plasmodium falciparum infection). However, there is a lack of evidence suggesting that vitamin A is equivalent or superior to well-established drug therapies used for the prevention or treatment of malaria. Patients with malaria or those who are living or traveling in endemic areas should speak with a physician about appropriate measures. | A |
Measles (supportive agent)Vitamin A should be administered to children diagnosed with measles in areas where vitamin A deficiency may be present. Measles is a viral disease that can lead to serious complications, such as diarrhea, pneumonia, and encephalitis. Supplementation with vitamin A in children with measles has been shown to be beneficial, by decreasing the length and impact of the disease. Side effects such as diarrhea, pneumonia, and death have been reduced with the use of vitamin A. Management of measles should be under strict medical supervision. | A |
Mortality reduction (childhood; all-cause)Vitamin A is necessary for healthy growth and development, and recommended dietary allowances (RDAs) should be assured, particularly in children. Major causes of vitamin A deficiency in children are maternal vitamin A deficiency (thus low concentrations of vitamin A in breast milk), inadequate vitamin A intake upon weaning, and prevalent illness. Experts have maintained that in developing countries, diet alone is insufficient to main adequate vitamin A levels in children. Vitamin A is associated with a reduced risk of mortality in children. | A |
Retinitis pigmentosaRetinitis pigmentosa is a genetic disorder that affects night vision. Early symptoms include night blindness and progressive loss of vision over time. Based on recent findings, vitamin A in the palmitate form has been recommended in patients with retinitis pigmentosa. | A |
Skin damage caused by the sunSome studies suggest that topical tretinoin (all- trans retinoic acid, the acid form of vitamin A) may improve the appearance and integrity of photodamaged skin. Common adverse effects are skin pain and redness. | A |
Vitamin A deficiencyVitamin A deficiency is generally rare in industrialized nations. In developing countries, diet alone may be insufficient to maintain adequate vitamin A levels, especially in children. Vitamin A supplementation can help prevent or treat vitamin A deficiency. | A |
Xerophthalmia (dry eye)Prolonged vitamin A deficiency can lead to xerophthalmia (dry eye). It is most prevalent in rural, underdeveloped areas, such as India and Southeast Asia. Oral vitamin A is the treatment of choice for xerophthalmia caused by prolonged vitamin A deficiency, and it should be given immediately once the disorder is established. Bitot's spot, or the buildup of keratin debris in the conjunctiva, is a sign of xerophthalmia and may also be treated with vitamin A supplementation. | A |
Healing after photorefractive keratectomy (adjunct therapy)Photorefractive keratectomy is a type of laser eye surgery used to correct nearsightedness. High-dose vitamin A supplementation in addition to vitamin E has been suggested to help improve ocular healing after surgery and to improve visual acuity, although additional evidence is necessary before a definitive conclusion can be reached. | B |
HIV (supportive treatment)The role of vitamin A in the prevention, transmission, or treatment of HIV is controversial and not well established. A clear conclusion cannot be formed based on the available scientific research. | B |
Oral leukoplakiaVitamin A may improve clinical resolution of oral leukoplakia (white patches or plaque in the mouth), although relapse is common. Further research is required. | B |
Age-related macular degenerationAlthough this has not been well studied in humans, the use of vitamin A and carotenoids may be useful in the prevention of age-related macular degeneration. Further research is required. | C |
AsthmaVitamin A intake is inversely associated with asthma risk and severity. A clear conclusion cannot be formed based on the available scientific research. | C |
Breast feeding (nipple pain)Vitamin A and D ointment may be useful for sore and cracked nipples that occur during breastfeeding. However, available studies have not shown vitamin A or any other topical therapy to relieve the pain of breastfeeding. | C |
BronchiolitisVitamin A is thought to be important in immune function. A clear conclusion cannot be formed on the effects of vitamin A on bronchiolitis (inflammation of the bronchioles) based on the available scientific research. | C |
Bronchopulmonary dysplasia in premature infantsResearch results are not clear as to whether vitamin A is beneficial for bronchopulmonary dysplasia in premature infants (chronic lung condition). Further research is needed. | C |
Chemotherapy adverse effectsThe effect of vitamin A supplementation on chemotherapy-related side effects, including nausea, vomiting, diarrhea, or mouth sores, is unclear. Also, it is unclear if vitamin A interacts with chemotherapy agents. Further research is needed. | C |
Colorectal cancerAlpha-carotene and vitamin A may protect against recurrence of colorectal cancer in nonsmokers and nondrinkers or be indicative of compliance or another healthy lifestyle factor that reduces risk. Further research is needed before a conclusion can be drawn. | C |
Cystic fibrosisHuman research is lacking, and further research is needed in this field. | C |
Esophageal cancerHigher intakes of beta-carotene and vitamin A were associated with reduced risk of esophageal adenocarcinoma. There is not sufficient evidence to form a clear conclusion at this time. | C |
Liver diseaseThere is insufficient evidence to support or refute the benefits or adverse effects of antioxidant supplements (including vitamin A) in patients with liver disease. | C |
Lung cancerVitamin A has been studied as a possible treatment for lung cancer, without evidence of benefits. The available evidence suggests that high-dose vitamin A and beta-carotene may actually increase the risk of adverse effects, especially among alcohol users and smokers. | C |
Miscarriage (prevention)Poor nutrition is associated with an increased risk of miscarriage. However, excess intake of vitamin A has been reported to increase the risks of some birth defects. Vitamin A supplementation above the RDA is therefore not recommended in pregnancy. | C |
Mortality reductionAdequate vitamin A (either through diet or supplementation) appears to have a major role in the prevention of morbidity and mortality. Further research is needed. | C |
Mortality reduction (maternal; maternal supplementation postpartum)Maternal supplementation of vitamin A postpartum provides limited number of benefits to maternal health status. A clear conclusion cannot be formed based on the available scientific research. | C |
Mortality reduction (maternal; supplementation during pregnancy)Vitamin A supplementation during pregnancy and lactation does not appear to reduce infant morbidity and mortality; however, it does appear to reduce maternal morbidity. A clear conclusion cannot be formed based on the available scientific research. | C |
Parasite infection (Ascaris reinfection)After deworming, children supplemented with vitamin A may be less prone to Ascaris parasite reinfection. These benefits may be less in children with stunted growth. | C |
Prostate cancer (prevention)It is unclear whether dietary vitamin A affects prostate cancer risk. Interventional studies are lacking. More research is needed in this area. | C |
Skin cancerIt is not clear if vitamin A or beta-carotene, taken by mouth or used on the skin with sunscreen, is beneficial in the prevention or treatment of skin cancers or wrinkles. | C |
TuberculosisThere is insufficient evidence to assess vitamin A for tuberculosis. Further research is needed before a conclusion can be drawn | C |
Viral infection (Norovirus (NoV) infection)Vitamin A supplementation has been suggested to help prevent NoV infection in children and reduce the symptoms associated with NoV infections. | C |
Weight lossDaily vitamin A with calcium has been suggested for weight loss. In one study, an average loss of two pounds was reported after two years of supplementation in young women. | C |
Wound healingIn preliminary research, retinol palmitate significantly reduced rectal symptoms of radiation proctopathy, perhaps because of wound-healing effects. Further research is needed to confirm these results. | C |
ArthritisThe available evidence does not support the effectiveness of vitamin A (or combination products containing vitamin A) for the treatment of any form of arthritis. Further research is needed to confirm these results. | D |
Childhood growth promotionVitamin A is necessary for healthy growth and development, and recommended dietary allowances (RDA) should be assured, particularly in children. Overall, the available evidence has not shown significant changes in growth in children with respect to height and weight due to vitamin A. | D |
HIV (mother-to-child transmission)Overall evidence does not support the use of vitamin A supplementation in HIV-infected pregnant women to reduce mother-to-child transmission of HIV. | D |
Infant mortality (maternal postpartum supplementation)Overall, studies suggest a lack of effect of postnatal vitamin A supplementation on infant mortality. | D |
Infant mortality (maternal supplementation during pregnancy)Overall, studies suggest a lack of effect of prenatal vitamin A supplementation on perinatal or neonatal infant mortality. | D |
Respiratory tract infectionsOverall evidence is not sufficient to support the reduction of pneumonia incidence or mortality in children without measles. | D |
Cancer (gastrointestinal; prevention)The overall evidence not only suggests that vitamin A does not reduce the rates of gastric cancer or precancerous gastric lesions but also links vitamin A supplementation with increased mortality. | F |
A Strong scientific evidence for this use
B Good scientific evidence for this use
C Unclear scientific evidence for this use
D Fair scientific evidence against this use (it may not work)
F Strong scientific evidence against this use (it likely does not work)
Uses based on tradition or theory
The below uses are based on tradition or scientific theories. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.
Aging, AIDS (adjunct), allergic rhinitis, autism, burns, cancer (treatment), candidiasis, cataracts, cervical cancer, chemical sensitivities (pollutant protection), chronic diseases (prevention), conjunctivitis, Crohn's disease, deafness, deficiency (protein), diabetes, diarrhea, dysentery (shigellosis), dysmenorrhea, eczema, epilepsy, fibrocystic breast disease, gastric ulcers, glaucoma, hay fever, headache (persistent), heart disease, hepatocellular carcinoma (chemoprevention), herpes (cold sores), hyperthyroidism, immune enhancement, increasing sperm count, infections (general, nose), kidney stones, lichen planus pigmentosus, menorrhagia (heavy menstruation), metabolic disorders (Hurler syndrome), mouth cancer, neurodegenerative diseases, nutritional supplement, pancreatic cancer, pancreatitis, periodontal disease, pityriasis rubra pilaris, premenstrual syndrome (PMS), psoriasis, respiratory disorders, sebaceous cysts, sinus infections, sinusitis, skin disorders (Darier's disease, ichthyosis), sleep (regulation), smell disorders, stroke, sunburn, tinnitus, tumors (neoplasms), ulcers (stress ulcers in severely ill hospitalized patients), urinary tract infection, vaginal atrophy, vaginal infections, vaginitis, vascular diseases (prevention), vision enhancement (nearsightedness, blurred vision), warts, yeast infection.
The below doses are based on scientific research, publications, traditional use, or expert opinion. Many herbs and supplements have not been thoroughly tested, and safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients, even within the same brand. The below doses may not apply to all products. You should read product labels, and discuss doses with a qualified healthcare provider before starting therapy.
