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Some suggested removing renewable fuel regulations either initially or eventually to address duplication of requirements (c hiv infection statistics buy starlix 120 mg. Harmonization: Some stakeholders called for the harmonization of baselines hiv infection rate washington dc starlix 120mg without a prescription, carbon-intensity targets quimioterapia antiviral generic 120mg starlix amex, fuel blending requirements rate of hiv infection in jamaica 120 mg starlix with mastercard, accounting methodology and reporting practices. It was noted that duplication and double taxation (arising from carbon pricing) should be avoided. One stakeholder argued that streamlined subnational regulations may be more effective than a federal approach. There is also potential for interaction with building codes, Reduction of Carbon Dioxide Emissions from Coal-Fired Generation of Electricity Regulations and the natural gas emissions intensity standards in the electricity sector, to name a few. Some stakeholders expressed support for stronger carbon intensity targets to avoid backsliding towards the lowest common denominator. Several stakeholders recommended that compliance mechanisms should be complementary, and a credit generation policy should be compatible with provincial programs or interchangeable with similar systems in other markets. A number of submissions referenced research related to the cost effectiveness of carbon pricing policies as a primary tool for meeting emission-reduction objectives. A number of organizations referenced experience in California and British Columbia, where a low-carbon fuel standard is applied in tandem with carbon pricing policies to drive additional reductions. Preference over carbon pricing policies, such as a carbon tax and cap-and-trade regimes, were noted for their ability to drive cost-effective change, applied across economic sectors, providing simple and predictable market signals and allowing for compliance flexibility. Others noted that emission reductions would be best achieved where possible through carbon pricing signals, and that additional opportunities were limited. Some noted carbon pricing as a tool that can be used to price that which is undesired and exempt from the pricing policy fuels that are desired. However, comments from renewable energy sector companies and an association noted that a carbon price paid by consumers did not differentiate emission intensity of fuels or provide the necessary incentive for higher renewable fuel content. Some support was expressed for pricing fuels based on their life-cycle emissions and to increase public awareness, ensure that the lower-carbon portion of fuels are not charged the same tax and appropriate labelling is applied at the point sale. Both proponents and opponents of renewable fuel regulations referenced achieving emission-reduction objectives and reducing compliance burden in support of their position. Stakeholders listed a number of additional benefits, including its benefits for the agricultural sector. Others outlined an approach where more ambitious volumetric requirements replacing existing renewable fuel regulation could reduce regulatory burden and eliminate the patchwork of policies across the country. Caution about backsliding was also noted by a number of renewable energy companies in a switch from volumetric requirements to an emission intensity approach. Some stakeholders specifically asked for the application of volumetric targets in the transportation sector. A number of stakeholders commented on a hybrid approach of emission intensity requirements in conjunction with renewable fuel targets. It was noted that such an approach could drive innovation and result in additional emission reductions by incentivizing lower-carbon and next-generation fuels. It was noted that emissions considerations, compliance flexibility and technology neutrality could drive investment towards lower-carbon and next-generation fuels, beyond the current renewable fuel requirements. In addition, concerns were noted regarding the multiplicity of volumetric mandate policies, the patchwork of policies across jurisdictions and related administrative burden. Regarding ethanol, it was noted that the Canadian average content in 2014 reached 7 per cent. Comments on coverage of renewable fuel requirements included the need for broader definition of alternative fuels and clean electricity, additional feedstocks. Sector-specific comments were also provided, including: Rail: It was noted that railways are highly integrated within a North American network, competing with other operators within the network. Aviation: It was noted that the approval of jet fuels and renewable blends is done at the international level and that a national approach could be prohibitively expensive. Another stakeholder emphasized that aviation fuels are already strictly regulated by a range of bodies, such as Transport Canada, the U. Buildings: It was noted that manufacturing standards from the United States should be considered, and potentially aligned with, when designing a national approach. Section 1838(b) and 1818A(c)(2)(B) of the Social Security Act require filing of notice advising the Administration when termination of Medicare coverage is requested. While you are not required to give your reasons for requesting termination, the information given will be used to document your understanding of the effects of your request. The time required to complete this information collection is estimated to average 10 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection.

