Purpose To develop an evidence-based clinical practice guideline for the prevention of oral mucositis in children (0–18 years) receiving treatment for cancer or undergoing haematopoietic stem cell transplantation (HSCT).
Methods The Mucositis Prevention Guideline Development Group was interdisciplinary and included internationally recognised experts in paediatric mucositis. For the evidence review, we included randomised controlled trials (RCTs) conducted in either children or adults evaluating the following interventions selected according to prespecified criteria: cryotherapy, low level light therapy (LLLT) and keratinocyte growth factor (KGF). We also examined RCTs of any intervention conducted in children. For all systematic reviews, we synthesised the occurrence of severe oral mucositis. The Grades of Recommendation, Assessment, Development and Evaluation approach was used to describe quality of evidence and strength of recommendations.
Results We suggest cryotherapy or LLLT may be offered to cooperative children receiving chemotherapy or HSCT conditioning with regimens associated with a high rate of mucositis. We also suggest KGF may be offered to children receiving HSCT conditioning with regimens associated with a high rate of severe mucositis. However, KGF use merits caution as there is a lack of efficacy and toxicity data in children, and a lack of long-term follow-up data in paediatric cancers. No other interventions were recommended for oral mucositis prevention in children.
Conclusions All three specific interventions evaluated in this clinical practice guideline were associated with a weak recommendation for use. There may be important organisational and cost barriers to the adoption of LLLT and KGF. Considerations for implementation and key research gaps are highlighted.
Oral and oropharyngeal mucositis are important and common consequences of cytotoxic cancer treatment and haematopoietic stem cell transplantation (HSCT) conditioning in adults and children.1 This guideline for the prevention of oral and oropharyngeal mucositis was developed in order to prevent or reduce the severity of mucositis in children 0–18 years of age receiving cytotoxic chemotherapy or radiotherapy for cancer or undergoing HSCT. For the purpose of this guideline, oesophageal mucositis is encompassed by the terms oral and oropharyngeal mucositis; these conditions will be referred to as oral mucositis for the remainder of this guideline for the sake of brevity.
We have explicitly excluded lower gastrointestinal mucositis from the scope of this guideline. While oral hygiene is an important component of clinical care, we have not addressed its role in the prevention or reduction of oral mucositis, as good oral care should be encouraged in all children, including children with cancer.6 Reduction or modification of subsequent chemotherapy as an option for secondary oral mucositis prevention is outside the scope of this guideline.
The target users of this guideline are healthcare providers who care for children (0–18 years) who are receiving chemotherapy and/or radiotherapy for cancer or undergoing HSCT, and who are at risk of experiencing oral mucositis. This guideline is aimed particularly at physicians, nurse practitioners, nurses, pharmacists and dentists treating paediatric oncology, and HSCT patients. The overall objective was to develop an evidence-based clinical practice guideline for the prevention of oral mucositis in children (0–18 years) receiving treatment for cancer or undergoing HSCT.
The Pediatric Oncology Group of Ontario (POGO) Mucositis Prevention Guideline Development Group was formed in March 2014 (see online supplementary appendix 1). Members were selected with a view to obtain interdisciplinary representation from internationally recognised experts in paediatric mucositis and POGO institutions. Panel members completed conflict of interest forms; no members had important conflicts. The guideline was editorially independent from the funding body.
There is a large literature base of studies that evaluate oral mucositis prevention in single arm and randomised controlled trials (RCTs) among adult and paediatric populations. Biologically, interventions that are effective in adult populations are likely to have a similar effect in children. However, differences in efficacy may arise related to changing pharmacokinetics and pharmacodynamics, age-related variance in the distribution of receptors for targeted interventions and lack of patient cooperation for some interventions. Specific interventions may have less utility in children if there is limited use of an antineoplastic agent in children when the mechanism of protective activity is agent specific. Toxicities of therapy may also be different and interference with anticancer activity may differ by underlying tumour type. Paediatric studies are also critical to determine dosing recommendations. Consequently, we decided to evaluate the adult and paediatric literature with an emphasis on the appraisal of paediatric studies.
In order to limit the scope of the adult and paediatric review, we took a pragmatic approach that builds on work conducted by a recent Cochrane Collaboration systematic review,7 and The Mucositis Study Group of the Multinational Association of Supportive Care in Cancer and International Society of Oral Oncology (MASCC/ISOO).8–17 More specifically, because our health question was to identify prophylactic interventions that are effective at preventing or reducing the severity of oral mucositis, we chose to systematically review interventions that were recommended or suggested in any population by MASCC/ISOO for the prevention of oral mucositis and that showed evidence of benefit in the Cochrane Collaboration systematic review. These interventions were cryotherapy, low level light therapy (LLLT) and keratinocyte growth factor (KGF). Since the best way to evaluate the efficacy of an intervention is through conduct of RCTs, we evaluated RCTs of these agents in any age group and assessed if the effect appeared to differ by adult or paediatric population. We did not conduct systematic reviews of agents that the MASCC/ISOO guideline recommended against using.
We also conducted additional reviews restricted to paediatric patients. Because of the potential risk of harm with KGF in children, we undertook a systematic review of any primary study type of KGF use in paediatric cancer or HSCT. Finally, in order to better understand the full scope of the evidence base for mucositis prevention in children, we conducted a systematic review of all RCTs of any intervention to prevent oral mucositis in paediatric patients. If an agent other than cryotherapy, LLLT or KGF appeared promising in children, we had planned to conduct a combined adult and paediatric review of that agent. The search strategies, selection criteria, approach to appraisal and specific search details can be found in online supplementary appendix 2.
For all systematic reviews, we synthesised the occurrence of severe oral mucositis when at least three studies reported on this outcome for a specific intervention. Severe oral mucositis was defined as WHO, National Cancer Institute—Common Terminology Criteria for Adverse Events (NCI-CTCAE) V.2.0 or Radiation Therapy Oncology Group (RTOG) scale score of 3 or 4. All these scores use a five-point scale ranging from 0 to 4 in which scores of 3 and 4 represent the worst mucositis. The NCI-CTCAE V.3.0 scale ranges from 1 to 5 in which 5 is fatal mucositis. NCI-CTCAE V.3.0 scores of 3–5 were considered severe. All syntheses used the risk ratio (RR) as the effect measure where ratios less than 1 suggest that the intervention is better than placebo or no therapy. The 95% CI was also described. As we anticipated heterogeneity across studies, a random effects model was used for all analyses. Analyses were conducted using Review Manager (RevMan, V.5.2, Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2011).
We identified outcomes most important for this guideline. Outcomes of critical importance were severe oral mucositis, mucositis of any severity, pain and adverse events associated with the intervention. Outcomes of lower importance included receipt of opioid analgesia, enteral or parenteral nutrition, infection outcomes and fever, since these outcomes are subject to confounding and institutional variation.
We used the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach to describe quality of evidence and strength of recommendations.18 ,19 Quality of evidence was evaluated in terms of risk of bias (methodological limitations), imprecision of estimates, inconsistency of results between studies and indirectness (lack of applicability to the target population). In this guideline, indirectness primarily occurred when the data were not paediatric specific. A strong recommendation was made when benefits clearly outweighed the risks and burdens or vice versa. In contrast, a weak recommendation was made when benefits and risks or burdens were closely matched, or when there was considerable uncertainty about the magnitude of the benefits and risks. Each recommendation was carefully deliberated by the panel. Decisions were taken through panel discussions and any differences in opinion were resolved by consensus.
The draft guideline was distributed to 12 external experts in adult and paediatric mucositis. Specific recommendations were reviewed by the panel and the guideline was revised accordingly. The guideline development process took 6 months from constitution of the panel to guideline completion. This guideline will be reviewed every 5 years or earlier if important new information becomes available.
Online supplementary appendix 3 outlines the results of the search strategies and flow charts of study identification, selection and reasons for exclusion. Table 1 presents the summary of recommendations, strength of recommendations, level of evidence and remarks.
Recommendation 1.1: We suggest that cryotherapy may be offered to cooperative children receiving chemotherapy or HSCT conditioning with regimens associated with a high rate of mucositis.
Remarks: This recommendation places high value on the possible reduction in mucositis with an intervention with a low risk of harm. It is a weak recommendation because of the lack of paediatric-specific evidence, because the majority of studies that demonstrated the benefit of cryotherapy were conducted using chemotherapy regimens not commonly given to children and because of the methodological limitations of the conducted trials. Regimens appropriate for cryotherapy are restricted to agents with a short infusion time and short half-life.
Oral cryotherapy involves placing ice cubes or ice chips in the mouth and continually replenishing fresh ice during the period of cytotoxic treatment (typically 30–60 min). It is an attractive intervention because of its low cost and universal access. In reviewing the evidence tables (see online supplementary appendices 4–6), there have been 14 RCTs conducted of cryotherapy in which 1301 patients have been randomised. In 13 studies, cryotherapy was given during chemotherapy administration and in 1 study, it was given before and after localised radiotherapy to the head and neck. Of the 14 studies, 12 reported a benefit of cryotherapy. Figure 1 illustrates that cryotherapy significantly reduced severe oral mucositis (RR 0.46, 95% CI 0.30 to 0.71; p=0.0005) among the eight studies reporting this outcome.