Adults (18 years and older)
Vitamin A is found in dairy products, fish, and darkly colored fruits and vegetables. Consumption of five servings of fruits and vegetables daily supplies 5-6 milligrams daily of provitamin A carotenoids, which provides about 50-65% of the adult recommended dietary allowance (RDA) for vitamin A.
Vitamin A is included in most multivitamins, often in 5,000 IU doses as softgels, capsules, tablets, or liquid. U.S. RDAs for adults have been established by the U.S. Institute of Medicine of the National Academy of Sciences. The recommendations are as follows: 900 micrograms daily (3,000 IU) for men and 700 micrograms daily (2,300 IU) for women. For pregnant women 19 years old and older, 770 micrograms daily (2,600 IU) is recommended. For lactating women 19 years old and older, 1,300 micrograms daily (4,300 IU) is recommended.
For vitamin A deficiency not involving xerophthalmia, the following has been used: 100,000 IU by mouth or injected into the muscle daily for three days, followed by 50,000 IU daily for two weeks. A maintenance dose of 10,000-20,000 IU daily for two months has been recommended.
For community-based in intervention, 200,000 IU has been taken as a single dose by mouth monthly for six months.
For acute promyelocytic leukemia (treatment), all- trans retinoic acid (Vesanoid® (tretinoin)) has been administered as follows: 45 milligrams per square meter of body surface area daily by mouth, as two evenly divided doses until complete remission; therapy should be discontinued 30 days after the achievement of complete remission or after 90 days of treatment, whichever occurs first.
For HIV, vitamin A (400,000 IU in adults and 50,000 IU in infants) has been given to women and infants by mouth during the postpartum period for two years.
For mortality reduction, 1,333-200,000 IU has been taken by mouth daily or on alternate days for 28 days to 12 years.
For oral leukoplakia, 300,000 IU has been taken by mouth weekly for 12 months or 200,000 IU has been taken by mouth weekly for six months or 1-2 milligrams of 13- cis -retinoic acid per kilogram of body weight has been taken by mouth daily for three months. Topical 0.1% isotretinoin gel three times daily for four months or a topical formulation of 20 milligrams of acitretin daily in a two-layer mucoadhesive tablet has been used.
For retinitis pigmentosa, the National Eye Institute (NEI) recommends that patients with typical forms receive 15,000 IU of supplemental vitamin A palmitate daily under medical supervision.
For tuberculosis, 5,000-200,000 IU has been taken three times by mouth prior to antituberculosis medication.
For UV-induced skin damage, topical all- trans retinoic acid (tretinoin, the acid form of vitamin A), at a concentration of 0.02% or higher, has been used over a period of 4-11 months.
Supporting care following chemotherapy may include weekly injections of 100,000 IU of vitamin A. Patients receiving vitamin A should be observed carefully for liver toxicity.
Injections should always be performed by a licensed healthcare provider.
Children (under 18 years old)
Recommended dietary allowances (RDAs) have been established by the U.S. Institute of Medicine of the National Academy of Sciences. The recommendations are as follows: for children 1-3 years old, 300 micrograms (1,000 IU) daily; for children 4-8 years old, 400 micrograms (1,300 IU) daily; and for children 9-13 years old, 600 micrograms (2,000 IU) daily. For pregnant women 14-18 years old, 750 micrograms (2,500 IU) daily is recommended. For lactating women 14-18 years old, 1,200 micrograms (4,000 IU) daily is recommended.
The World Health Organization (WHO) has established dosage guidelines for children 6-11 months old to receive 100,000 IU of vitamin A. This increases to 200,000 IU every six months from 12 to 59 months of age.
For anemia, 3,000 micrograms of vitamin A has been taken by mouth daily for two months.
For bronchopulmonary dysplasia in premature infants, 2,000 IU on alternate days to 4,000 IU three times weekly by mouth has been taken.
For childhood growth promotion, 60 milligrams of vitamin A has been taken for up to six months.
For cystic fibrosis, the 2002 cystic fibrosis guidelines recommend vitamin A supplements for all children with cystic fibrosis and pancreatic insufficiency, specifically 3,000 micrograms of retinol activity equivalents (RAEs) daily for children over the age of eight years.
For infant mortality, the following has been taken: three milligrams by mouth daily from 18 to 28 weeks' gestation; 7,000 micrograms by mouth once weekly during gestation; 5,000-10,000 IU daily by mouth from 12-24 weeks' gestation; 200,000 IU weekly, or 200,000 IU at time of delivery; and 200,000-400,000 IU daily by mouth postpartum. A dose of 2,000 IU has been taken every two days for 28 days, injected into the muscle of infants. Also injected into the muscle, 4,000 IU every two days or 3,750 IU every two days for 16 days has been used. Doses between 1,500 and 5,000 IU, by mouth or injected into the muscle of the infant, have been used every other day or three times weekly. Doses from 8,333 IU weekly to 200,000 IU every six months by mouth have been used.
For malaria, children aged 6-60 months were given one capsule (or half a capsule if younger than 12 months) of 200,000 IU of vitamin A (in 200 microliters of peanut oil with 10 micrograms of vitamin E as a preservative) every three months for 13 months.
For measles, the World Health Organization (WHO) recommends 200,000 IU daily by mouth for two days for children with measles who live in areas of vitamin A deficiency. For infants with measles, the WHO recommends 100,000 IU daily by mouth for two days.
For childhood mortality, does from 8,333 IU weekly to 200,000 IU every six months by mouth have been used. Doses from 10,000 IU weekly for 40 weeks to 206,000 IU once very four months, for up to six doses, have been used.
For HIV, a large dose of vitamin A (400,000 IU in adults and 50,000 IU in infants) has been given to women and infants during the postpartum period for two years.
For xerophthalmia (dry eye), the World Health Organization (WHO) recommends 200,000 IU daily by mouth immediately on diagnosis, 200,000 IU on the following day, and then 200,000 IU prior to discharge, or if clinical deterioration occurs, or 2-4 weeks later. Infants under 12 months of age and very small and very-low-weight children should be given half the dosage.
The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.
Avoid in individuals with a known hypersensitivity or allergy to vitamin A or any component of the formulation.
Side Effects and Warnings
Vitamin A is considered safe when consumed in recommended dietary allowances (RDAs). Adults who eat fortified foods with vitamin A, such as low-fat dairy products and a lot of fruits and vegetables, generally do not require supplements or multivitamins that contain vitamin A.
Adverse effects from vitamin A may include mouth ulcers, cracked lips, psoriasis flare-ups, cracked fingernails, sore eyes, scaling skin, hair loss, skin irritation, skin dryness, pain, and redness (topical analogs), as well as diarrhea, dyspepsia, steatosis (fatty change), perisinusoidal fibrosis (in the liver), chronic hepatitis, cirrhosis, transient fullness and bulging of the anterior fontanelle, cough, fever, respiratory infection, and increased risk of lung cancer, HIV transmission (through breastfeeding), and mortality.
Vitamin A toxicity, or hypervitaminosis A, is rare in the general population. Vitamin A toxicity can occur with excessive amounts of vitamin A taken over short or long periods of time. Consequently, toxicity can be acute or chronic. Symptoms of acute (short-term) toxicity include nausea, headache, fatigue, loss of appetite, dizziness, dry skin, desquamation (loss of skin), and cerebral edema (swelling in the brain). Symptoms of chronic (longer-term) toxicity include dry itchy and cracking skin, desquamation, dry lips, scaling anorexia, headache, psychiatric changes, cerebral edema, bone and joint pain, osteoporosis, and hip fracture. Severe toxicity can lead to eye damage, high levels of calcium, and liver damage. In children, signs of toxicity include irritability, drowsiness, dizziness, delirium, coma, vomiting, diarrhea, increased intracranial pressure with bulging fontanelles in infants, headache, swelling of the optic (eye) disk, bulging eyeballs, visual disturbances, and skin redness and peeling.
Persons with liver disease and high alcohol intake may be at risk for hepatotoxicity from vitamin A supplementation. Vitamin A toxicity may lead to intrahepatic cholestasis, a condition where bile cannot flow from the liver into the intestines. Treatment with ursodeoxycholic acid has been shown to greatly improve the symptoms of cholestasis.
Use cautiously in children and infants, as high-dose vitamin A has been shown to increase the risk of respiratory infection in preschool-aged children and infants less than one month of age.
Use cautiously in combination with bile acid sequestrants, oral contraceptives, mineral oil, neomycin, or orlistat, due to reduced absorption of vitamin A.
Use cautiously in combination with alcohol or anticancer agents, due to the potential for increased risk of adverse effects.
Vitamin A may increase the risk of bleeding. Avoid in patients with bleeding disorders or those taking drugs that may increase the risk of bleeding.
Avoid in combination with tetracycline antibiotics, hepatotoxic agents, or retinoids, due to the increased risk of toxic effects.
Avoid in patients with fat malabsorption syndromes, intestinal infections, severe protein energy malnutrition, liver disease, or type V hyperlipoproteinemia (a genetic disorder).
Smokers who consume alcohol and beta-carotene may be at an increased risk for lung cancer or cardiovascular disease. High-dose vitamin A and beta-carotene should be avoided in patients at high risk of lung cancer.
Avoid in individuals with a known hypersensitivity or allergy to vitamin A or any component of the formulation.
Pregnancy and Breastfeeding
Vitamin A should only be used within the recommended dietary allowance, because vitamin A excess, as well as deficiency, has been associated with birth defects. Excessive doses of vitamin A have been associated with central nervous system malformations.
Vitamin A is excreted in human breast milk. The benefits or dangers to nursing infants have not been clearly established.
This patient information is based on a professional level monograph edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).
Monograph methodology
Selected references
- Becker P, Maurer B, Schirmacher P, et al. Vitamin A-induced cholestatic hepatitis: a case report. Z Gastroenterol 2007 Oct;45(10):1063-6.
- Bjelakovic G, Nikolova D, Simonetti RG, et al. Antioxidant supplements for preventing gastrointestinal cancers. Cochrane Database Syst Rev 2008 Jul 16;(3):CD004183.
- Block KI, Koch AC, Mead MN, et al. Impact of antioxidant supplementation on chemotherapeutic toxicity: a systematic review of the evidence from randomized controlled trials. Int J Cancer 2008 Sep 15;123(6):1227-39.