Significant increases were seen for cancers of the lung and kidney and antiviral uses purchase starlix 120mg mastercard, among 10-year survivors antiviral condoms generic starlix 120 mg on-line, for cancers of the stomach hiv infection rates miami purchase starlix 120 mg, kidney hiv infection and aids discount starlix 120 mg without a prescription, and brain. A population-based study of cancer incidence in a cohort of 7417 patients treated with 131I in the West Midlands region of the United Kingdom between 1950 and 1991 was carried out (Franklyn and others 1999). The subjects were followed up for cancer incidence and mortality from 1971 to 1991. Studies of patients treated for ankylosing spondylitis, benign breast disease, benign gynecological disease, and peptic ulcer have provided valuable information for the quantification of radiation risk estimates for cancers of the lung, breast, and stomach and for leukemia. These estimates are reviewed in detail, and compared with risk estimates derived from other medical exposure studies, in section "Evaluation of Risk for Specific Cancer Sites. Radiotherapy for Benign Disease Among Children Tinea Capitis Between 1948 and 1960 nearly 20,000 children, primarily immigrants to Israel or children of immigrants from North Africa and the Middle East, were treated with radiation for tinea capitis (ringworm of the scalp) in Israel (Ron and others 1988b). This treatment modality was used in other countries as well, and a study also was carried out in New York (Shore and others 1984). In Israel, mortality in a cohort of 10,834 irradiated children, 10,834 matched comparison subjects, and 5392 sibling controls was studied by Ron and colleagues (1989). Crude dose estimates were derived from treatment information (dosage, area), age of the child, and the use of filtration. Radiotherapy in childhood was associated with an increased risk of mortality from tumors of the head and neck (particularly brain and thyroid tumors) and leukemia. The dose reconstruction method used was improved compared to the above paper, relying heavily on dosimetric studies and measurements in a simulated phantom model of a 6-year-old child. Doses used in the treatment of benign conditions were generally not as high as those used to treat malignant disease, so that cell-killing effects do not predominate, survival after treat- Copyright National Academy of Sciences. Delivered doses ranged from 3 to 6 Gy depending on the portion of the scalp, with lower doses to the skin of the face and neck (0. In the irradiated group, 41 subjects had a diagnosis of basal carcinoma of the scalp or face, compared to 3 in the control group. The minimum latent period was long (about 20 years); skin cancers were more pronounced on the face, where the potential for exposure to ultraviolet is higher, and were restricted to Caucasians although one-quarter of the study population was African American. A more recent study (Sadetski and others 2005) conducted a survival analysis using Poisson regression to estimate the excess relative and absolute risks for brain tumors. Modan and colleagues (1989) reported on an additional 5-year follow-up (until 1986) of the Israeli tinea capitis cohort. The increase was seen only among women who were 5­9 years of age at the time of radiation exposure (10 cases). Ron and colleagues (1989) reported on the risk of thyroid cancer following irradiation in childhood for tinea capitis, based on an extended follow-up (until 1986). To adjust the dose for possible head movement during treatment, individual dose estimates were multiplied by a factor of 1. Overall, 98 thyroid tumors were identified among the exposed and 57 among the two control populations. A clear dose-response association with both cancer and benign tumors was demonstrated. In New York, about 2200 children who received X-ray treatment for tinea capitis during the 1940s and 1950s and a comparable group of 1400 treated without X-rays were fol- Enlarged Thymus Gland Patients in Rochester, New York who received X-ray treatment between 1926 and 1957 in infancy (before 6 months of age) for an enlarged thymus gland and their nonirradiated siblings have been followed up periodically through the use of a mail questionnaire (Shore and others 1985, 1993a, 1993b; Hildreth and others 1985). Information on X-ray treatment factors was extracted from medical records and supplemented by interviews with the treating physicians. These, along with anatomic measurements for infants, allowed estimation of doses to various nearby organs. The thyroid doses were estimated by irradiating a radiological phantom of an infant. The irradiated group had a statistically significant increase of both benign and malignant thyroid tumors (Shore and others 1985) and extrathyroid tumors (Hildreth and others 1985), particularly benign tumors of the bone, nervous system, salivary glands, skin, and breast (women only) and malignant tumors of the skin and breast. In the most recent paper on thyroid cancer, which reports on follow-up to 1986, the cohort included 2657 exposed subjects and 4833 unexposed siblings with at least 5 years of follow-up (Shore and others 1993a). There were 37 pathologically confirmed thyroid cancers among the irradiated group and 5 among the sibling controls. An increased risk was seen even at low doses, with a significant positive slope in the dose range 0­0. The risk ratio decreased over time, but was still highly elevated 45 years after exposure. Analyses of interactions suggested that all Jewish subjects and women with older ages at menarche Copyright National Academy of Sciences.