Cryotherapy versus no cryotherapy for the reduction of severe oral mucositis in patients receiving treatment for cancer or undergoing haematopoietic stem cell transplantation. Forest plot of incidence of severe (grade 3 or 4) mucositis in adults and children randomised to cryotherapy, versus no cryotherapy in patients with cancer and those receiving haematopoietic stem cell transplantation. Squares to the left of the vertical line indicate that the intervention reduces mucositis. Horizontal lines through the squares represent CIs. The size of the squares reflects each study's relative weight, and the diamond represents the aggregate risk ratio and 95% CI.
In spite of the many RCTs available, the quality of evidence supporting this recommendation was only moderate due to indirectness and limitations in study design. Only one study included children, and the youngest child was 8 years of age.20 This study included adults and children undergoing allogeneic HSCT, and cryotherapy was administered with low-dose methotrexate for graft-versus-host disease (GVHD) prophylaxis. Notably, this study was one of only two studies that failed to show a benefit of cryotherapy. Likely, the conditioning regimen contributed much more to the risk of mucositis than did low-dose methotrexate given for GVHD prophylaxis; thus, this study is difficult to interpret. In addition, the most common regimen used in the studies of cryotherapy was 5-fluorouracil (8/14 studies); this agent is rarely used in children. Indirectness is also a concern as there is likely to be an age at which children cannot or will not comply with cryotherapy during chemotherapy administration.
Limitations in study design are also a concern. Online supplementary appendix 5 illustrates that three of the studies were quasi-RCTs. Adequate sequence generation was only present for two studies and it was inadequate in three. None of the 14 RCTs adequately concealed allocation, a major methodological limitation, as lack of allocation concealment has been associated with exaggerated treatment effects.21 Finally, only two studies used blinded outcome assessors. The low quality of the RCTs evaluating the efficacy of cryotherapy for mucositis prevention raises concerns about the possibility of bias.
Cryotherapy is only feasible if chemotherapy is administered as a short infusion and has a short half-life. The chemotherapeutic agents used in the studies of cryotherapy were 5-fluorouracil (8 studies), melphalan as conditioning for HSCT (2 studies), a variety of conditioning regimens for autologous and allogeneic HSCT (1 study), and etoposide, cisplatin, mitomycin-C and vinblastine (1 study). It would be reasonable to use cryotherapy for paediatric patients receiving short infusions of these chemotherapeutic agents. In addition, since the biological mechanism underlying the effect of cryotherapy is likely related to reduced distribution of the cytotoxic agent to the oral mucosa due to vasoconstriction, it may also be reasonable to use cryotherapy for other regimens associated with a higher risk of mucositis as long as the regimen is given over a short period of time such as 30 min, and the agent has a short half-life. Flavoured ice popsicles, ice slushy drinks or 'freezies' are likely to be more acceptable to children than plain ice.
There are two safety considerations with cryotherapy. First, if ice chips are to be used, they may be a choking hazard in very young children, although children who are old enough to comply with cryotherapy are unlikely to be at risk for choking. Second, vasoconstriction of the oral tissues may influence local anticancer activity, although this issue has not been noted in the adult studies.
Recommendation 1.2: We suggest that LLLT may be offered to cooperative children receiving chemotherapy or HSCT conditioning with regimens associated with a high rate of mucositis.
Remarks: This recommendation places high value on the possible reduction in mucositis with an intervention with a low risk of harm. It is a weak recommendation because this strategy requires specialised equipment and expertise, and it is unknown whether it is feasible to deliver this therapy modality in routine clinical practice, particularly in a paediatric population. The ideal treatment parameters and cost-effectiveness of this approach are unknown.
LLLT is based on the physiological effects of low-energy light without thermal generation. The main effects of phototherapy are anti-inflammatory, influence on wound healing and analgesic. While the precise mechanism of action of LLLT in preventing oral mucositis is not fully understood, a number of biological effects have been well characterised at the molecular, cellular and tissue-based levels.22 It is typically administered intraorally, although there is some experience with external application. In the systematic review by Oberoi et al,23 18 prophylactic LLLT studies were identified; online supplementary appendix 7 summarises the type of laser, wavelength, energy and laser schedule. LLLT significantly reduced the incidence of severe mucositis (RR 0.37, 95% CI 0.20 to 0.67; p=0.001). LLLT also reduced the incidence of severe pain (RR 0.26, 95% CI 0.18 to 0.37; p<0.0001). Two studies included children and there was no difference in the effect of LLLT by age (p for interaction=0.90). One study included adults and children receiving autologous or allogeneic HSCT24 while the second study included children receiving chemotherapy or autologous HSCT.25 There was no difference in the effect of LLLT by underlying condition (patients with head and neck cancer receiving radiotherapy or chemoradiotherapy versus patients receiving chemotherapy or HSCT; p for interaction=0.85).
The review identified a significant interaction by allocation concealment, with the effect of LLLT to prevent severe mucositis being RR 0.61 (95% CI 0.30 to 1.25) in studies with adequate concealment and RR 0.16 (95% CI 0.07 to 0.41) for studies with unclear or inadequate concealment (p for interaction=0.03). There was also evidence of publication bias with four outlying studies in the funnel plot. When the 'trim and fill' technique26 was used to account for publication bias, the effect of LLLT remained significant (RR 0.51, 95% CI 0.29 to 0.90; p=0.0197).
In summary, LLLT is effective in reducing severe mucositis in patients receiving treatment for cancer and undergoing HSCT, although methodological concerns and potential publication bias may mean that the treatment effects observed in these trials are exaggerated.
Recommendation 1.3: We suggest that KGF may be offered to children receiving HSCT conditioning with regimens associated with a high rate of severe mucositis.
Remarks: This recommendation places high value on the evidence of efficacy of KGF in adult populations. It is a weak recommendation because of the lack of efficacy and toxicity data in children, a theoretical concern that young children may be at increased risk of adverse effects related to mucosal thickening and the lack of long-term follow-up data in paediatric cancers.
KGF is an epithelial growth factor; it is a 28 kD, heparin-binding member of the family of fibroblast growth factors. The most commonly studied KGF is palifermin, a recombinant human KGF. It is contraindicated in patients with known hypersensitivity to Escherichia coli derived proteins. Online supplementary appendices 8–10 describe the 11 RCTs conducted of KGF; they included 1470 randomised patients. Ten studies evaluated palifermin while one study evaluated repifermin (no longer available). Use of KGF was evaluated in the context of HSCT conditioning (5 studies); chemoradiotherapy for head and neck cancer (3 studies); and chemotherapy alone (3 studies). Of the 11 studies, 9 reported a benefit of KGF.
Figure 2 illustrates that KGF significantly reduced severe oral mucositis (RR 0.81, 95% CI 0.67 to 0.97; p=0.02) in the eight studies reporting this outcome. Primary toxicities were related to the pharmacological properties of the agent with thickening of the oral mucosa and altered taste sensation. The quality of these studies was high and all studies were placebo controlled. All 11 trials were sponsored by a pharmaceutical company. Only one study included children, and it evaluated KGF for the prevention of GVHD following allogeneic HSCT in a mixed adult and paediatric sample.27 Mucositis severity was evaluated as a secondary outcome and a significant reduction in the mean severity of oral mucositis with KGF compared with placebo was observed (WHO 2.3 vs 2.8; p=0.01). In a long-term follow-up of this study, no difference in invasive fungal infection, chronic GVHD, or overall survival between the KGF and placebo cohorts was evident at 2 years.28 However, relapse rates were not described, few patients had solid tumours (number not specified) and outcomes were not specifically reported for paediatric patients.
Keratinocyte growth factor (KGF) versus no KGF for the reduction of severe oral mucositis in patients receiving treatment for cancer or undergoing haematopoietic stem cell transplantation. Forest plot of incidence of severe (grade 3 or 4) mucositis in adults and children randomised to KGF versus no KGF in patients with cancer and those receiving haematopoietic stem cell transplantation. Squares to the left of the vertical line indicate that the intervention reduces mucositis. Horizontal lines through the squares represent CIs. The size of the squares reflects each study's relative weight, and the diamond represents the aggregate risk ratio and 95% CI.
We made a weak recommendation that KGF may be considered for children undergoing HSCT if the benefits of mucositis prevention outweigh the risks and costs. If used, KGF should be administered at a dose of 60–90 µg/kg/day for 3 days prior to conditioning and 3 days following stem cell infusion.
Other growth factors, glutamine and Traumeel S, were not consistently effective in reducing mucositis in paediatric patients in more than one study. Single studies of topical vitamin E,37 transforming growth factor-β2-enriched feeding,38 chewing gum,39 chlorhexidine gluconate,40 sucralfate41 and a preventive oral disease protocol42 were not effective in reducing mucositis. Given that our focus was on the identification of effective interventions to prevent or reduce mucositis, we did not make strong or weak recommendations against the use of any of these agents. Recommendations against the use of an agent would require adult and paediatric systematic reviews and the development of specific criteria on which to make such a recommendation. However, the identification of ineffective interventions is an important area for future research and is identified as a research gap.