- Cooney TM, Johnson CS, Elner VM. Keratomalacia caused by psychiatric-induced dietary restrictions. Cornea 2007 Sep;26(8):995-7.
- Cox SE, Arthur P, Kirkwood BR, et al. Vitamin A supplementation increases ratios of proinflammatory to anti-inflammatory cytokine responses in pregnancy and lactation. Clin Exp Immunol 2006 Jun;144(3):392-400.
- Darboe MK, Thurnham DI, Morgan G, et al. Effectiveness of an early supplementation scheme of high-dose vitamin A versus standard WHO protocol in Gambian mothers and infants: a randomised controlled trial. Lancet 2007 Jun 23;369(9579):2088-96.
- Diness BR, Fisker AB, Roth A, et al. Effect of high-dose vitamin A supplementation on the immune response to Bacille Calmette-Guerin vaccine. Am J Clin Nutr 2007 Oct;86(4):1152-9.
- Kafi R, Kwak HS, Schumacher WE, et al. Improvement of naturally aged skin with vitamin A (retinol). Arch Dermatol 2007 May;143(5):606-12.
- Klemm RD, Labrique AB, Christian P, et al. Newborn vitamin A supplementation reduced infant mortality in rural Bangladesh. Pediatrics 2008 Jul;122(1):e242-50.
- Long KZ, Rosado JL, DuPont HL, et al. Supplementation with vitamin A reduces watery diarrhoea and respiratory infections in Mexican children. Br J Nutr 2007 Feb;97(2):337-43.
- Newton S, Owusu-Agyei S, Ampofo W, et al. Vitamin A supplementation enhances infants' immune responses to hepatitis B vaccine but does not affect responses to Haemophilus influenzae type b vaccine. J Nutr 2007 May;137(5):1272-7.
- Payne LG, Koski KG, Ortega-Barria E, et al. Benefit of vitamin A supplementation on ascaris reinfection is less evident in stunted children. J Nutr 2007 Jun;137(6):1455-9.
- Saltzman MD, King EC. Central physeal arrests as a manifestation of hypervitaminosis A. J Pediatr Orthop 2007 Apr-May;27(3):351-3.
- Swami HM, Thakur JS, Bhatia SP. Impact of mass supplementation of vitamin A. Indian J Pediatr. 2007 May;74(5):443-7.
- Tielsch JM, Rahmathullah L, Katz J, et al. Maternal night blindness during pregnancy is associated with low birthweight, morbidity, and poor growth in South India J Nutr 2008 Apr;138(4):787-92.


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I look like a gay Eskimo.
MoapaPk wrote:Here I am as a teenager, on the "chimney" of Chimney Mountain in the Adirondacks.
The ridiculous mop of hair, and the 5lb boots are interesting memories. Note there are trees as high as the 40' pinnacle.
Chimney is, to my knowledge, the only mountain the Adirondacks, with significant prominence, that requires a class 4 climb for the true summit.
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2 of 2 people found the following review helpful:
By Joe from USA on 2013-03-15 20:35:30 Things I liked:Good craftsmanship, no surprise here. The Walnut stock looks great and feels good against my face on a cold day, as compare to a synthetic stock. This gun shoots quieter than my RWS 34 and even quieter than my FWB 601 The Trigger is a Match trigger, light and crisp. I left it the way it came. I found it very convenient not having to unscrew the air cylinder to charge it. I just insert a charging probe into the air cylinder to fill it with air. I charged the gun to 200 bars. After 45 shots, the air pressure meter in front of the air cylinder shows 120bar. The yellow zone starts at 100 bars.Things I would have changed:I wish the wood stock has an adjustable cheek piece, and a rail under the forend of stock so that I can mount a Hand Stop or bipod. What others should know:I noticed that this barrel is thinner then my old HW100 without barrel shroud, thus I was worry that this gun may not shoot well. It likes JSB Exact Heavy, 5-shot group at 25 meters is 0.15 inch. I shot another 5-shot group, but this time it measure 0.17 inch. This tells me that a heavy thick barrel is not necessary for accuracy. Which leads me to think…Does a heavy barrel guarantee high accuracy? Perhaps a reader here can answer this. |
2 of 2 people found the following review helpful:
By Sonny Ray from USA on 2013-04-18 10:03:47 Things I liked:Well where do I start to tell you how much that I like this HW 100 TFSB First of all it is made in Germany that is where some of the very best air guns come from, Every part of this air rifle has been tested and tested agin until perfection Was meant. Mine is A 22 cal the stock is A thing of beauty and the blueing dark and rich accuracy is excellent I think you all can tell that I LOVE THIS GUN.Things I would have changed:Not A thing when you get to this point they should leave it be What others should know:When you buy an air rifle like this HW-100 TFSB you pay for what you get I have 17 teen air rifle,s two of them are the Benjamin Marauder in 22 cal & 25 cal and are great guns and are worth every penny but I just can't put my HW 100 down every thing about this gun is perfection.Beeman has sold me on this one now you try it you will love it to. |
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By Joe from USA on 2013-11-08 |
By Walter from USA on 2013-07-03 |


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MT. KISCO, N.Y. – For the second consecutive year, legendary tennis coach Nick Bollettieri and Disney singer Tiffany Giardina will headline TennisFest at the Saw Mill Club in Mt. Kisco on Sunday, May 20.
The United States Professional Tennis Association's Eastern Division organizes the free event, which will run from 9 a.m. to 4:30 p.m., and participants can receive free tennis lessons. Bollettieri will speak and the 18-year-old Giardina, who is from the New York City area, will perform.
"They enjoyed themselves so much that they're coming back. And they're doing this on gratis, also," said Bill Mecca, executive director of the USPTA Eastern Division.
Certified instructors will lead lessons, while young players can take part in USTA 10 and Under Tennis activities. Tournaments, workouts and games for young and old will also be part of the festivities.
"We are very excited to bring TennisFest back this year," Mecca said. "It is a great way to showcase all of the ways families can enjoy the sport, from private lessons and clinics to tournaments and leagues. We are also pleased to welcome back Disney singing sensation Tiffany and Nick Bollettieri, the dean of American tennis coaches, who along with other master professionals will be working with attendees to improve their games."
Mecca said the USPTA Eastern Division decided it wanted to give back to both the tennis community and non-tennis players while building a tennis program for its members. Thus, TennisFest was born.
"(We said) 'Let's have just a day of tennis, a huge tennis festival as much as we can make it,'" Mecca said.
Last year, the festivities drew 40 pro volunteers and 750 participants, many of them from New York City, New Jersey and upstate New York. The USPTA Eastern Division paid for the buses that transported the participants and will do the same this year.
Mecca said many locals in the Westchester area did not attend last year because it poured rain on the day of the TennisFest and most people assumed the event was cancelled. In actuality, the organizations that ran the event moved it from the eight outdoor courts at the Saw Mill Club to the five indoor courts.
Approximately one-and-a-half of those courts were unusable because a stage was built for Giardina's performance, so the event became somewhat crowded, but Mecca said the attendees still enjoyed the day.
This year, Mecca said he hopes to double the attendance. Twice as many buses are scheduled to shuttle people to the event, and Horace Greeley High School's tennis team has volunteered to lead classes this year. Girl Scouts will also run face-painting stations.
Other TennisFests this year will be held in Syracuse, Albany, Long Island and New Jersey.
More information on the event can be found here.
Information from a press release by USPTA Eastern was used in this report.


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Regular Price: $19.95
Special Price: $16.95
Catalog Product Code: WIN0372CB
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Operating System: Microsoft Windows Media: DVD Product Description
Fritz Chess Software for PC, the program that for many years now hasfascinated the chess world. Whether it was the match against World ChampionVladimir Kramnik in Bahrain in 2002, or against Garry Kasparov in New York in2003, or the revenge match against World Champion Kramnik in the National ArtGallery in Bonn, Germany, in 2006 - the pitting of wits of the strongestplayers on the planet against the world's finest chess playing program hasgenerated unprecedented media attention and fired the imagination of people fromall walks of life. "Man vs. Machine" has become one of the greatthemes of our time.
Don't be afraid - Fritz has a different side to its personality. The programwill help you along during the game, with numerous sophisticated coachingfunctions, adjusting its playing strength to exactly match that of any opponent.It graphically displays threats and plans, and provides full opening statistics.For beginners Fritz will explains moves and positions, or warn you of dangersand of errors you are committing. It has instructive training modules andamusing handicap levels. For club and tournament players Fritz has long become atrusted friend and indispensable advisor, helping them to study their games andfind new opening ideas for their next tournaments. A database with more than amillion games provides the basis for state-of-the-art analysis. Even GarryKasparov has used Fritz on a regular basis.
How often have you attended personal grandmaster lectures or trainingsessions? With its Chess Media System Fritz brings the world's greatestchess players into your living room, in full high resolution video and sound anda synchronised graphic chessboard. Listen to Garry Kasparov, Viktor Korchnoi,Alexei Shirov or (former world champion) Rustam Kasimdzhanov while they explainimportant openings and ideas that lead to success. A host of famous chessteacher provide instruction in more mundane subjects, like opening traps,middlegame strategy, or endgame skills. For those of you who have never playedchess before there are elementary courses to teach you the basics in a matter ofhours. Fritz has a variety of beautiful photo realistic 3D chessboards, and canprovide amusing verbal comments during the game.
Fritz makes it easy for you to play against other human beings, at any time,day or night. It provides you with a one-click connection to the largest chesscommunity in the world, Playchess.com, which has over 200,000 members. You canplay quick and informal games at any level, take part in tournaments, or attendlive lectures and training sessions. You can also watch great internationalevents, which are broadcast live on the server, and you can discuss the moveswith players and grandmasters from all over the world. It is an experience youwill not want to miss.
New in FRITZ: enhanced and improved chess engine developedespecially for the 2006 Kramnik vs Fritz match; extended openings book; updateddatabase; dynamic graphic tips for attack and defence; improved graphics andmove entry on the 2D board; new high resolution 3D piece sets in classical wood;live display of the thinking process on the chessboard; more efficient positionanalysis.
New chess server features: additional ranking lists, fullrankings for all players, filters for challengers with bad Internet connections,new and simple video conference function, bullet lists in the engine room,animated global weather display, direct link to Google Earth.
We're sorry, but all purchases of Download Productsare final and can not be returned or exchanged. There are NO exceptions to this rule as this is the industry standard for downloadable products.