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Such a definition is provided after the discussion of a numerical characterization of dose-response curvature upon which it is based hiv infection rates by country cheap starlix 120mg amex. There is stronger evidence of curvature from radiobiological considerations and experimental results anti viral cleanse discount starlix 120 mg online. Я Since the low dose and low dose rate slopes are equivalent it can also be used to convert a risk estimate from high dose to low dose rates antiviral coconut oil discount starlix 120mg amex. An explanation of why this low-dose effect also applies to low-dose-rate effects is provided in Chapter 3 hiv infection dose starlix 120mg fast delivery. A natural numerical quantity for curvature characterization, therefore, is /, which is not tied to any particular high dose. Table 10-1 may be used as an aid in interpreting radiobiological evidence for curvature. The probability density labeled "radiobiological prior" expresses the belief about curvature deduced from animal data, as detailed in Annex 11B. As shown in Annex 10B and evident in Figure 10B-1, there is a statistically significant difference in curvatures for the different mouse strains, sex, and cancer outcome combinations investigated (p-value <. Some results indicate large curvature, some no curvature, and some curvature in the opposite direction. Because of the wide variability, the analysis is sensitive to the particular studies chosen and the approach for estimating a curvature that is presumed to be constant across studies. Given these consequences, it is judged preferable to choose a cutoff dose that is too low rather than one that is too high. Nevertheless, the fact remains that the relationships shown in Figure 10-3 would be quite different if different dose ranges were used. It could be that a linear relationship is the result of some cancelation of inward curvature and high-dose leveling-off. It is not obvious that the linear relationship resulting from such cancelation overestimates low-dose risk. The difference between that estimate and one based on the unadjusted linear model will be small relative to the size of the associated confidence interval. A recent similar analysis on cancer mortality (Preston and others 2004) has provided the somewhat larger estimated curvature 0. Adaptive Responses Adaptive responses to radiation are represented in a range of studies that purport to demonstrate that a low priming dose of radiation can influence the subsequent response of cells or experimental animals to subsequent challenge by a second higher dose. The stress-related mechanisms that have been suggested to underlie postirradiation signal transfer via cellular gap junctions or cell culture medium are not well understood. In addition, the in vivo expression of bystander effects and their impact on tumor development have yet to be adequately addressed. Cellular data and mechanistic considerations on adaptive responses are reviewed in Chapter 2. Accordingly, cellular and mechanistic data on adaptive responses are as yet insufficient to develop specific judgments on the fundamental aspects of low-dose cancer risk. Recent animal studies on adaptive responses to radiation and cancer risk are considered in Chapter 3. These studies provide some evidence that under certain conditions, a low priming dose of radiation can modestly influence the rate of development of certain tumors. However this response is not accompanied by a reduction of overall lifetime cancer risk. Uncertainties remain about the specific conditions of irradiation under which this form of adaptive response is expressed, and its mechanistic basis is a matter of speculation. Accordingly, these animal data, although of considerable scientific interest, are not sufficiently well developed to influence the modeling and interpretation of epidemiologic data. Induced Genomic Instability Induced genomic instability is a term used to describe a set of cellular phenomena whereby radiation exposure alters the state of a cell in a way that generally leads to a persistent elevation of mutation rate over many cell generations. The cellular data reviewed in Chapter 2 highlight the inconsistent mode of expression of this phenomenon and the current lack of information on the cellular mechanisms that might be involved. It is notable that many of these data sets relate to cells established in culture for many years. Despite these problems of interpretation, there has been speculation that radiation-induced genomic instability might make a significant contribution to cancer induction in vivo and thereby confound the interpretation of epidemiologic data.