In this guideline, we identified three interventions that may be appropriate for mucositis prevention in children. Figure 3 illustrates an algorithm for strategy implementation consideration. All three specific interventions (cryotherapy, LLLT and KGF) evaluated in this clinical practice guideline were associated with a weak recommendation for use. Since all systematic reviews compared the intervention against placebo or no therapy, it may be helpful to compare the RRs to gain insight into prioritisation. The RR against placebo or no therapy for LLLT, cryotherapy and KGF were 0.37, 0.46 and 0.81, respectively. In evaluating all three interventions, KGF is an intervention associated with high costs and a potential for harm. In contrast, cryotherapy is associated with very few costs and little risk of harm. On balance, if all three interventions are available, and clinically relevant, cryotherapy or LLLT should likely be prioritised for implementation whereas KGF should be used carefully in individual patients after weighing risks and benefits. There may also be important organisational and cost barriers to the adoption of LLLT since it requires specialised equipment and training for those who will administer therapy.
Suggested implementation approach for the prevention of oral mucositis guideline recommendations (HSCT, haematopoietic stem cell transplantation; KGF, keratinocyte growth factor, LLLT, low level light therapy).
Dissemination of this guideline will be an important step in effective knowledge translation. We plan to disseminate this guideline through peer-reviewed publication, presentation at conferences and through paediatric oncology and dental organisations.
Research gaps are highlighted in box 1 and include identification of chemotherapeutic agents appropriate for cryotherapy. Important research gaps related to LLLT include better mechanistic information on how the modality could be effective, determination of ideal treatment parameters and comprehensive long-term adverse-effect evaluation, since enhanced bone growth has been reported in preclinical studies.49 ,50 For KGF, research is needed to identify the optimal KGF dose and its short-term and long-term toxicities in paediatric patients. Data related to compliance and cost-effectiveness are needed for these strategies. More paediatric evidence is required to evaluate existing and new interventions to prevent or reduce the severity of mucositis particularly since some children at risk for mucositis, especially infants and very young children, will not be eligible for any of the interventions identified in this guideline.
Another important gap is the identification of ineffective interventions to prevent mucositis in children. In randomised trials, equivalence trials require larger sample sizes than superiority trials because the minimal clinically important difference (in superiority trials) is larger than the margin of clinical equivalence. In synthesising trial results, it is unclear how much information is required before concluding equivalence in efficacy outcomes. Similarly, it is unclear how much information demonstrating lack of benefit is required before panels can recommend against use of an agent for interventions without meaningful harms or costs. Finally, how panels should weigh indirect adult evidence in making paediatric recommendations against use of an intervention is another question. Among these research gaps, research priorities that should be addressed early include the identification of paediatric anticancer treatment protocols appropriate for cryotherapy, feasibility of cryotherapy and LLLT in clinical practice, and child preferences for these strategies.
The authors would like to acknowledge the assistance of Elizabeth Uleryk, Director, Hospital Library, The Hospital for Sick Children with the literature searches and the administrative/research assistance of Sandra Cabral and Amanda Celis. They also wish to thank the following individuals for assisting with translation: Amanda Celis, Hisaki Fujii and Olena Shatokhina. The authors also gratefully acknowledge the following content experts who externally reviewed the guideline: Dr Victor Aquino, Dr Carlton Brown, Dr Camila Merida Carrillo, Dr June Eilers, Dr Dorothy Keefe, Dr Rajesh Lalla, Dr John Levine, Dr Michael Nieder, Dr Doug Peterson, Dr Sérgio Petrilli, Dr Juliana Castilho Chaves Rojz and Dr Stephen Sonis. They would also like to acknowledge the Pediatric Oncology Group of Ontario for providing research support.
. Oral complications of cancer therapy. In: De Vita VT Jr., Hellman S, Rosenberg SA, eds. Principles and practices of oncology. Philadelphia: Lippincott-Raven, 1993:2385–94.
American Academy of Pediatric Dentistry. Policy on oral health care programs for infants, children, and adolescents. Oral Health Policies, 2011.
, eds. Cochrane handbook for systematic reviews of interventions, Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011.
. Transient oral cavity and skin complications after mucositis preventing therapy (palifermin) in a patient after allogeneic PBSCT. Case history. Adv Med Sci 2006;51(Suppl 1):66–8.
. Use of recombinant human granulocyte colony-stimulating factor to increase chemotherapy dose-intensity: a randomized trial in very high-risk childhood acute lymphoblastic leukemia. J Clin Oncol 2000;18:1517–24.
. Effectiveness of oral chlorhexidine for reducing stomatitis in a pediatric bone marrow transplant population. Pediatr Dent 1989;11:37–42.
. Oral-disease prevention in children with cancer: testing preventive protocol effectiveness. Medicina Oral 2001;6:326–34.
Correction notice This article has been corrected since it published Online First. The Open Access licence has now been added.
Contributors LS, PR and LLD contributed to the conception and design, collection and assembly of data, data analysis and interpretation, and manuscript writing. NT, TB, PG, WT, JW and JB contributed to the interpretation and manuscript writing. All authors approved the final manuscript.
Funding Funding support was provided by the Pediatric Oncology Group of Ontario. LS is supported by a New Investigator Award from the Canadian Institutes of Health Research (Grant no. 87719).


text:
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Here is another fun blue tomato that is amazing in color, cherry sized and great for salads.
The more intense the sunlight the deeper the purple Fahrenheit Blues gets.
High in anthocyanins like blueberries.
The plant itself grows 3-4' tall and has narrow silver-green leaves.
Fahrenheit Blues is grown organically here at Sustainable Seed Farms.
I'm just getting my garden things together and I'm so excited to try all the new seeds I got! Everything from ordering to shipping to packaging has made me a happy customer. I'll be ordering again as I assume all my seeds will grow just fine!
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Simon Hackett dispels the myths, promoted from a 2006 Citigroup report, that claim ADSL2+ has poor performance in the real world. Simon, the managing director of national broadband trailblazer Internode and network infrastructructure pioneer Agile Communications, first published this article about the history of ADSL broadband in Australia on his blog www.simonhackett.com.
Internode was the first company to launch commercial ADSL2+ services in Australia well over a year ago.
As such, Internode, along with other organisations such as iiNet that were early movers in deploying ADSL2+ services, has lot of real world experience with the achievable and sustainable data speeds available in Australia using this technology. This is experience that Telstra does not have.
Various members of the media have, this week, cited a report by Citigroup about FTTN and ADSL2+ which is, simply, codswallop.
To my chagrin, many respectable journalist have cited and repeated these most remarkably wrong claims, as if they were fact.
These statements, which claim ADSL2+ can only deliver a realistic speed of about 3 megabits per second (Mbps) on copper lines averaging distances of 2km are simply rubbish.
Accuracy about real world ADSL2+ performance is critical to the entire debate over this issue. Inaccurate claims only perpetuate the Telstra party line that its mysterious and never fully revealed FTTN proposals held a secret magic pudding that somehow works better than ADSL2+, and that is somehow different in some way to existing FTTN deployments.
The truth is that speeds touted by Telstra as requiring FTTN are already available, and are being enjoyed today, across Australia.
This paper from iiNet provides actual data points from the iiNet ADSL2+ deployment in the Sydney basin. These are real world Australian results, not consultants projections or assumptions based on ... well, certainly not based on fact.
Internode's experience with its ADSL2+ deployment mirrors that of iiNet in this regard.
More than 90 per cent of our ADSL2+ customers in metro areas enjoy speeds faster than 6Mb/s today.
With Internode's impending launch of ADSL2+ Annex M services â?? which are already used on a trial basis by a number of Internode customers â?? we are now adding to our capabilities by being able to offer upstream speeds of the order of 2 Mbps.
This upstream data rate is well beyond the paltry 256 kilobit upload data rate that Telstra has locked most of its own ADSL its lines to since 1999.
If you look at the Internode Speed v. Distance graph at http://www.internode.on.net/adsl2/graph/index.htm, you can see the dramatic speed advantage of unconstrained ADSL compared with the anaemic 1.5Mb/s limit that Telstra has administratively enforced in its network since 1999.
Even Australia's first generation ADSL is capable of data transfer speeds far above the numbers cited from the Citigroup report at distances far beyond the 1.5km line length that Telstra has promoted as a drop-dead limit for high performance broadband over copper.
The 1.5km limitation assumed this "magic" limitation status because Telstra propagated this limit during the farcical FTTN debate and various parts of the media picked it up and copied it - regardless of the demonstrated reality in Australia.
So, lets specifically note and then rebut every bullet point ascribed to that Citigroup report by various Australian journalists this week.
"The thin diameter of Australian copper"
Australian copper is not unusually thin at all. Indeed, typically the opposite is the case.