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Tools that Work for Coping with Labor Pain
Support throughout labor: Support from an experienced woman or trained doula can help you and your partner through labor and birth. Knowledge: Knowing what to expect can reduce your fear, which can in turn reduce your pain. Skin stimulation: Massage, warm bath or shower, and/or cold compresses on your neck and face. Relaxation: Progressive relaxation of all your muscles will allow your uterus to do its hard work and help you feel less pain. Change of position: Walk, stand, sit, squat, rock on all fours, or lie down. Only you know what's most comfortable. Nourishment: Nourishment (food and liquid) reduces stress hormones in your body and gives you needed energy. Always check with your health care provider before eating or drinking during labor. Brain activity: Puzzles, word games, cards, listening to music (in early labor), and breathing can help you cope with labor pain. Comfort in Labor (PDF), by Penny Simkin, provides different pictures of labor positions that use some of these suggestions. Most recent page update: 9/9/2010
© 2013 Childbirth Connection. All rights reserved.
Childbirth Connection is a national not-for-profit organization founded in 1918 as Maternity Center Association. Our mission is to improve the quality and value of maternity care through consumer engagement and health system transformation. Childbirth Connection promotes safe, effective and satisfying evidence-based maternity care and is a voice for the needs and interests of childbearing families. |
News and Features
Listening to MothersSM III: New Mothers Speak Out (June 2013) reports on new national surveys about issues women face in the postpartum period and their views about maternity care.
Access the full report and supplementary materials Listening to MothersSM III (May 2013) is the third national survey exploring women's experiences in pregnancy and childbirth. Commissioned by Childbirth Connection, conducted by Harris Interactive, and funded by the W.K. Kellogg Foundation, the survey polled 2,400 women who gave birth in U.S. hospitals from 2011 to 2012. Results show that medically intensive experiences are typical, and evidence-based practices are underutilized. Childbearing women need better support and knowledge to navigate their maternity care. Access the full report and supplementary materials New Report: Maternity Care and Liability Go to report and supporting materials New Report: The Cost of Having a Baby in the United States Go to report and supporting materials New Cesarean Resources: Go to Best Evidence Report Go to web pages and booklet for women
For 95 years, Childbirth Connection has been dedicated to improving the
quality and value of maternity care for all women and their families. Learn
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Childbirth Connection works to ensure that all women and babies get the best
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The Transforming
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Alternative dance draws Medina teens
Saturday, February 05, 2011 11:20 PM
Medina high school students make their way into the high school for a dance Saturday, February 5, 2011 in Medina. Medina has dueling high school dances because some teens object to new, tougher rules the school has imposed. (Joshua Gunter/ The Plain Dealer)
Related articles
- Medina High School students shun dance with new rules; alternative dance sells out February 05, 2011, 9:50 PM


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Trains may be one of the most environmentally capable modes of transportation, but that doesn't mean there isn't still room for improvement. With that in mind, GE has been readying its locomotives for the next generation of emissions standards: Tier 3.
Tier 3 is a continuation of the US Environmental Protection Agency's program to monitor and lower exhaust emissions by locomotives. It follows, naturally, Tier 0, 1 and 2 emissions standards, and marks a 50 % reduction in acceptable particulate matter levels from Tier 2 levels.
The process of enhancing locomotive emissions standards began with Tier 0: all locomotives built after 1972, be they new or overhauled, must be up to those standards. Then, from 2002-2004, all new locomotives were built to a Tier 1 standard. Locomotives built between 2005 and December 31, 2011 were held to Tier 2 standards—and when it comes time to overhaul those locomotives, they will be brought to the most regulatory level.
The new regulations will be implemented in two phases: on new locomotives built starting in 2012; and starting this year, via overhauls to locomotives that were originally built between 1973 and 2004. Tier 3 locomotives will emit no more than 0.1 grams of particulate matter (PM)—tiny particles that escape from the exhaust after the combustion process—per horsepower hour. Furthermore, they will have maximum nitrogen of oxides (NOx) levels of 5.5 g/bhp·hr.


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Wii Fit Rechargeable Battery Pack for Nintendo WiiOrdering is simple - Payment is 100% Secure - Delivery is QUICK!
In over 95% of cases, our customers are playing their game the NEXT DAY...
Title: | Wii Fit Rechargeable Battery Pack for Nintendo Wii |
Stock status: | In Stock |
Price: | £4.85 |
Official Release Date: | 17th April 2008 |
Delivery Method: | Royal Mail 1st Class Standard (FREE) |
Product Platform: | Nintendo Wii |
Publisher: | Blue Ocean |
Category: |
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THIS PRODUCT IS EASY TO USE AND FIT. SAVES ON USING BATTERIES BECAUSE THE Wii FIT CAN USE ALOT OF BATTERIES, DEPENDING HOW MUCH YOU USE THE PRODUCT. THE DESPATCHING OF THIS PRODUCT IS SECOND TO NONE,GREAT WORK FROM THE COMPANY AND IT'S STAFF.THANK-YOU.
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Is the U.S. missing the boat on green tech?
The United States risks missing the business opportunity posed by moving to low-carbon energy, two prominent business leaders argued in an editorial aimed at policy makers.
General Electric CEO Jeffrey Immelt and venture capitalist John Doerr of Kleiner Perkins Caufield & Byers, published an editorial in The Washington Post Monday to warn that the U.S. is lagging China is developing clean-energy technologies.
"We are clearly not in the lead today. That position is held by China, which understands the importance of controlling its energy future. China's commitment to developing clean energy technologies and markets is breathtaking," … Read more


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Hirs Wrote:Is there a way to disable the menu loop in home screen?Well, all three list types loop, but try the following changes and see what suits you.
In HomeMenu.xml modify line 21
Change wraplist to fixedlist
or, if you don't have many items in the menu (i.e. they all fit onto the screen), you can change it to list.


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We were all up and glued to our phones or laptops to watch Kiko come in to the world and it COULD happen again! Kiko's mom and dad are hoping (and trying) for another baby. Read the story here.
Winnie the Pooh
June 15-23, 2013 (weekends)
Peace Center Gunter Theatre
For tickets, call (864) 467-3000
You have probably played this game on your phone before or your friends have been talking about it...well, I wanted to get in on the action and see if I could stump you!
Everyday, right before you head to your lunch break, check my blog for a new game. I'll post one around 11:45 every work day and I'll give you the answer later in the afternoon. Cool? Cool...let's do it!
Here are the pics.
We were all up and glued to our phones or laptops to watch Kiko come in to the world and it COULD happen again! Kiko's mom and dad are hoping (and trying) for another baby. Read the story here.
Photo Credit: Getty Images www.gettyimages.com
How are the POPE and MILEY Cyrus on the same list? Maybe the Naught Nice list? Not exactly...check it out here.
Photo Credit:Getty Images
That's quite a budget, but I guess when you are Katie Holmes, you could afford a lot more...
NOW magazine claims Katie Holmes has set a $500 Christmas budget for Suri. A source tells the magazine, ''Katie's concerned that Suri's way too pampered and thinks it's time to start cutting back. She's made a concerted effort to keep Suri grounded since splitting with Tom - and cutting back on toys and her wardrobe's the next stage.''
How does your Christmas budget compare?
Here are some of the biggest Bowl Game Matchups including Clemson Carolina and the HUGE game between Auburn and Florida State. Some Vegas oddsmakers have Florida State as a 7-point favorite over Auburn for the BCS Championship
Dec. 31 AdvoCare V100 Hyundai Sun AutoZone Liberty Chick-fil-A Jan. 1 TaxSlayer.com Gator Heart of Dallas Capital One Outback Rose Bowl Game presented by VIZIO Tostitos Fiesta Jan. 2 Allstate Sugar Jan. 3 Discover Orange AT&T Cotton Jan. 4 BBVA Compass Jan. 5 GoDaddy Jan. 6 VIZIO BCS National Championship |
Photo Credit: Getty Images www.gettyimages.com
It's True! The Anderson Christmas Parade, set for tomorrow (Dec 8th), has been postponed due to probable inclement weather.. There is no word on a make up date for the parade.
Here is a list of the rest of the Upstate parades going on this season.


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Fantastic! Share your favorites and earn zulily credit. see detailsconnect
Whether entertaining little ones in their first language or immersing them in a new one, this Sesame Street DVD is the perfect way to educate. It features language options in Arabic and Spanish and follows Ernie as he makes learning numbers a musical treat.


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The Go-Ahead Group plc
The Go-Ahead Group owns public transport companies that operate bus, rail, car-parking and aviation support services throughout the UK. http://www.go-ahead.com
Go-Ahead Bus
Anglian Buses
based in Beccles, Suffolk and operates 71 buses, the company runs services from the Suffolk coast to, from and within Norwich, as well as in Yarmouth, Lowestoft and on the Suffolk coastal strip down to Ipswich. The business has two depots, in Beccles and Rackheath, and 133 staff including 100 bus drivers. It operates a mix of commercial routes and school and local bus contracts. www.anglianbus.co.uk
The name for quality bus services in and around South Hampshire. We run popular inter-urban and commuter links into Southampton from around the region, as well as local services in and out of the city. www.bluestarbus.co.uk
Brighton & Hove
The award winning company runs a comprehensive network of high frequency bus services across the Brighton and Hove conurbation. www.buses.co.uk/
Carousel Buses High Wycombe and Buckinghamshire's Better Bus Company
We operate bus services in and around High Wycombe in Buckinghamshire. We pride ourselves in running a safe, reliable, affordable and customer focused service with a modern fleet of vehicles that use lower emission diesel, driven by drivers of the highest standard most of whom have had several years of experience. www.carouselbuses.co.uk
Go-Ahead North America
In November 2009, Cook-Illinois Corporation and UK transport operator Go-Ahead Group formed a new company, Go-Ahead North America to provide high quality school bus services to local communities and School Districts www.go-aheadnorthamerica.com/
Hedingham & District
The name Hedingham & District was chosen to reflect the extension of the original operating area.