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Although fuel and oil spills have the potential to cause adverse impacts to walruses and possibly some prey species life cycle of hiv infection purchase 120 mg starlix overnight delivery, operational spills associated with the exploration activities are not considered a major threat antiviral valtrex generic 120 mg starlix with visa. Operational spills would likely be of a relatively small volume antiviral cream contain buy starlix 120mg without prescription, and occur in areas of open water where walrus densities are expected to be low hiv infection rate homosexual heterosexual starlix 120mg mastercard. For these reasons, any impacts associated with an operational spill are expected to be limited to a small number of animals. Effects of Waste Discharge and Potential Oil Spills on Polar Bear Individual polar bears can potentially be affected by Industry activities through waste product discharge and oil spills. In 1980, Canadian scientists performed experiments that studied the effects to polar bears of exposure to oil. Effects on experimentally oiled polar bears (where bears were forced to remain in oil for prolonged periods) included acute inflammation of the nasal passages, marked epidermal responses, anemia, anorexia, and biochemical changes indicative of stress, renal impairment, and death. Many effects did not become evident until several weeks after the experiment (;ritsland et al. Oiling of the pelt causes significant thermoregulatory problems by reducing the insulation value. Irritation or damage to the skin by oil may further contribute to impaired thermoregulation. Polar bears are biological sinks for pollutants because they are the apical predator of the Arctic ecosystem and are opportunistic scavengers of other marine mammals. Additionally, their diet is composed mostly of high-fat sealskin and blubber (Norstrom et al. The highest concentrations of persistent organic pollutants in Arctic marine mammals have been found in polar bears and seal-eating walruses near Svalbard (Norstrom et al. Sub-lethal, chronic effects of any oil spill may further suppress the recovery of polar bear populations due to reduced fitness of surviving animals. In addition, subadult polar bears are more vulnerable than adults are to environmental effects (Taylor et al. Subadult polar bears would be most prone to the lethal and sub-lethal effects of an oil spill due to their proclivity for scavenging (thus increasing their exposure to oiled marine mammals) and their inexperience in hunting. Indeed, grizzly bear researchers in Katmai National Park suspected that oil ingestion contributed to the death of two yearling grizzly bears in 1989, after the Exxon Valdez oil spill. They detected levels of naphthalene and phenathrene in the bile of one of the bears. Because of the greater maternal investment a weaned subadult represents, reduced survival rates of subadult polar bears have a greater impact on population growth rate and sustainable harvest than reduced litter production rates (Taylor et al. During the open-water season (July to October), bears in the open water or on land may encounter and be affected by any such oil spill; however, given the seasonal nature of the Industry activities, the potential for direct negative impacts to polar bears would be minimized. During the ice-covered season (November to May), onshore Industry activities will have the greatest likelihood of exposing transiting polar bears to potential oil spills. Although the majority of the Chukchi Sea polar bear population spends a large amount of time offshore on the annual or multiyear pack ice and along the Chukotka coastline, some bears could encounter oil from a spill regardless of the season and location. Small spills of oil or waste products throughout the year by Industry activities on land could potentially affect small numbers of bears. The effects of fouling fur or ingesting oil or wastes, depending on the amount of oil or wastes involved, could be short-term or result in death. For example, in April 1988, a dead polar bear was found on Leavitt Island, in the Beaufort Sea, approximately 9. The cause of death was determined to be poisoning by a mixture that included ethylene glycol and Rhodamine B dye. The major concern regarding large oil spills is the impact a spill would have on the survival and recruitment of the Chukchi Sea and southern Beaufort Sea polar bear populations that use the region. Currently, the Southern Beaufort Seas bear population is approximately 1,500 bears, and the Chukchi Sea bear population estimate is 2,000. These populations may be able to sustain the additional mortality caused by a large oil spill if a small number of bears are killed; however, the additive effect of numerous bear deaths due to the direct or indirect effects from a large oil spill are more likely to reduce population recruitment and survival. Indirect effects may occur through a local reduction in seal productivity or scavenging of oiled seal carcasses and other potential impacts, both natural and human-induced. The removal of a large number of bears from either population would exceed sustainable levels, potentially causing a decline in bear populations and affecting bear productivity and subsistence use. The time of greatest impact from an oil spill to polar bears is most likely during the ice-covered season when bears use the ice. To access ringed and bearded seals, polar bears concentrate in shallow waters less that 300 m deep over the continental shelf and in areas with greater than 50 percent ice cover (Durner et al.