Internode's experience with rural ADSL2+ deployments demonstrate that the long distances covered by copper in country areas (and the corresponding choice of heavier gauge copper in those runs) mean that it is routine for our customers in regional zones to achieve speeds above 6Mb/s at distances far exceeding those in the city.
The graph at http://www.internode.on.net/adsl2/graph/index.htm displays that the performance achieved by ADSL2+ remains far in excess of that achievable by ADSL.
Indeed, even ADSL1 is operating much faster than 1.5Mb/s far beyond that distance. Telstra has made a decision to keep its peak network speed in 2006 â?? six years down the track â?? to 1.5Mb/s as per the red Telstra administrative constraint box on that graph.
It is important to appreciate that ADSL1 â?? the standard deployed in Australia since 1999 â?? was capable of speeds of up to 8Mb/s on day one. Constraint below that speed is a business decision of Telstra, not a technical limitation. Recently, it has been touted as due to technical limitations to advance the underlying deceit in the selling of FTTN to the market. Put simply, it ain't so.
Internode has practical experience which shows that while cross-talk does degrade performance to a mild extent, as a designed-in part of the protocol, it's entirely manageable in practice. Years of careful deployment rule design by ACIF, with Telstra as a key participant, have ensured that the mangement of crosstalk in the copper line network is entirely tenable.
Long cables don't slow data flow down, thin or full ones do.
Internode operates at this time (August 2006) almost three gigabits per second of leased capacity on the Southern Cross Cable Network in its own right. Our customers hit the peak performance of their ADSL2+ Extreme broadband services at any time they wish to â?? 24x7x365.
Properly engineered international networks work fine – and, by the way, are absolutely unrelated to the engineering of properly deployed local loop networks. A great ISP engineers its whole network well. A lacklustre one does not. This is nothing to do with ADSL2+ and everything to do with professional deployments v. "cowboy" ones.
These filters work just fine. The latest generation of filters comply with all of the applicable standards and do what they're supposed to do.
Internode customers see fast, real-world speeds using our supplied filters.
Occasional cases of problems with internal house wiring (or a need to interwork properly with back-to-base alarms) can be handled with the (routine and inexpensive) installation of a 'Central Splitter" into the premises by a licensed cabler.
This may be a problem for Telstra, in its 1999 generation ATM backhaul network, but its an utter non-issue for its competitors, such as Internode and iiNet. We use 'dark fibre' â?? i.e. fibre operating at an unconstrained data rate â?? leased from dark fibre service providers such as Pipe Networks. Those links operate at multi-gigabit speeds, and are expandable by changing the equipment at each end, without any further expenditure on the access costs to use those fibres.
Non-Telstra ADSL2+ deployments are already built in this 'next generation network' manner that Telstra is scrambling to copy. Backhaul is not a problem for any properly engineered competitor's network. Indeed, there are already plenty of ADSL2+ competitors for Telstra â?? in exactly the same coverage areas that FTTN was expected to serve.
In conclusion, media coverage of the 'facts' about ADSL2+ lately contain a combination of falsehoods and misunderstandings as well as descriptions of constraints that exist on the Telstra network but not in any elses' network.
In the real world, Telstra's competitors â?? who have sold ADSL2+ services for more than a year, in essentially the same coverage area that the FTTN farce would have covered â?? are providing customers with the services that Telstra claimed to need AUS$4bn and the destruction of a decade of competition reform (by physically unplugging 100% of their competitors, permanently) to achieve.
Telstra's FTTN campaign has worked to pull the wool over the eyes of its shareholders, the public and the media for more than a year.
Proper scrutiny produces the revelation that not only does the emperor have no clothes, but the competitors to the emperor have been selling their customers a fine choice of designer clothing since March 2006.
The truth is that the broadband situation in Australia is not bad. It's actually great - and getting better by the week - without FTTN.
There is a strong and exciting scope, now that FTTN is dead, for innovative competitors, and for groups like the G9 to take the ball and run with it - to deploy even more cost effective, and more efficient, ways to improve broadband outcomes in Australia.
The paying customers of Internode (and other companies deploying ADSL2+ in Australia) are providing, daily, that 'real' broadband is extremely available in Australia - today - and its deployment is becoming more and more widespread by the week.
Well within the touted build timeframe for 'FTTN' ('40 months'), more than 90% of customers who want 'faster than 1.5Mb/s' broadband in Australia will be able to buy it, from multiple service providers.
The remaining 10% can be addressed by the efforts of the G9 and other individual service providers in various ways. This can be accelerated if Telstra decide to become a part of the solution, but one way or another - we'll get there.


You are here: Home > The Consciously Parenting Blog > Do we have mistaken ideas about sleep?
My oldest son wasn't a very good sleeper. In fact, I didn't know how little sleep one could survive on and still talk in complete sentences until he came into my life. When he was diagnosed with colic and reflux, I was told to prop him up to sleep, and to feed him rice cereal in a bottle (which I didn't do). I was told that he would out-grow his night waking as the months went by and was reassured by countless parents that all children do eventually sleep. And he did eventually sleep. At 11, my challenge is now to get him out of bed!
It seems that sleep-deprived parents are given two choices: cry- it-out or just wait until they outgrow it.
Was my son's lack of sleep more than just an inconvenience?
Was he trying to communicate something to me through his night waking?
A few months ago, I recorded an audio series with Ray Castellino and Mary Jackson about infant and toddler sleep. I was amazed to learn that the way that a baby comes into the world has a profound effect on the way that a baby sleeps or doesn't sleep. In fact, through their work at BEBA (Building and Enhancing Bonding and Attachment) in Santa Barbara, CA, Ray and Mary have learned that babies communicate with their parents at night (when they have our full and undivided attention) through waking, body movements, and sounds to tell their story. When babies' stories are expressed and listened to during the day, sleep improves.
This idea intrigued me. Was it possible that my son's very quick birth had been difficult for him? Was it possible that he was communicating the stress he had felt during my pregnancy with him while I was working 70 hours/week doing home visits for my master's degree? Or the preterm labor that landed us in the hospital on medications to stop my labor? Or the pitocin that was used to start my labor after my water broke at term?
Could that really affect his sleep?
My 11 year old, as I mentioned, is sleeping just fine; however, I am working with families with children who aren't sleeping well. What happens to a child's sleep patterns when we support a child to tell his story?
In my blog next week, I'll share some things that parents can do to see this challenge in a different light and start moving toward more peaceful night sleeps no matter how old your child is now. I'm excited to share this ground-breaking clinical experience with you and your family.
Home > The Consciously Parenting Blog > Do we have mistaken ideas about sleep?