We operate more than 20 services throughout Essex with a modern fleet of about 120 low floor buses, and carry over a million passengers a year for school, shopping, commercial and leisure. www.hedingham.co.uk/
Go North East
The founding company of the Go-Ahead Group. Go North East is now the largest bus operator in the North East of England. www.simplygo.com/
Our routes cover much of the Dereham, Watton, Wymondham and Swaffham areas providing essential links to local towns and beyond to Norwich and the Norfolk & Norwich University Hospital. www.konectbus.co.uk
Metrobus' fleet services bus contracts for Transport for London (TfL), whilst the remaining services cover large parts of Sussex, Surrey and Kent. www.metrobus.co.uk/
The Oxford Bus Company
The company's operations can be split into three main areas: Express coach services Park & Ride Local bus services. www.oxfordbus.co.uk/
Plymouth Citybus
Runs a high quality fleet of 173 buses and 11 coaches from a large depot in the centre of Plymouth, carrying around 14 million passengers each year across a wide network in and around the City. www.plymouthcitybus.co.uk
Southern Vectis
We run the local buses on the Isle of Wight. Our routes connect most parts of the island to all major towns. Buses are frequent with some routes running through the night. Our latest buses have full air-conditioning and plenty of space inside. Our terrific double-deck open top tours are a grandstand way to see the beauty of our glorious island. We also run dedicated school routes and special buses to get you to key island events. www.islandbuses.info/
Thames Travel
Based in Wallingford, Oxfordshire, the company started in 1998 with a fleet of four vehicles and has gone from strength to strength, expanding to its position as the third largest bus operator in Oxfordshire. It now employs about 75 staff and maintain a fleet of 34 vehicles. Services cover the geographical area of South Oxfordshire and part of West Berkshire, currently carrying 1.25 million passengers per year. www.thames-travel.co.uk
Wilts & Dorset
Operator of intensive urban bus networks across Poole, Bournemouth, Christchurch and Salisbury, in addition to operations on the Isle of Purbeck in Dorset and the New Forest in Hampshire. As well as its network services, the company also operates a number of inter-urban and rural services. www.wdbus.co.uk/
Go-Ahead Rail
Gatwick Express
The fastest and only non-stop train service between central London and Gatwick Airport.
Gatwick Express is one of the most popular and favourite train service in the United Kingdom, having won the independent National Passenger Survey a number of times.
Operating between London Victoria station and Gatwick Airport, our dedicated airport train service is renowned for its speed and frequency. Departing every 15 minutes, with no traffic jams, taxi queues or stops to worry about, you can be in the centre of London (Victoria), or right inside Gatwick airport (South Terminal) in just 30 minutes www.gatwickexpress.com
provides rail services in south east London, Kent and part of East Sussex. Southeasterns aim is to provide a growing railway for a growing region. www.southeasternrailway.co.uk/
Southern Railway
Southern operates fast frequent rail services to over 135 million passengers, mainly in south London and the adjoining home counties. The majority of passengers are commuters into London, but there is also a significant leisure market to Gatwick, Brighton and the Sussex coast. http://www.southernrailway.com/
London Midland
Operator of over 1200 train services a day through the heart of England, connecting London, the Midlands and the North West. The business manages 149 stations and each year over 45 million journeys will be undertaken on London Midland. www.londonmidland.co.uk/
Other Sites
Transport Direct
The only website that offers information for door-to-door travel for both public transport and car journeys around Britain. Our aim is to provide you with comprehensive, easy-to-use travel information to help you plan your journeys effectively and efficiently. www.transportdirect.info
Transport for London
Its main role is to implement the Mayor's Transport Strategy for London and manage transport services across the Capital for which the Mayor has responsibility.
These services include:
London's buses
London Underground
Docklands Light Railway (DLR)
London Overground
London River Services
Victoria Coach Station www.tfl.gov.uk/
The Greater London Bus Map
The site tells you where you can purchase the range of London Bus Maps. http://www.busmap.org/
London Transport Museum
Features displays of buses, trains and trams. Includes events, activities, opening times, fees and directions. www.ltmuseum.co.uk/


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Contractor picked for vets clinicDecember 03,2012Contractor picked
for vets clinic
Plans to build a new $2.6 million outpatient clinic for veterans in Burlington are moving forward.
U.S. Sen. Bernard Sanders said Monday that the Department of Veterans Affairs has picked a contractor Fortieth Burlington LLC to build the facility, which will replace a clinic in Colchester that has outgrown its space.
The new clinic on Lakeside Avenue will be nearly twice as large as the Colchester clinic and serve about 4,000 veterans.
Its expected to be completed in early 2013.
Sanders said the VA now serves about 8,600 veterans at clinics in Colchester, Brattleboro, Rutland, Bennington and Newport, providing primary care, specialty treatment and mental health services.MORE IN National / World BusinessNEW YORK Sparse crowds at malls and 50 percent off signs at The Gap and other stores offer... Full StoryNEW YORK — Mayor Michael Bloomberg is leaving the nation's biggest mayoral job with a... Full StoryWASHINGTON The growing gap between the richest Americans and everyone else isnt bad just for... Full Story -
- VIDEO: The play that's under appeal from the DIII state football championships
- VIDEO: Downhill excitement at Silverheels Cup at Okemo
- VIDEO: Woodstock takes on U-32 football
- VIDEO: 2013 Vermont Amateur Golf Tournament
- VIDEO: Police investigate Pittsford homicide
- VIDEO: Rutland High School Graduation


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Search for any place in the USA:
Overview, People, Health, Economy, Housing, Rankings, Climate Crime, Comments, Transportation, Cost of Living, Religion, Voting
As of 2012, Jefferson County's population is 116,229 people. Since 2000, it has had a population growth of 7.80 percent.
The median home cost in Jefferson County is $122,700. Home appreciation the last year has been -2.59 percent.
Compared to the rest of the country, Jefferson County's cost of living is 3.70% Higher than the U.S. average.
Jefferson County public schools spend $7,773 per student. The average school expenditure in the U.S. is $5,691. There are about 14 students per teacher in Jefferson County.
The unemployment rate in Jefferson County is 9.40 percent(U.S. avg. is 8.60%). Recent job growth is Negative. Jefferson County jobs have Decreased by 0.12 percent.
See Places Rated and Ranked Click Here
Average Commute time is 22 minutes. The National Average is 28 minutes.
Jefferson County's Real Estate Market (click to see properties) • Newly Listed Homes • Most Expensive Listing • Million Dollar Houses • Homes from $750,001 to $1,000,000 • Homes from $500,001 to $750,000 • Homes from $250,000 to $500,000 • Homes under $250,000 • Median Priced Homes
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Research on LNS
This list of published studies is divided into two sections: "LNS for prevention"; and "Acceptability and use of LNS". The first section includes studies on use of LNS for promotion of healthy growth, development, or micronutrient nutrition, prevention of stunting, or prevention of wasting. Studies assessing breast milk intake are also included. The second section includes acceptability studies, studies on LNS and infant feeding practices, qualitative studies on mothers' views of LNS, and studies of intra-household distribution/sharing of LNS.
Studies of the use of LNS for treatment of severe or moderate acute malnutrition are not included.
Download the list with links to abstracts, but without annotation, here.
LNS for prevention
- Randomized comparison of 3 types of micronutrient supplements for home fortification of complementary foods in Ghana: effects on growth and motor development. (abstract and free full-text)
Adu-Afarwuah S, Lartey A, Brown KH, Zlotkin S, Briend A, Dewey KG. Am J Clin Nutr. 2007 Aug;86(2):412-20.
Randomized controlled trial to test the effect of three different approaches for home-fortification of complementary food (multi-micronutrient powder, LNS and a crushable micronutrient tablet) on child growth (between 6 and 12 months of age) and motor development in Ghana.
- Home fortification of complementary foods with micronutrient supplements is well accepted and has positive effects on infant iron status in Ghana. (abstract and free full-text)
Adu-Afarwuah S, Lartey A, Brown KH, Zlotkin S, Briend A, Dewey KG. Am J Clin Nutr. 2008 Apr;87(4):929-38.
Randomized controlled trial to test the acceptability and effect of three different approaches to home-fortification of complementary food (multi-micronutrient powder, LNS and a crushable micronutrient tablet) on micronutrient status (iron and zinc) and anemia in Ghanaian children between 6 and 12 months of age.
- Randomized controlled trial of the effectiveness of a soybean-maize-sorghum–based ready-to-use complementary food paste on infant growth in South Kivu, Democratic Republic of Congo. (abstract)
Bisimwa G, Owino VO, Bahwere P, Dramaix M, Donnen P, Dibari F, and Collins S. Am J Clin Nutr. 2012 May;95(5):1157-64. Epub 2012 Apr 4.Randomized controlled trial comparing a lipid-rich ready-to-use complementary food with a standard corn-soy blend on the prevalence of underweight and stunting. Infants were enrolled at 6 months of age and received the complementary food for 6 months. Lab measurements included hemoglobin, triglyceride, and cholesterol.
- A large-scale distribution of milk-based fortified spreads: Evidence for a new approach in regions with high burden of acute malnutrition. (abstract and free full-text)
Defourny I, Minetti A, Harczi G, Doyon S, Shepherd S, Tectonidis M, Bradol JH, Golden M. PLoS ONE 4(5): e5455. Doi:10.1371/journal.pone.0005455.
Evaluation of a preventive distribution program implemented during the hungry-season (May-October 2007) in the Maradi region of Niger that provided a monthly ration of Plumpy'doz to children 6-36 months of age. The prevalence and incidence of severe acute malnutrition (SAM) and SAM treatment admission trends were compared to previous years, where no preventive program was in place.
- Lipid-based nutrient supplements: How can they combat child malnutrition? (abstract and free full-text)
Dewey KG and Arimond M. PLoS Med 2012 Sep;9(9): e1001314.
A perspective article that addresses the variety of lipid-based products, the controversy of providing lipid-based products to infants and children, and reviews some recent research.
- Use of lipid-based nutrient supplements by HIV-infected Malawian women during lactation has no effect on infant growth from 0 to 24 weeks. (abstract)
Flax VL, Bentley ME, Chasela CS, Kayira D, Hudgens MG, Knight RJ, Soko A, Jamieson DJ, van der Horst CM, Adair LS. J Nutr. 2012 Jul;142(7):1350-6.
This research is part of the Breastfeeding, Antiretroviral, and Nutrition (BAN) study, a randomized controlled trial with a 2 x 3 factorial design (mothers were randomly assigned to receive LNS or no LNS, and mother-infant pairs were randomly assigned to maternal ARV, infant ARV, or no ARV). This paper assesses the effect of BAN study interventions on infant weight, length, and BMI during the period of exclusive breastfeeding, from 0 to 24 wk.