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Back Catalogue: Indie
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Live At Third Man (7")
Third Man US
Cat: TMR 437. Rel: 19 Jan 18
Broken Necks (3:39)
Alone At The Party (2:08)
in stock $5.76
David O'DOWDA
Better In The Dark (7")
Cat: VAN 344. Rel: 08 Nov 19
Wait (4:04)
Better In The Dark (2:39)
ODD HOPE
All The Things (7" + MP3 download code)
Slumberland US
Cat: SISLR 246. Rel: 11 Jun 20
All The Things (2:07)
What's Your Part Of It? (3:02)
The ODD NUMBERS
Windmills (7")
Sons of Pioneers US
Cat: SOPR 002. Rel: 18 Jan 19
Windmills (3:15)
Wasteland (2:51)
OFFICERS/FIZZY BLOOD
Attack (7" + MP3 download code)
Come Play With Me
Cat: CPWM 2. Rel: 24 Feb 16
Officers - "Attack" (4:25)
Fizzy Blood - "Sweat & Sulphur" (2:52)
OGIKUBO STATION
Okinawan Love Songs (limited coloured vinyl 7" + MP3 download code (comes in different coloured vinyl, we cannot guarantee which one you will receive))
Asian Man US
Cat: AM 3497. Rel: 09 Aug 19
Would I Break My Heart Enough For You (2:47)
Spend Some Time With Me (1:48)
Dr Worm (2:47)
OHMNS
The Rice Tape (12")
K Ultrax
Cat: KXLP 005. Rel: 03 Sep 20
Boil D Rice (3:12)
View From Here (2:30)
Paul Is Sure (4:52)
El Chapo (4:26)
Keshi Heads (7:30)
ONE SUMMER
Spirit (Record Store Day 2017) (pink vinyl 12")
Cat: VR 010. Rel: 02 May 17
Spirit (6:03)
British Summertime (4:28)
Can't Stop Falling (3:35)
OOGBOGO
Oogbogo (12")
God? US
Cat: GOD 017. Rel: 17 Jan 20
Broken Book (3:36)
Hot Rock (3:17)
Tower's Ladder (4:34)
Coyote Loves The City At Night (2:41)
ORUA
Tudo Posso (7")
Cat: IFB 128. Rel: 04 Jan 21
Prece Alafim (2:58)
Domador (1:11)
Cruz De Almas (4:10)
Escola De Arte Moderna (2:16)
Crunchy Zest (12")
Africantape
Cat: AT 022. Rel: 01 Jan 90
Crunchy Zest
Crunchy Zest (Antoni Maiovvi extended disco mix)
Orange Jewelryist (Orange Blossom Special Tractor Pull mix)
Bad Timing (LP)
Drag City US
Cat: DC 120. Rel: 01 Jan 90
There's Hell In Hello But More In Goodbye
94 The Long Way
Bad Timing
Eureka (LP)
Prelude To 110 Or 220/Women Of The World
Ghost Ship In A Storm
Movie On The Way Down
Through The Night Softly
Please Patronize Our Sponsors
Something Big
(What's The Story) Morning Glory? (remastered) (trifold heavyweight vinyl 2xLP + MP3 download code)
Cat: RKIDLP 73. Rel: 23 Sep 14
The Swamp Song
Some Might Say
Cast No Shadow
She's Electric
Champagne Supernova
Definitely Maybe (remastered) (heavyweight vinyl gatefold 2xLP + MP3 download code)
Cat: RKIDLP 70. Rel: 13 May 14
Rock 'N' Roll Star
Shakermaker
Live Forever
Bring It On Down
Cigarettes & Alcohol
Digsy's Dinner
Gespielt von: Juno Recommends Rock/Indie, Upside Down
OBNOX
Savage Raygun (gatefold 2xLP)
Ever/Never US
Cat: EN 047. Rel: 25 Sep 20
Superdope (1:31)
Catbird (2:52)
Supernatural (3:24)
How To Build A Bum (3:56)
Blessed Black Soldier (4:00)
Heaven (2:56)
Misery (2:54)
Return Fire (4:10)
She (Was All About That Life) (3:23)
Hawkwindian Summer (1:56)
Huggin' The Block (0:38)
Avalanche Grave (3:25)
Cut Me A Switch (3:52)
Scenicide (3:07)
Concrete Rose (3:05)
Music Saves (1:06)
Underground Timebomb (2:40)
Party Starter (3:04)
Young Neezy (2:53)
Savage Raygun (1:46)
OBSCURA HAIL
Siren/Zero (heavyweight vinyl LP + insert + MP3 download code)
Dot Dash US
Cat: DASH 066LP. Rel: 13 Oct 20
Doomer (Siren) (3:56)
Idle Hands (3:27)
Penumbra (3:43)
Uniform (3:29)
Town Cryer (4:36)
Swear Jar (Zero) (3:01)
Goth (3:00)
Sex Appeal (3:58)
The Thin Man (3:00)
Psychic Cemetery (3:15)
Moseley Shoals (reissue) (gatefold heavyweight vinyl 2xLP)
Cat: 776835 7. Rel: 27 Sep 19
The Riverboat Song (5:01)
The Day We Caught The Train (2:58)
The Circle (3:47)
Lining Your Pockets (3:40)
Fleeting Mind (5:07)
40 Past Midnight (4:02)
One For The Road (3:46)
It's My Shadow (4:21)
Policemen & Pirates (4:05)
The Downstream (5:08)
You've Got It Bad (4:48)
Get Away (7:55)
OCTOBER DRIFT
Forever Whatever (heavyweight clear vinyl LP)
Cat: PERLPX 003. Rel: 22 Jan 20
Losing My Touch (3:58)
Oh The Silence (3:31)
Cherry Red (3:39)
Don't Give Me Hope (3:50)
Just Got Caught (5:03)
Milky Blue (4:17)
Cinnamon Girl (3:41)
Naked (4:02)
Forever Whatever (3:25)
The Past (4:26)
OD DAVEY
Some Waking Woman (LP)
Tomlab Germany
Cat: TOM 151. Rel: 15 Dec 17
Some Walking Woman (4:50)
Every Rebel Campaign (2:38)
Two Fingers Flicked (3:15)
The Way Home (2:56)
Holy Land (2:57)
Crash (3:55)
The Blue Note (2:27)
The Mustard Cloud (3:13)
This Time (3:02)
A Right Honourable Friend (3:37)
OF BLOOD & MERCURY
Strangers (LP)
Consouling Sounds Belgium
Cat: SOUL 0143LP. Rel: 23 Apr 20
The Small Room (3:50)
The Body (5:23)
Estranged (5:01)
Zero (5:15)
Abyss Watcher (5:10)
Walk The Void (5:05)
Strangers (4:35)
Ghost Molecules (4:23)
How Much Is It Worth (4:04)
OF MONSTERS & MEN
Fever Dream (limited gatefold heavyweight splattered vinyl LP)
Cat: 778540 2. Rel: 26 Jul 19
Alligator (3:04)
Ahay (2:57)
Rororo (4:17)
Waiting For The Snow (3:43)
Vulture, Vulture (2:57)
Wild Roses (4:01)
Stuck In Gravity (4:14)
Sleepwalker (3:19)
Wars (3:37)
Under A Dome (4:34)
Soothsayer (3:36)
Gespielt von: Juno Recommends Rock/Indie
White Is Relic/Irrealis Mood (cassette + MP3 download code)
Polyvinyl US
Cat: PRC 350MC. Rel: 14 Mar 18
Soft Music/Juno Portraits Of The Jovian Sky (5:37)
Paranoiac Intervals/Body Dysmorphia (7:21)
Writing The Circles/Orgone Tropics (6:20)
Plateau Phase/No Careerism No Corruption (5:19)
Sophie Calle Private Game/Every Person Is A Pussy, Every Pussy Is A Star! (8:09)
If You Talk To Symbol/Hostility Voyeur (8:38)
I Wasn't Only Thinking About You (blue vinyl LP + MP3 download code)
ATO US
Cat: ATO 0434. Rel: 26 Oct 18
25 (3:33)
Asking For (3:30)
Hurt Nobody (3:18)
Truths (4:18)
What's The Deal With David? (3:11)
Up Against The World (3:05)
Parallel (3:48)
Bleeding Hearts (3:55)
Your Nail & Your Hammer (2:47)
There Would Be A Riot (3:06)
Review: Cutesy Australian duo Oh Pep! celebrate the release of their second album, scoring a bolstered release on American label ATO Records, home to the likes of Ben Kweller, Kaiser Chiefs and Alabama Shakes. It sees the pair continue to playfully enjoy their time in the indie-pop and alt-folk sun, with an album dedicated to the sweet themes of relationships; the ups, downs and middles. Highlights include the atmospheric and hushed tones of "Hurt Nobody" to the more full and chorus heavy "What's The Deal With David?" - a song for highway driving - to the melodious "Your Nail & Your Hammer". A record that will appeal to fans of Lana Del Ray and First Aid Kit.
Ultralife (gatefold LP + insert)
Solo (3:17)
Ultralife (3:34)
Lifetimes (3:51)
High On Humans (3:11)
All About You (3:02)
Heavy (3:13)
Bigger Than Love (3:39)
Heart Strings (3:27)
Slip Away (3:38)
Overgrown (4:00)
My Friends (4:46)
Waste (4:21)
OH! PEARS
Wild Part Of The World (LP)
Acuarela Spain
Cat: NOIS 1999LP. Rel: 07 Mar 15
The Sounding Of The Earth
Dark & Muted Eyes
I'm A Wild Part Of The World
Under The Olive Trees
Fill Your Lungs
Fantasize Your Ghost (limited blue vinyl LP + MP3 download code)
Joyful Noise US
Cat: JNR 330LPC 1. Rel: 31 Jul 20
Flood Your Gut (3:41)
Selling Candy (3:27)
The Limit (3:18)
Spell It Out (4:28)
TwitchTwitch (4:13)
3 2 4 3 (4:02)
Some Kind Of Calm (4:40)
Sturgeon Moon (4:06)
After All (3:35)
Josefin OHRN/THE LIBERATION
Mirage (coloured vinyl LP + MP3 download code)
Cat: LAUNCH 096. Rel: 14 Oct 16
The State (I'm In) (4:54)
Sister Green Eyes (4:30)
In Madrid (3:18)
Rainbow Lollipop (3:58)
Endless Ocean (4:03)
Looking For You (4:18)
Rushing Through My Mind (5:46)
Circular Motion (2:52)
Where I'm Going (3:49)
Imagine You (6:00)
Sacred Dreams (blue & black swirl vinyl LP + MP3 download code)
Cat: LAUNCH 162SLP. Rel: 26 Apr 19
Feel The Sun (2:00)
I Can Feel It (2:00)
Desire (2:00)
Hey Little Boy (2:00)
Only Lovers (2:00)
Baby Come On (2:00)
New Horizons (2:00)
Caramel Head (2:00)
Let It Come (2:00)
Whatever You Want (2:00)
Floating Away (2:00)
Sacred Dreams (limited orange vinyl LP + MP3 download code)
Cat: LAUNCH 162LP. Rel: 26 Apr 19
The OLD CEREMONY
Sprinter (LP + MP3 download code)
Yep Roc US
Cat: YEP 2369. Rel: 29 Jul 15
The Sprinter (3:10)
Live It Down (2:21)
Ghosts Of Ferriday (4:26)
Magic Hour (4:20)
Mission Bells (4:12)
Over Greenland (4:04)
Fall Guy (4:19)
Hard Times (3:35)
Efige (4:18)
Go Dark (3:35)
See Now & Know (LP)
Cat: KLP 272LP. Rel: 08 Mar 19
Jeremiad (2:14)
Dragon Juice (2:45)
I Know I'm Alive (3:13)
Crows In A Row (3:16)
El Naranjo Gritando (4:44)
Danau Lindu (3:19)
In This World (3:13)
Old World (LP + MP3 download code)
Record Outlet US
Cat: ROTL 116. Rel: 03 Aug 18
Stock Bomber (2:37)
Hourgalss Heads (3:24)
Fall Down Some Stairs (3:20)
Dead Clone (1:33)
Wire Forx (2:50)
Bill Cosby Robotoid (6:50)
Been Dead (3:54)
I Just Want To Start A Flame In Your House (4:03)
John Peel Session (LP + MP3 download code)
Chunklet US
Cat: CHKLP 012LP. Rel: 21 Jan 14
Suite One (Memories Of Jacqueline 1906/The Giant Day/Outer Themes/Green Typewriters)
Suite Two (Frosted Ambassador/Green Typewriters/The Princess Turns The Key To Cubist Castle/Looking For Meaning)
Music From The Unrealized Film Script: Dusk At Cubist Castle (gatefold 2xLP)
Cat: CHKLP 006. Rel: 19 Oct 11
Frosted Ambassador
Jumping Fences
Define A Transparent Dream
No Growing (Exrgesis)
Holiday Surprises 1, 2, 3
Memories Of Jacqueline 1906
Tropical Bells
Can You Come Down With Us?
Track 12 (Green Typewriters)
Spring Succeeds
Theme For A Very Delicious Grand Piano
I Can Smell The Leaves
Dusk At Cubist Castle
The Gravity Car
NYC-25
Black Foliage: Animation Music Volume One (deluxe gatefold 2xLP + free MP3 download code)
Cat: CHKLP 007LP. Rel: 11 Feb 12
A Peculiar Noise Called Train Director
Black Foliage (Animation 1)
The Sky Is A Harpsichord Canvas
A Sleepy Company
Grass Canons
I Have Been Floated
Paranormal Echoes
A Place We Have Been To
Black Foliage (Itself)
The Sylvan Screen
The Bark & Below It
California Demise 3
Looking For Quiet Seeds
Another Set Of Bees In The Museum
Hilltop Procession (Monetum Gaining)
Whole New Mess (gatefold LP + poster + MP3 download code)
Jagjaguwar US
Cat: JAG 354LP. Rel: 28 Aug 20
Whole New Mess (3:43)
Too Easy (Bigger Than Us) (2:33)
(New Love) Cassette (2:42)
(We Are All Mirrors) (2:35)
(Summer Song) (4:05)
Waving Smiling (3:51)
Tonight (Without You) (4:00)
Lark Song (6:31)
Impasse (Workin' For The Name) (3:46)
Chance (Forever Love) (5:27)
What It Is (What It Is) (2:22)
Review: "Lark", "Summer" and "Chance" from this release will be familiar to fans of Angel Olsen. They are slightly reworked and sometimes re-titled pieces from 'All Mirrors', her huge 2019 oeuvre that got high praise and plenty of glossy magazine coverage. They all serve, next to the other tracks, as reminders that songs can be more than just words, but complex webs of moods and emotions that add up to more than the sum of their parts. Here Olsen is frank and unflinching on subjects like love, loss and survival. It's a troubled but rewarding listen.
Burn Your Fire For No Witness (LP)
Cat: JAG 244LP. Rel: 13 Feb 14
Forgiven/Forgotten
White Fire
Dance Slow Decades
My Woman (gatefold LP + MP3 download code)
Cat: JAG 284LP. Rel: 02 Sep 16
Intern (2:46)
Never Be Mine (3:40)
Shut Up Kiss Me (3:22)
Give It Up (2:56)
Not Gonna Kill You (4:56)
Heart Shaped Face (5:31)
Sister (7:42)
Those Were The Days (4:14)
Woman (7:31)
Pops (4:32)
All Mirrors (gatefold heavyweight vinyl 2xLP + 12 page booklet + insert + MP3 download code)
Cat: JAG 344LP. Rel: 04 Oct 19
Lark (6:03)
All Mirrors (4:47)
Too Easy (2:52)
New Love Cassette (3:18)
Spring (3:21)
Impasse (4:12)
Tonight (4:43)
Summer (4:04)
Endgame (5:19)
Chance (6:01)
Whole New Mess (limited gatefold clear marbled vinyl LP + poster + MP3 download code)
Cat: JAG 354LPC1. Rel: 28 Aug 20
Review: If you felt Angel Olsen's 'All Mirrors' album would benefit from a stripped down, pared back interpretation this is your lucky day. Far from some rushed attempt to release anything into the music industry's COVID-19 infested waters, the intimate, often hushed and delicate versions here are actually the original recordings of the tracks, which were then elevated to the scale we heard on that LP of last year.
The plan was always to release these as a counterpoint to the bigger sounding takes, and there will be few reasonably minded people who won't delight in that decision. It's as if we've watched her sepia-hued show-stopping performance in the main ballroom and then retired for intimate drinks in the dressing room. A staggering sibling to what was already one of our favourite records from recent years.
Whole New Mess (cassette)
Cat: JAG 354CASS. Rel: 28 Aug 20
Waving, Smiling (3:51)
Strange Cacti (LP)
Bathetic US
Cat: BATH 040. Rel: 04 May 11
Tiniest Lights
If It's Alive, It Will
So That We Can Be Still
Drunk & With Dreams
Some Things Cosmic
Creator, Destroyer
Flamingo (gatefold heavyweight pink vinyl LP + MP3 download code)
Opposite Number
Cat: OPPONO 11LP. Rel: 05 Jul 19
Star City (3:24)
Come Back (3:43)
Easy Pleasure (3:35)
Nervous Riders (3:01)
Hounds (3:42)
Won't Say That (3:31)
Shoot To Forget
First You Leave
Wrong Number
BBC Radio 1 (gatefold coloured vinyl 2xLP 10")
Cat: DC 761. Rel: 18 Oct 19
Gethsemane (11:17)
State Of Non Return (8:20)
Cremation Ghat I (3:43)
Cremation Ghat II (5:29)
Networker (limited blue vinyl LP + MP3 download code)
Sub Pop US
Cat: SP 1326X. Rel: 01 Nov 19
Sincerely Yours (2:44)
Courtesy Call (3:46)
Moat (1:58)
Underage (3:34)
Skeleton Key (3:36)
Genuine Person (2:44)
Present Tense (3:30)
Blunt Force (1:35)
Flat Earth (2:54)
Networker (1:53)
Sleep Mask (3:32)
Review: If you wanted proof that distance and location can fade into insignificance when it comes to stylistic direction and musical interpretations of the world around us then consider this. While there are thousands (upon thousands) of miles between Atlanta, Georgia and North East England, Omni - who hail from America's Deep South - and Field Music, from the UK's industrial heartland - are kindred spirits in terms of sound and intonation. Take the title track for example. It's as jaunty as it is deep, as lyrically down to Earth as it is packed with evocative imagery. A meditation on the everyday and yet capable of taking you out of the here and now. Wherever that may be. Tracks like "Moat" segue between tempos and rhythms with ease, "Present Tense" rolls and tracks its way into the very centre of your mind, simple electronic keys used like mind control devices, while "Blunt Force" takes things down a woozy, art rock avenue.
Cullen OMORI
The Diet (gatefold coloured vinyl LP + MP3 download code)
Cat: SP 1234X. Rel: 17 Aug 18
Four Years (3:49)
Borderline Friends (3:11)
All By Yourself (2:33)
Happiness Reigns (3:07)
Master Eyes (4:10)
Quiet Girl (3:27)
Black Rainbow (3:00)
Natural Woman (4:08)
Millennial Geishas (3:04)
Last Line (1:54)
Queen (2:50)
A Real You (3:03)
The ON & ONS
Welcome Aboard (LP + MP3 download code)
Cat: CITLP 594. Rel: 26 Mar 18
Rounabout (3:07)
No Good For Yourself (2:30)
Mystic Eyes (3:19)
Things I Love (2:59)
Whole World (2:50)
She's Leaving (2:27)
To Die For (3:09)
Not The Only One (3:48)
Can't Avoid (3:11)
(Not A) Sweet Girl (2:41)
Sugar Anne (2:04)
Welcome Aboard (3:33)
November (limited cassette + MP3 download code)
Electronica Russia
Cat: ETAPE 005. Rel: 05 Sep 16
November (4:26)
Crumpled Memories (4:19)
Sirens (4:00)
Gravity (2:28)
Deception (5:58)
Denial (4:26)
Glow (5:15)
Not Enough Hope (4:51)
Into The Wild (4:08)
In The Wind (bonus track) (3:12)
ONE TRUE PAIRING
One True Pairing (limited 180 gram clear vinyl LP + MP3 download code)
Cat: WIGLP 445X. Rel: 20 Sep 19
Zero Summer (3:28)
I'm Not Afraid (3:39)
One True Pairing (3:32)
Weapons (3:58)
Dawn At The Factory (6:13)
Blank Walls (3:54)
Reaper Of Souls (3:32)
Elite Companion (3:44)
Alive In The Resplendent Flames (4:24)
King Of The Rats (5:17)
Only God Can Judge Me (3:25)
Genre wechseln
Disco/Nu-Disco
Klassiker/Ska
josefin ohrn
the liberation
whole new mess
sacred dreams
(what's the story) morning glory? (remastered)


Located in East Kelowna, this park is a must-do for spring hikers. The trail, located behind the locally-known Layer Cake Mountain, starts above the canyon. On the way down to the creek, you're greeted with amazing views of the mountainside and its geologically unique cliffside that was created by ancient volcanic activity.