- Lipid-based nutrient supplements are feasible as a breastmilk replacement for HIV-exposed infants from 24 to 48 weeks of age. (abstract)
Flax VL, Bentley ME, Chasela CS, Kayira D, Hudgens MG, Kacheche KZ, Chavula C, Kourtis AP, Jamieson DJ, van der Horst CM, Adair LS. J Nutr. Epub 2013 Mar 6.
This research is part of the Breastfeeding, Antiretroviral, and Nutrition (BAN) study, a randomized controlled trial in Malawi with a 2 x 3 factorial design (mothers were randomly assigned to receive LNS or no LNS, and mother-infant pairs were randomly assigned to maternal ARV, infant ARV, or no ARV). Assigned interventions were provided from birth to 28 wk. In addition, all infants were given LNS during (24–28 wk) and following (28–48 wk) weaning. This paper assesses the feasibility of infant LNS as a breastmilk replacement and uses longitudinal random effects models to examine associations of interventions, morbidity, and season with weight-for-age (WAZ), length-for-age (LAZ), and BMI-for-age (BMIZ) Z-scores from 24 to 48 wk.
- Breast milk intake is not reduced more by the introduction of energy dense complementary food than by typical infant porridge. (abstract and free full-text)
Galpin L, Thakwalakwa C, Phuka J, Ashorn P, Maleta K, Wong WW, Manary MJ. J Nutr. 2007 Jul;137(7):1828-33.
Randomized controlled trial to assess the effect of providing LNS as a complementary food on breast-milk intake in 6-month old infants as compared to a micronutrient-fortified maize-soy flour (likuni phala) used in Malawi for complementary feeding.
- Effect of mass supplementation with ready-to-use supplementary food during an anticipated nutritional emergency. (abstract and free full-text)
Grellety E, Shepherd S, Roederer T, Manzo ML, Doyon S, Ategbo EA, Grais RF. PLoS One. 2012;7(9):e44549.
Compares the incidence of wasting, stunting, and mortality in Niger among children aged 6-23 mo participating in the distribution (intervention) of RUSF versus children not participating in the distribution (comparison).
- Growth in late infancy among HIV-exposed children in urban Haiti is associated with participation in a clinic-based infant feeding support intervention. (abstract)
Heidkamp RA, Stoltzfus RJ, Fitzgerald DW, Pape JW. J Nutr. 2012 Apr;142(4):774-80. Epub 2012 Feb 29.
This study implemented and evaluated a new infant feeding support intervention for HIV-exposed, uninfected, non-breast-fed infants enrolled at 6 months of age in Haiti. The 24-wk intervention examined the effect of an integrated package that included LNS, education, promotion of existing clinical services, and social support on growth outcomes measured at 12 months of age.
- The effect of adding ready-to-use supplementary food to a general food distribution on child nutritional status and morbidity: A cluster-randomized controlled trial. (abstract and free full-text)
Huybregts L, Houngbe´ F, Salpéteur C, Brown R, Roberfroid D, Ait-Aissa M, Kolsteren P. PLoS Med 2012 Sep;9(9): e1001313.
A two-arm cluster-randomized controlled trial comparing the effect of receiving staple foods vs. staple foods + RUSF for 4 mo on the prevention of wasting in children aged 6-36 mo. Study was conducted within the framework of a general food distribution program in Chad and anthropometric measurements and morbidity were recorded monthly.
- Prenatal food supplementation fortified with multiple micronutrients increases birth length: a randomized controlled trial in rural Burkina Faso. (abstract and free full-text)
Huybregts L, Roberfroid D, Lanou H, Menten J, Meda N, Van Camp J, Kosteren P, for the MISAME Study Group. Am J Clin Nutr 2009 Jan; 90: 1593-600.
Randomized controlled trial in Burkina Faso to determine whether a daily prenatal multiple-micronutrient (MMN)-fortified food supplement (composed of peanut butter, soy flour, vegetable oil and sugar) improved anthropometric measures at birth compared with a daily prenatal MMN pill alone.
- Effect of preventive supplementation with ready-to-use therapeutic food on the nutritional status, mortality, and morbidity of children aged 6 to 60 months in Niger: a cluster randomized trial. (abstract and free full-text)
Isanaka S, Nombela N, Djibo A, Poupard M, Van Beckhoven D, Gaboulaud V, Guerin PJ, Grais RF. JAMA. 2009 Jan 21;301(3):277-85.
Cluster-randomized controlled trial that evaluated the effect of providing three months of RUTF to 6-60 month-old children in Niger on the prevention of moderate and severe wasting during an 8-month follow-up period.
- Reducing wasting in young children with preventive supplementation: a cohort study in Niger. (abstract)
Isanaka S, Roederer T, Djibo A, Luquero FJ, Nombela N, Guerin PJ, Grais RF. Pediatrics. 2010 Aug;126(2):e442-50. Epub 2010 Jul 26.Cohort study assessing the relative impact on wasting, stunting and mortality of two follow-up interventions. RUSF (6 mo, daily dose of 46 g) or RUTF (4 mo, daily dose of 92 g) were distributed in villages where RUTF was provided the previous year, during the "hunger gap" each year.
- Iterative design, implementation and evaluation of a supplemental feeding program for underweight children ages 6-59 months in Western Uganda. (abstract and free full-text)
Jilcott SB, Ickes SB, Ammerman AS, Myhre JA. Matern Child Health J. 2010 Mar;14(2):299-306.
This paper describes the development, implementation, and evaluation of a supplemental feeding program for underweight children aged 6-59 months in Western Uganda. Children received ready-to-use-food (RUF) for five weeks. The program was evaluated by examining RUF nutrient composition, weight gain velocity, and qualitative data from key-informant interviews and home feeding observations.
- A lipid-based nutrient supplement mitigates weight loss among HIV-infected women in a factorial randomized trial to prevent mother-to-child transmission during exclusive breastfeeding. (abstract)
Kayira D, Bentley ME, Wiener J, Mkhomawanthu C, King CC, Chitsulo P, Chigwenembe M, Ellington S, Hosseinipour MC, Kourtis AP, Chasela C, Tembo M, Tohill B, Piwoz EG, Jamieson DJ, van der Horst C, Adair L; for the BAN Study Team. Am J Clin Nutr. 2012 Mar;95(3):759-765. Epub 2012 Jan 18.
Evaluated the efficacy of LNS for prevention of excess weight loss in breastfeeding, HIV-infected women. Mothers were randomized at delivery according to a 2-arm (with and without LNS) by 3-arm (maternal triple-antiretroviral prophylaxis, infant-nevirapine prophylaxis, or neither) factorial design and received LNS for 28 weeks.
- Growth and change in blood haemoglobin concentration among underweight Malawian infants receiving fortified spreads for 12 weeks: a preliminary trial. (abstract)
Kuusipalo H, Maleta K, Briend A, Manary M, Ashorn P. J Pediatr Gastroenterol Nutr. 2006 Oct;43(4):525-32.
Randomized-controlled trial in Malawian children aged 6-17 months. Children received for 12 weeks, at home, 1 of 8 food supplementation schemes: nothing, 5, 25, 50, or 75 g/day milk-based LNS or 25, 50, or 75 g/day soy-based LNS. Outcome measures included change in weight, length and blood Hb concentration.
- An energy-dense complementary food is associated with a modest increase in weight gain when compared with a fortified porridge in Malawian children aged 6-18 months. (abstract and free full-text)
Lin CA, Manary MJ, Maleta K, Briend A, Ashorn P. J Nutr. 2008 Mar;138(3):593-8.
Randomized comparison of the effects of a peanut-/soy-based LNS and a corn porridge fortified with fish powder as complementary foods on growth and micronutrient status (zinc and selenium) in rural Malawian children between 6 and 18 months of age.
- A Single-Centre, Randomized, Single-Blind, Parallel Group Clinical Trial in Rural Malawi, Testing the Growth Promoting Effect of Long-Term Complementary Feeding of Infants with a High-Energy, Micronutrient Fortified Spread. (abstract and free full-text)
Mangani C, Ashorn P, Manary M, Alho L. FANTA-2 Technical Report; Washington, DC: Mar 2012.
A randomized controlled trial in rural Malawi to compare the incidence and prevalence of very severe linear growth failure and symptoms of common childhood illnesses among infants receiving dietary supplementation with milk-LNS, soy-LNS, a corn-soy blend (CSB), or nothing. Healthy infants were tracked for 12 months from the age of 6 to 18 months.
- A randomized trial to investigate the effects of pre-natal and infant nutritional supplementation on infant immune development in rural Gambia: the ENID trial: Early Nutrition and Immune Development. (abstract and free full-text)
Moore SE, Fulford AJ, Darboe MK, Jobarteh ML, Jarjou LM, Prentice AM. BMC Pregnancy Childbirth. 2012 Oct 11;12(1):107.
This paper describes the study design of the ENID (Early Nutrition and Immune Development) trial, a randomized controlled trial in The Gambia with 4 intervention groups: 1) Iron-folate (standard care), 2) multiple micronutrients (MMN), 3) protein-energy (PE), and 4) PE + MMN. Both PE supplements are LNS. Study participants include pregnant women (from < 20 weeks gestation to term) and their infants (from 6 to 12 months of age), with the primary outcome measures of thymic development during infancy and antibody response to vaccination.
- Breast-milk intake of 9-10-mo-old rural infants given a ready-to-use complementary food in South Kivu, Democratic Republic of Congo. (abstract)
Owino VO, Bahwere P, Bisimwa G, Mwangi CM, Collins S. Am J Clin Nutr. 2011 Jun;93(6):1300-4. Epub 2011 Mar 30.
Sub-study within a cluster-randomized controlled trial; sub-study compared breast milk intakes of 9 mo old infants who had received, since 6 mo of age, either a lipid-rich ready-to-use complementary food or a standard corn-soy blend.
- Developmental outcomes among 18-month-old Malawians after a year of complementary feeding with lipid-based nutrient supplements or corn-soy flour. (abstract)
Phuka JC, Gladstone M, Maleta K, Thakwalakwa C, Cheung YB, Briend A, Manary MJ, Ashorn, P. Matern Child Nutr. Epub ahead of print 2011 Feb 22.