No one has reviewed Scenic Canyon Regional Park yet, have you been here?..


It is a skin condition that makes itchiness and affects mainly the scalp. Dandruff is also known as 'seborrheic dermatitis' which is the extreme form of the condition includes inflammation of the skin. This cause top layer of the skin gets damaged with scalp starts to broken out. Top layer controls the dead cells that protect more brittle cells below. Flaking of dead skin is a part of the regular process where dead skin cells drop with a new layer formulated below. However, certain factors makes inordinate flaking of the skin.
Dandruff can be really embarrassing and irritating to deal with. And the worst thing about dandruff is that it may cause acne and mess up with skin too. The dandruff flake is either dry or greasy. It affects the strength of your hair and leads them to hair fall.
Dry Skin-Related Dandruff: Dandruff that occurs because of dry skin is a very common type. Generally, during winters, when you wash your hair with warm water, it becomes more dry and flaky.
Oil-Related Dandruff: It is also a common cause of dandruff in which sebum or oil secreted from the scalp gets accumulated on the skin. It happens as a result of sporadic or improper washing of hair. If the scalp is unclean, sebum or skin oil gels with all the dead skin cells and dirt, giving itchy flakes.
Fungal Dandruff: Malassezia is a fungus present on the scalp and skin. Generally, its growth is limited, but when there is excessive oil on the scalp, it favors the growth of this fungus. Malassezia gives oleic acid as a byproduct. This acid produces a lot of dead skin cells, causing white flakes.
Disease-Related Dandruff: Some conditions like psoriasis lead to excess production of dead skin cells that result in the scaly skin. Skin cells combine with dirt and sebum to cause dandruff. Eczema also makes skin flaky and itchy and may contribute to the formation of dandruff.
It is clear that dandruff is not really dangerous and is pretty harmless but there are risk factors that may make some people more susceptible to dandruff than others.
Dandruff is more common in young adults up to those who are middle-aged. Older adults may also get dandruff and for some, it could be lifelong.
Men are also more susceptible to dandruff than women. Some researchers think it's because of certain hormones in men.
If you have really oily skin and hair, you are more prone to dandruff.
As a final note, certain illnesses are also some of what causes dandruff. Those with neurological diseases like Parkinson's are more likely to have it as well as those with weakened immune systems.
Seborrheic dermatitis: This is a condition characterized by irritated, oily skin. Skin will appear red and greasy and covered by flaky white or yellow scales. It can affect the scalp and other areas rich in oil glands, including the eyebrows, sides of the nose, backs of the ears, breastbone, groin area and sometimes the armpits.
Malassezia: This is a yeast-like fungus that lives on the scalp of most adults. In some cases, it will irritate the scalp and create more skin cell growth. These new cells die and fall off, and create white dandruff flakes.
Not shampooing enough: Oils and skin cells from the scalp build up over time if you don't wash your hair often enough, which causes dandruff.
Dry skin: Flakes from dry skin are typically smaller and less oily than those from other causes, and redness or inflammation is unlikely. In these cases, dry skin is likely more noticeable on other areas of the body besides the scalp, as well.
Contact dermatitis: This is sensitivity to certain ingredients in hair care products. It can cause a red, itchy, scaly scalp.
It is very unusual for complications to develop as a result of dandruff and seborrhoeic dermatitis.
The most likely complication is an adverse reaction to any treatments you may be using. If a product irritates your scalp, stop using it immediately. Your GP or pharmacist can recommend a more suitable alternative.
It is possible for dandruff or seborrhoeic dermatitis to cause an infection if a germ enters a break in your skin or scalp.
Contact your GP if your dandruff does not improve after using over-the-counter medicated shampoos, or if your scalp becomes swollen and red.
Although dandruff and seborrhoeic dermatitis are not signs of poor hygiene, they can sometimes cause psychological distress and affect a person's self-esteem.
In rare instances, highly atypical cases may require more exams and tests including skin scrapings for, microscopic evaluation, and skin biopsies.
A healthcare practitioner may scrape some scales off the rash and look at them under the microscope to make sure the rash is not caused by a fungus. A very small piece of skin may be taken (a biopsy) for microscopic examination to exclude other causes like psoriasis, lupus, and other skin diseases.
Dandruff, in most cases, can be controlled. In cases of mild dandruff, cleaning the head daily with a gentle shampoo for reducing oil and buildup or growth of excessive skin cells may be helpful. There are dandruff shampoos available depending on the medications they contain.
Pyrithione Zinc Shampoos: These shampoos contain antifungal and antibacterial agent – zinc pyrithione. This type of shampoo reduces fungus on the scalp that results in dandruff.
Tar-Based Shampoos: Coal tar helps in reducing dandruff as it slows down the rate of the death of skin cells that causes flakiness. For light colored hair, this shampoo may lead to discoloration.
Salicylic Acid-Based Shampoos: Shampoos containing salicylic acid helps get rid of the scale. However, it leaves the scalp dry, which further causes more flakiness. Using a conditioner after shampooing can be beneficial.
Shampoos Containing Selenium Sulfide: These shampoos slow down the rate at which skin cells dry and may also reduce the fungus, Malassezia.
Ketoconazole Shampoos: It is an antifungal agent, which generally works when other shampoos have failed. It is available over the counter (OTC) and also as the prescription.
Apply these shampoos often or every day till the time your hair becomes completely free of dandruff. Once the dandruff is gone, one can still use these shampoos twice or thrice a week.
If you have religiously shampooed for many weeks, but still have not found any relief, then you must consult a doctor or dermatologist, who may suggest you a prescription-strength shampoo or treatment with the steroid lotion.
Coconut Oil and Lemon Massage: Coconut oil nourishes the scalp and at the same time, lemon juice treats dandruff without the involvement of any harmful chemical. Heat about 2 tablespoons of coconut oil and mix it with an equal amount of lemon juice. Gently massage your scalp with the mixture. Let it stay for 20 minutes before you rinse it off.
Fenugreek Pack: Soak fenugreek in water overnight. Mash the soaked fenugreek in a paste and remove the water. Apply the paste for about half an hour and then, rinse it off with a shampoo.
Curd: Applying curd could be cumbersome, but it is highly effective in treating dandruff. Apply curd to your hair strands and let it remain for half an hour before you rinse it off with a shampoo.
Baking Soda: It has also been used as an effective treatment for dandruff. Slightly wet your hair and apply baking soda. Leave it on for about two to three minutes and then, washing it off.
Tea Tree Oil: It is highly effective in treating dandruff. Put a few drops of tea tree oil and spread it evenly across the scalp. Let the scalp soak it for five minutes. Then, rinse it off with a shampoo.
Apple Cider Vinegar: Mix apple cider vinegar with equal an amount of water and after having a hair wash, apply the mixture on the wet hair. Massage your scalp and let it remain for 15 minutes before washing it off.
Neem Juice: Neem has anti-bacterial properties. One can grind a bunch of neem leaves to form a thick paste. Apply it on the scalp for 10 minutes and wash it off with water.
Orange Peel Pack: Take some orange peel and squeeze some lemon juice in it. Grind it into a paste and apply it for half an hour. Then, wash it off with a shampoo.
One may use an antifungal or anti-dandruff shampoo once a week. This may help prevent dandruff.
Also, spend time in the sun, but in the limit as too much exposure to the sun may have damaging effects on the skin. Dandruff is more severe in the winter months, so the best way to increase humidity is to buy humidifiers. Make sure humidifier is clean before you use it.
Reduce stress as stress aggravates dandruff. Stress may trigger or worsen the condition of dandruff. A little modification in one's diet can also be beneficial. When it comes to dandruff, foods containing zinc, omega-3 fatty acids, and vitamin B may be beneficial.
Next Esophageal atresia – Description, Causes, and Complications.
Exellent article….. Hope so it will be helpful against dandruff….. thanks for ur hardwork and suggestions.
Chloroquine retinopathy, also known as Bull's eye maculopathy, is a retinopathy (damage of the retina) caused by the drugs chloroquine or hydroxychloroquine, which are sometimes used in the treatment of autoimmune disorders such as rheumatoid arthritis and systemic lupus erythematosus. This eye toxicity limits long-term use of the drugs.
Thank you it is very educative.
for the lecture on dandruff.
Thanks for the lecture on dandruffs. I really enjoyed the lecture.
The article is quite educative and simple to comprehend. keep it up!
nakapagbibigay na po kayo ng dagdag na kaalaman, nakakatulong pa kayo para mapagaan ang problemang pinansyal na may kinalaman sa kalusugan. maraming salamat at mabuhay po kayo!!!
pls my back head is full bumps scratching me , if i cut my hair it will come out more. what shall i do.
Yes due to dandruff, skin will also get diseased.
PLEASE HELP. I have been fighting dandruff for months using dandruff type shampoos. To no avail. It seems the scalp has this white moist pieces when hair is washed and appears on shoulders of clothes, and brush or comb. When scalp is dry there are white crusty bumps. Does wearing a cap or head bands a problem? Is it contagious? Is coconut shampoo and conditioner, or Tea Tree Oil helpful? Would you please recommend a treatment plan?
It is better to get a prescription from a dermatologist.
I feel I am having wet dandruff…I do apply coconut oil 5 days a week… when it itches & i scratch blackish greasey things get into my nails…so I feel it is wet dandruff…..once in a week I have shampoo head bath & leave it no applying oil…is this ok..
Please apply Aloe vera gel before getting the head bath or it is better to get advice from a dermatologist.
Very informative article. Most of the people struggle with a variety of hair problems such as hair fall, itchy scalp, dry flakes, dandruff or other serious hair issues. These tips are very helpful for healthy hair care routine. Thanks for sharing and keep guiding us.


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Amarillo Opera presents 'Opera You Love' at its Gala and Dinner April 2
Brianna Maestas
The Amarillo Opera will present a night of "Opera You Love" during its Opera Gala and Dinner, 7:30 p.m. Saturday, April 2, at the Globe-News Center for the Performing Arts.
"This is another style that we have not had in Amarillo, lots of personality, lots of athletic ability, brilliant music. Even better, all of these songs are well known, so it is perfect for someone who has never been to the opera before," said Mary Jane Johnson, executive and artistic director for the Amarillo Opera.
This gala is a collection of well-known opera pieces, including "Treulich geführt," or "The Wedding March" by Richard Wagner; "Ah! Mes amis" by Gaetano Donizetti; the "Humming Chorus" in "Madama Butterfly" by Giacomo Puccini, and many more.
The program will include a total of 12 opera pieces, including five chorus pieces performed by a 31-member chorus, along with duets, a trio piece and solos performed by artists Rafael Porto, Cara Collins, Sabatina Mauro and Angelo Silva and conducted by general artistic director of Opera Hispanica, Jorge Parodi.
Messo soprano Sabatina Mauro spoke about joining the stage with tenor Angelo Silva to perform "Un soave non so chè," or "A Certain Something" from Gioachino Rossini's "La cenerentola."
"This song is a very old Italian take on the story of Cinderella, and our duet is from the very beginning of the opera, when the prince disguises himself as his own servant to explore the palace and town. And he meets Cinderella, or La cenerentola, for the first time; of course we fall in love. ... It's a very sweet piece, and I just adore this duet," Mauro said.
This concert will be Silva's first performance in two years, and he will also be performing La fille du régiment's "Ah! Mes amis" by Gaetano Donizetti, including five high C's.
"I'm excited to perform again. I think it's just being in a hall or room or venue with people who want to be a part of this in any way, whether they're onstage or in the crowd. I'm excited to be in a room full of people that want to experience this art form," Silva said.
The pre-dinner and wine catered by O.H.M.S. begins at 5:30 p.m. Tickets for the Opera Gala and Dinner are available online at https://www.amarilloopera.org/tickets or by calling (806) 372- 7464. Ticket prices begin at $25 for the opera and $75 for the dinner.


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Brands Taking Stands
Facebook on the Hot Seat Again: Where Will Advertisers Draw the Line?
Words by Tina Casey
Last year, a major data privacy scandal gave rise to an "advertiser revolt" against Facebook. The outrage soon faded, but as Facebook encounters yet another wave of bad press, brands may once again begin to question their relationship with the ubiquitous social media platform.
Brands in revolt, temporarily
The roots of the data privacy issue are deep, but the immediate cause of the 2018 advertiser backlash was fairly straightforward.
In March 2018, reports surfaced that information on 50 million Facebook users was accessed without their knowledge during the 2016 election cycle. Behind the data harvesting was Cambridge Analytica, a firm involved with the 2016 Trump presidential campaign.
As the news broke, Unilever was among a number of leading companies to bring up the issue of consumer trust. CEO Keith Weed warned that trusted brands could not afford to be associated with social media platforms that fail to safeguard users' privacy.
Facebook took steps to smooth the waters. In June 2018 it joined in the launch of the newly formed Global Alliance for Responsible Media, a collaborative effort between brands, ad agencies, and media platforms to address brand protection in the context of "harmful and misleading media environments."
When boycotts work
Consumer boycotts are notoriously difficult to sustain, but they do have a chance of success when they involve a leading brand that already shows signs of decline. That appears to be the case with Facebook.
Facebook's efforts at peacemaking may have reassured its advertisers, but users were not so easily pacified.
Last spring, The Verge reported that Facebook lost 15 million users in the past two years.
In addition, last Friday CBS News reported that Facebook has lost its slot in Interbrand's list of Top 10 Best Brands, falling from #8 in 2017 to #14 this year.
Aside from the continuing challenge of attracting younger generations, CBS attributed Facebook's problems to the company's record-setting $5 billing fine with the Federal Trade Commission over Cambridge Analytica's access to user data.
In addition, Facebook's ongoing attempts to build support among right-leaning politicians and pundits has motivated an organized backlash from the left.
Business-to-business boycotts can be somewhat more successful. That may also be in play, as controversy builds over Facebook's attempt to launch the digital currency Libra.
The Libra project initially received substantial backing from the financial community, but leading supporter PayPal jumped ship after consumer watchdogs and members of Congress raised concerns. As of last week, several others — including the five founding members Visa, Mastercard, eBay, Stride and Mercado Pago — also dropped out.
Facebook cleans house…
Over and above these issues, Facebook has also had to deal with an ongoing problem that is built into its DNA: the deliberate use of social media to amplify and spread lies, half-truths, conspiracy theories and political propaganda, especially regarding the efforts of Russia and other countries to interfere in U.S. elections.
Earlier this month, the U.S. Senate released a major report on the issue and concluded that Russia used Facebook and other digital media to interfere with the 2016 election, an effort that is still ongoing.
As if on cue, last week Facebook announced that it had spotted and removed pages, groups, and accounts linked to "coordinated inauthentic behavior" attributed to Russia and Iran.
"We're constantly working to detect and stop this type of activity because we don't want our services to be used to manipulate people," Facebook stated.
…but can't sweep the fake news under the rug
Facebook left an important loophole in its announcement, though. The company emphasized that it is taking down the fake accounts "based on their behavior, not the content they posted."
The "not the content" loophole, however, goes right to the heart of the matter.
In a high-profile speech at Georgetown University last week, Facebook co-founder and CEO Mark Zuckerberg reasserted the platform's core responsibility to protect its users' freedom of expression (here cited by The Hill):
"Whether you like Facebook or not, I think we need to recognize what is at stake and come together to stand for voice and free expression at this critical moment."
That's all well and good, but the U.S. Constitution protects against repression by the government. Private companies are under no constitutional obligation to maintain a hands-off position.
Where advertisers might draw the line
Be that as it may, the "not the content" loophole also extends to advertisers, as Zuckerberg emphasized in his Georgetown speech.
That position is going to be tough for Facebook to defend moving forward. Federal law requires broadcast networks to run political campaign advertisements regardless of content, but other platforms — including social media as well as cable television — are under no such obligation.
The federal no-censorship law also does not cover "issue advertisements" that are paid for by supporters outside of the candidate's official campaign.
Facebook does have the option to exercise discretion over political advertising. It also has a framework for doing so. Like virtually all other media organizations, the company places a long list of specific restrictions on advertising content. The list includes content that is "disrespectful" as well as content that is false.
While Facebook may be getting its "fake news" problem under control, the company's persistent defense of falsities in political advertising has already taken center stage in the runup to the 2020 election year.
The leak of audio from a recent Facebook employee internal town hall meeting also reinforces the perception that Facebook has picked sides in the 2020 election.
So far, companies that advertise on Facebook seem to have adopted a wait-and-see attitude. If the environment becomes too "harmful and misleading" during the 2020 election cycle, though, leading brands may decide to sit this one out.
Image credit: John Schnobrich/Unsplash
Tina Casey
Tina writes frequently for TriplePundit and other websites, with a focus on military, government and corporate sustainability, clean tech research and emerging energy technologies. She is a former Deputy Director of Public Affairs of the New York City Department of Environmental Protection, and author of books and articles on recycling and other conservation themes. She is currently Deputy Director of Public Information for the County of Union, New Jersey. Views expressed here are her own and do not necessarily reflect agency policy.
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