Randomized-controlled trial comparing supplementation for 12 months with LNS (two different doses) or a micronutrient-fortified maize-soy flour (likuni phala). Infant development was assessed at 18 mo; there were no differences between the three micronutrient-supplemented groups.
- Complementary feeding with fortified spread and incidence of severe stunting in 6- to 18-month-old rural Malawians. (abstract and free full-text)
Phuka JC, Maleta K, Thakwalakwa C, Cheung YB, Briend A, Manary MJ, Ashorn P. Arch Pediatr Adolesc Med. 2008 Jul;162(7):619-26. Erratum in: Arch Pediatr Adolesc Med. 2008 Oct;162(10):942.
Randomized-controlled trial that compared supplementation for 12 months with LNS or a micronutrient-fortified maize-soy flour (likuni phala) on child growth and incidence of malnutrition between 6 and 18 months of age.
- Postintervention growth of Malawian children who received 12-mo dietary complementation with a lipid-based nutrient supplement or maize-soy flour. (abstract and free full-text)
Phuka JC, Maleta K, Thakwalakwa C, Cheung YB, Briend A, Manary MJ, Ashorn P. Am J Clin Nutr. 2009 Jan;89(1):382-90.
Follow-up study of Malawian children at 36 months of age to assess the long-term impact on growth and incidence of malnutrition from exposure to 12-months of supplementation with either LNS or a micronutrient-fortified maize-soy flour (likuni phala) between 6 and 18 months of age.
- Supplementary feeding with fortified spread among moderately underweight 6-18-month-old rural Malawian children. (abstract)
Phuka J, Thakwalakwa C, Maleta K, Cheung YB, Briend A, Manary M, Ashorn P. Matern Child Nutr. 2009 Apr;5(2):159-70.
Randomized controlled trial comparing LNS vs. fortified maize-soy flour in children aged 6-18 months in Malawi. Children received the supplement for 12 weeks and the outcomes of underweight, wasting, and stunting were examined.
- Prevention of acute malnutrition during the lean season: Comparison of a lipid-based nutrient supplement and an improved dry ration, South Darfur, Sudan. A quasi-experimental study. (abstract and free full-text)
Talley L, Boyd E, el Sharief F, Blanton C, OmerAli M, Rahman M. J Nutr Disorders Ther 2012;2:117.
This study examined the effect of LNS vs. corn soy blend (CSB) on WHZ in children aged 6-36 months living in two internally displaced persons (IDP) camps in South Darfur. One camp received LNS and the other camp received CSB during a 4-month blanket supplementary feeding program.
- An effectiveness trial showed lipid-based nutrient supplementation but not corn–soya blend offered a modest benefit in weight gain among 6- to 18-month-old underweight children in rural Malawi. (abstract)
Thakwalakwa CM, Ashorn P, Jawati M, Phuka JC, Cheung YB, Maleta KM. Public Health Nutr. 2012 Jun 13:1-8.
Randomized controlled trial to determine the effect of corn–soya blend vs. LNS vs. no supplementation (control) for 12 weeks on weight gain in moderately underweight children aged 6-15 mo in Malawi.
- A lipid-based nutrient supplement but not corn-soy blend modestly increases weight gain among 6- to 18-month-old moderately underweight children in rural Malawi. (abstract)
Thakwalakwa C, Ashorn P, Phuka J, Cheung YB, Briend A, Puumalainen T, Maleta K. J Nutr. 2010 Nov;140(11):2008-13. Epub 2010 Sep 22.
Randomized controlled trial testing the growth-promoting effect and other health benefits of daily provision of LNS (daily dose 43 g) or CSB (daily dose 71 g) for 12 wk to infants aged 6-15 mo at baseline. The primary outcome measure was weight change during the follow-up period.
Acceptability and use of LNS
- Acceptability of lipid-based nutrient supplements (LNS) among Ghanaian infants and pregnant or lactating women. (abstract)
Adu-Afarwuah S, Lartey A, Zeilani M, Dewey KG. Matern Child Nutr. 2011 Oct;7(4):344-56. Epub 2010 Dec 23.
Study of the acceptability of two LNS (20 g doses) designed for infants and for pregnant/lactating women. Methods included direct observation of consumption of test meals by infants and mothers, maternal sensory reaction to the products (and her perception of infant's reaction), and maternal reports of experiences and reactions during a 2-week home-feeding trial.
- Intra-household use and acceptability of Ready-to-Use-Supplementary-Foods distributed in Niger between July and December 2010. (abstract)
Cohuet S, Marquer C, Shepherd S, Captier V, Langendorf C, Ale F, Phelan K, Manzo ML, Grais RF. Appetite. 2012 Aug 4;59(3):698-705. [Epub ahead of print].
A cross-sectional survey, focus groups, and individual interviews were performed in 16 villages in Niger receiving RUSF as part of a preventative distribution program. Caregivers of children 6-35 mo of age were asked about their perceptions, beliefs, social norms and opinion of RUSF, as well as their sharing practices within and outside of the household.
- Feeding patterns of underweight children in rural Malawi given supplementary fortified spread at home. (abstract)
Flax VL, Ashorn U, Phuka J, Maleta K, Manary MJ, Ashorn P. Matern Child Nutr. 2008 Jan;4(1):65-73.
A longitudinal observational study of 16 Malawian children aged 6-17 months examining how caregivers feed LNS to their undernourished children at home, and how LNS use affects other feeding patterns. LNS was provided for 12 weeks and 12-hour observations were conducted before supplementation and during weeks 1, 4, 8 and 12 of LNS use.
- Responsive feeding and child interest in food vary when rural Malawian children are fed lipid-based nutrient supplements or local complementary food. (abstract)
Flax VL, Mäkinen S, Ashorn U, Cheung YB, Maleta K, Ashorn P, Bentley ME. Matern Child Nutr. 2011 Nov 24. [Epub ahead of print]
Study of maternal feeding behavior and infant acceptance of bites when comparing LNS with local complementary food. Behaviors examined during videotaped feeding sessions of infants 6-17 months old in Malawi.
- Intake of lipid-based nutrient supplements during illness and convalescence among moderately-underweight Malawian children. (abstract and free full-text)
Flax VL, Maleta K, Ashorn U, Manary MJ, Briend A, Ashorn P. J Health Popul Nutr. 2008 Dec;26(4):468-70.
A letter-to-the-editor summarizing a study of 16 Malawian children aged 6-17 months, participating in a 12-week LNS supplementation trial. The study examined LNS intake during illness and convalescence.
- Feeding patterns and behaviors during home supplementation of underweight Malawian children with lipid-based nutrient supplements or corn-soy blend. (abstract)
Flax VL, Phuka J, Cheung YB, Ashorn U, Maleta K, Ashorn P. Appetite. 2010 Jun; 54(3):504-11. Epub 2010 Feb 11.
Based on in-home direct observations, detailed comparison of feeding and hygiene practices of caregivers of underweight infants aged 6-17 months; infants were supplemented with either LNS or corn-soy blend.
- Malawian mother's attitudes towards the use of two supplementary foods for moderately malnourished children. (abstract)
Flax VL, Thakwalakwa C, Phuka J, Ashorn U, Cheung YB, Maleta K, Ashorn P. Appetite. 2009 Oct;53(2):195-202. Epub 2009 Jun 21.
Evaluation of maternal attitudes towards LNS and corn-soy-blend for feeding moderately malnourished children in Malawi, including acceptability, use during illness, and willingness to pay.
- Acceptability of zinc-fortified, lipid-based nutrient supplements (LNS) prepared for young children in Burkina Faso. (abstract)
Hess SY, Bado L, Aaron GJ, Ouédraogo JB, Zeilani M, Brown KH. Matern Child Nutr. 2011 Oct; 7(4): 357-67. Epub 2010 Dec 15.
Study of the acceptability of LNS containing either 0 or 10 mg of zinc per daily 20 g LNS dose, among 9-15 month-old infants and their mothers in Burkina Faso. Included direct observation of consumption by infants, maternal sensory reaction to the products (and her perception of infant's reaction), and maternal reports of infant-feeding experiences during a 2-week home-feeding trial.
- Examination of facilitators and barriers to home-based supplemental feeding with ready-to-use food for underweight children in western Uganda. (abstract)
Ickes SB, Jilcott SB, Myhre JA, Adair LS, Thirumurthy H, Handa S, Bentley ME, Ammerman AS. Matern Child Nutr. 2012 Jan;8(1):115-29. Epub 2010 Jul 19.
During a supplemental feeding program, caregivers, RUF producers, and program staff were interviewed regarding facilitators and barriers to appropriate use of RUF. Locally produced RUF was well received by caregivers and children, and was perceived to be a healthy supplemental food for malnourished children. Child feeding practices, including sharing of RUF, compromised the nutrient delivery to the intended child.
- Acceptability of a Lipid-Based Nutrient Supplement among Guatemalan Infants and Young Children. (free full-text)
Matias SL, Chaparro CM, Perez-Exposito AB, Peerson JM, Dewey KG. FANTA-2 Technical Report; Washington, DC: Aug 2011.
Study of acceptability of LNS, testing both the "regular" peanut flavor and a new cinnamon flavor, among infants 6-18 months of age in Guatemala. A 2-day test-feeding trial was carried out, followed by a 2-week home-use trial. Measurements included amount consumed by infant, caregiver's sensory preferences, and caregiver's perception of infant's preferences.
- Heat Treatment of Expressed Breast Milk Is a Feasible Option for Feeding HIV-Exposed, Uninfected Children after 6 Months of Age in Rural Zimbabwe. (abstract)
Mbuya MN, Humphrey JH, Majo F, Chasekwa B, Jenkins A, Israel-Ballard K, Muti M, Paul KH, Madzima RC, Moulton LH, Stoltzfus RJ. J Nutr. 2010 Aug;140(8):1481-8. Epub 2010 Jun 23.
Evaluation of the feasibility of expressing and heat treating all breast milk fed to HIV-exposed, uninfected infants in rural Zimbabwe, following 6 months of exclusive breastfeeding. LNS (Nutributter®) was provided along with instruction on EHT and counseling on complementary feeding using local foods.
- Acceptability of Lipid-Based Nutrient Supplements and Micronutrient Powders among Pregnant and Lactating Women and Infants and Young Children in Bangladesh and Their Perceptions about Malnutrition and Nutrient Supplements. (free full text)
Mridha MK, Chaparro CM, Matias SL, Hussain S, Munira S, Saha S, Day LT, Dewey KG. FANTA-2 Bridge Technical Report; Washington, DC: Feb 2012.
Study of the acceptability of several flavors of LNS for pregnant and lactating women (PLW) and for infants and young children (IYC), using test feeding, home use trials and focus group discussions. During the test-feeding phase a randomized cross-over design was used for peanut and cumin flavors (PLW) and for peanut and cardamom flavors (IYC).
- Complementary feeding messages that target cultural barriers enhance both the use of lipid-based nutrient supplements and underlying feeding practices to improve infant diets in rural Zimbabwe. (abstract)
Paul KH, Muti M, Chasekwa B, Mbuya MN, Madzima RC, Humphrey JH, Stoltzfus RJ. Matern Child Nutr. 2012 Apr;8(2):225-38. Epub 2010 Aug 4.
Formative research was conducted in rural Zimbabwe to develop feeding messages to improve complementary feeding with and without LNS. Common feeding problems were poor dietary diversity and low energy density. While provision of LNS was crucial to ensure adequate intakes of iron and zinc for infants 6-11 mo, educational messages that were barrier-specific and delivered directly to mothers were crucial to improving the underlying diet.
- The Acceptance and Feasibility of Replacement Feeding at 6 Months as an HIV Prevention Method in Lilongwe, Malawi: Results From the BAN Study. (abstract)
Parker ME, Bentley ME, Chasela C, Adair L, Piwoz EG, Jamieson DJ, Ellington S, Kayira D, Soko A, Mkhomawanthu C, Tembo M, Martinson F, Van der Horst CM. AIDS Educ Prev. 2011 Jun;23(3):281-95.
This study investigated the use and acceptability of a lipid-based nutrient supplement (LNS) as a breast milk substitute when provided to infants (6-12mo) of HIV-positive mothers, as part of the Breast-feeding, Antiretroviral, and Nutrition (BAN) Study. At the time the study was implemented, WHO recommended exclusive breastfeeding for 6 months with rapid weaning thereafter.
- Acceptability of three novel lipid-based nutrient supplements among Malawian infants and their caregivers. (abstract)
Phuka J, Ashorn U, Ashorn P, Zeilani M, Cheung YB, Dewey KG, Manary M, Maleta K. Matern Child Nutr. 2011 Oct;7(4):368-77. Epub 2011 Apr 21.
Study of the acceptability of three new lipid-based nutrient supplements (LNS) designed for preventing undernutrition among infants 6-18 mo of age. Included direct observation of consumption by infants, maternal sensory reaction to the products (and her perception of infant's reaction), and maternal reports of infant-feeding experiences during a 2-week home-feeding trial.
- Formative research for the development of a market-based home fortification programme for young children in Niger. (abstract and free full-text)
Tripp K, Perrine CG, de Campos P, Knieriemen M, Hartz R, Ali F, Jefferds ME, Kupka R. Matern Child Nutr. 2011 Oct;7(Suppl 3):82-95.
Qualitative results from focus group discussions among mothers, fathers and grandmothers of children 6-23 months, assessing the acceptability and willingness to pay for LNS and a micronutrient powder.


text:
Dead Greyhound at Tucson Greyhound Park
Tuesday, January 29th, 2013Update: I did get a response from Director Bill Walsh today. See end of blog post.
On January 17, I faxed a public records request to Arizona Department of Racing regarding a racing greyhound who was found dead in her cage at Tucson Greyhound Park in mid December.
Tucson Tails found out about the incident from an inside source.
After faxing the public records request asking for information about the dead greyhound –Atomic Charm — and getting nothing, I contacted Mr. Bill Walsh, Director, Arizona Department of Racing. I had requested "all records & reports, including autopsy records/reports, necropsy reports/records, investigative records/reports regarding the death of ATOMIC CHARM, Greyhound at TGP – December 2012."
Here is my email correspondence with Mr. Walsh on Jan. 23:
to Bill, bcc: karyn
Mr. Walsh
On Wednesday, Jan. 16, 2013, I faxed in a public record request as to the death report or any report for a TGP greyhound – Atomic Charm – who was found dead inside a TGP kennel in mid December.
To date, a week later, I have not heard anything from Cassie or your office as to the cost for any reports.
Please advise
1) if you received the faxed request – according to my fax machine the request was sent
2) when I might expect the documents that I asked for
3) the cost
Thank you
Here is Director Walsh's response:
Bill Walsh
Jan 24 (5 days ago)
to Cassie, me
Ms. Zoldan,
I am unaware of both your request and of any report on this matter. But I was in Tucson last Friday and then there was a three day holiday weekend following which both Cassie and I have been slowed down by illness.
We will look into it today and if such a report exists and the Department possesses it, it will be on its way expeditiously.
Bill Walsh
Sent from my Verizon Wireless 4G LTE DROID
Atomic Charm would've turned 3 years old on January 26, 2013 if she lived that long. She ran 102 races. According to Greyhound-Data, she last last raced December 5, 2012 and her last win was November 12, 2012. Does Atomic Charm's owner know that she is dead? Does he care?
To date, I have not heard from Mr. Walsh again or received any documents. I don't want his stinking excuses either.
A TGP kennel operator comes in to work in the a.m. and a dog is dead.
–Does anyone in authority care?
–Does anyone in authority ask why?
–Is there a record of dead greyhounds at Tucson Greyhound Park?
–Is there any oversight for the welfare of the living or dead dogs at TGP by the Arizona Department of Racing?
In October 2012 Tim Vanderpool of the Tucson Weekly wrote an eloquent article about ADOR titled, Bad Track Record.
"Almost 70 greyhounds were injured over a two-month period at TGP—and the state handed out no punishment"
It surely seems that ADOR doesn't care about 70 injured racing greyhounds or about dead greyhounds either. The Greyhound Data site lets you see the detailed pedigree map of Atomic Charm (and a million other greyhounds) yet ADOR is clueless about one dog that died at TGP.
(photo courtesy Perry Wood)
(the bold words are mine not ADOR)
Bill Walsh
12:55 PM (2 hours ago)
to me, Cassie
Ms. Zoldan,
Please forgive the delay in getting back to you. The bottom line is that there is no document that we possess to respond to your public record request. I looked into the situation and, after talking to the Department's chief steward and chief veterinarian, learned that this greyhound (Atomic Charm) was found dead in its kennel one morning. The dog's carcass was placed in a freezer and when Dr. Carlton came to the track that evening, he inspected it and could find no outward evidence of any injuries to Atomic Charm – nothing broken, no evidence of any needle marks etc. Dr. Carlton could ascribe no reason other than natural causes for its death. I hope this helps answer your question.
Bill Walsh
Arizona Department of Racing
This is chilling on so many levels: 1) The Arizona Department of Racing refers to the dog as "it." I referred to the dog as "she." 2) Her body was referred to as a carcass. 3) The Arizona Department of Racing was unaware of a race dog's death. What exactly do they regulate? 3) "nothing broken, no evidence of any needle marks etc. Dr. Carlton could ascribe no reason other than natural causes for its death. 4) " If an almost 3 year old racing greyhound is found dead, how can Dr. Carlton assume natural causes?" Is that business as usual? Is it standard procedure to throw the carcass of a dog into the freezer without further investigation? Why can't a necropsy be done? Where is the Disposition Logs that every kennel is supposed to keep?


text:
Before: 258 pounds
After: 153 pounds
Height: 5'5"
Age: 42
When Monica Thayer graduated from high school she weighed around 150 pounds. By the time she got married 3 years later, she weighed 175 pounds. "I got 'comfortable' as I settled into a sedentary adult life," she says.
Her difficult pregnancies added to her weight gain. Eight years after she was married she suffered a miscarriage and was told not to diet or exercise for 6 weeks. "I got depressed and ended up eating a lot," she says. (Search: How to cure depression naturally) Then two full-term pregnancies followed, and Monica gained 41 pounds with the first baby and 24 pounds with the second. "I ate whether I was happy, sad, glad, mad. It didn't matter how I felt inside. It comforted me, regardless."
Do You Binge When You're Upset?
The Turning Point
Monica's initial weight loss started out as an "accident." In 2009 she decided to cut her bad habit of late-night snacking and soda drinking, and she lost 13 pounds. "When I was growing up I always had an 8:00 p.m. snack as a reward for finishing dinner," she said. "Popcorn, potato chips, cookies, ice cream—you name it and we'd eat it in front of the TV."
She went to the doctor that year for cold symptoms and said the doctor was "pleasantly surprised" to see she had lost 13 pounds—and that motivated her to get serious about losing weight. Three days before her 40th birthday she vowed to live her 40s "fabulous instead of frumpy."
Discover how to lose up to 15 pounds in 32 days!
The Lifestyle
Monica started to adjust her eating habits by cutting portions in half and staying away from soda and late-night snacks. "I don't use my normal-size plate anymore, and that helps me with portion control," she says. (Video: Eyeball perfect pasta portions) She also doesn't eat out at fast food places. And to control her sweet tooth, she tries to limit treats and ice cream.
But the biggest change in Monica's lifestyle has to do with exercise. At first, she started walking on the treadmill for 20 minutes a day, 7 days a week. She did that for a week and decided to start running on the treadmill 7 days a week for 5 miles or more.
"I was on the cross country team in high school and enjoyed it, but gave up running as I got heavier," she says. "Now I'm truly insane about running—I can be found running in the rain, snow, wind, or hail, because I found it helps give me a sense of accomplishment and helps me feel balance in life."
This fall she ran two races: a 10-mile race and a half-marathon. Now she runs 5 days a week and lifts weights twice a week for all-over toning.
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The Motivation
Monica said the support of her family and friends via Facebook has been a huge factor to her success. "I use Facebook to keep me accountable," she says. "Every month I post my weigh-in, whether it was a gain or loss, and a picture."
She also frequently discusses her run in status updates. "Many of my friends have been there from the get-go and tell me I look great and I'm an inspiration," she says. "I can tend to get negative and down on myself, so the compliments and positivity from my online community really help keep me going."
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The Reward
Monica loves bumping into someone she hasn't seen for awhile and seeing their reaction when they see how much she's changed. She also says an unexpected reward is how her personality has changed after the weight loss.
"I have more self-confidence and self-esteem than I ever had before in my whole life," she says. "People tell me that when I walk into the room they can see how much more confident I am compared with how I used to be."