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  1. Current and future management strategies in intensive crop production systems

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The root-knot nematode Control and Management Strategy chapter addresses the current and future developments in Meloidogyne spp. control in intensive crop production systems. Discussed are current nematode management strategies such as the use of cultural practices, host plant resistance, applicati...

  2. Urinary Tract Infections: Current and Emerging Management Strategies

    PubMed Central

    Barber, Amelia E.; Norton, J. Paul; Spivak, Adam M.; Mulvey, Matthew A.

    2013-01-01

    Acute cystitis is one of the most commonly encountered bacterial infections and is responsible for substantial morbidity and high medical costs in the United States and across the globe. Though generally considered to be self-limiting and easily treated with antibiotics, urinary tract infections (UTIs) are often incompletely resolved by antibiotic therapy and frequently recur. This is in part due to the ability of uropathogenic bacteria to invade, replicate, and persist within host epithelial cells. The biological complexity of these infections combined with a dramatic rise in antibiotic-resistant pathogens highlight the need for alternative therapies. In this review we examine current management strategies for UTIs, as well as emerging treatments, including novel compounds that block bacterial interactions with the urothelium and vaccines focused on preventing both acute and recurrent infections. PMID:23645845

  3. Current nutritional recommendations and novel dietary strategies to manage sarcopenia.

    PubMed

    Calvani, Riccardo; Miccheli, Alfredo; Landi, Francesco; Bossola, Maurizio; Cesari, Matteo; Leeuwenburgh, Christiaan; Sieber, Cornel C; Bernabei, Roberto; Marzetti, Emanuele

    2013-01-01

    Sarcopenia, the loss of skeletal muscle mass and function that occurs with aging, is associated with increased risk for several adverse health outcomes, including frailty, disability, falls, loss of independent living, and mortality. At present, no pharmacological treatment exists that is able to definitely halt the progression of sarcopenia. Likewise, no pharmacological remedies are yet available to prevent the onset of age-related muscle wasting. In this scenario, the combination of nutritional interventions and physical exercise appears to be the most effective strategy presently available for the management of sarcopenia. The purposes of this review are to summarize the current knowledge on the role of nutrition as a countermeasure for sarcopenia, illustrate the mechanisms of action of relevant dietary agents on the aging muscle, and introduce novel nutritional strategies that may help preserve muscle mass and function into old age. Issues related to the identification of the optimal timing of nutritional interventions in the context of primary and secondary prevention are also discussed. Finally, the prospect of elaborating personalized dietary and physical exercise recommendations through the implementation of integrated, high-throughput analytic approaches is illustrated. PMID:26082911

  4. Current nutritional recommendations and novel dietary strategies to manage sarcopenia

    PubMed Central

    Calvani, Riccardo; Miccheli, Alfredo; Landi, Francesco; Bossola, Maurizio; Cesari, Matteo; Leeuwenburgh, Christiaan; Sieber, Cornel C.; Bernabei, Roberto; Marzetti, Emanuele

    2015-01-01

    Sarcopenia, the loss of skeletal muscle mass and function that occurs with aging, is associated with increased risk for several adverse health outcomes, including frailty, disability, falls, loss of independent living, and mortality. At present, no pharmacological treatment exists that is able to definitely halt the progression of sarcopenia. Likewise, no pharmacological remedies are yet available to prevent the onset of age-related muscle wasting. In this scenario, the combination of nutritional interventions and physical exercise appears to be the most effective strategy presently available for the management of sarcopenia. The purposes of this review are to summarize the current knowledge on the role of nutrition as a countermeasure for sarcopenia, illustrate the mechanisms of action of relevant dietary agents on the aging muscle, and introduce novel nutritional strategies that may help preserve muscle mass and function into old age. Issues related to the identification of the optimal timing of nutritional interventions in the context of primary and secondary prevention are also discussed. Finally, the prospect of elaborating personalized dietary and physical exercise recommendations through the implementation of integrated, high-throughput analytic approaches is illustrated. PMID:26082911

  5. Sports-related concussions: diagnosis, complications, and current management strategies.

    PubMed

    Hobbs, Jonathan G; Young, Jacob S; Bailes, Julian E

    2016-04-01

    Sports-related concussions (SRCs) are traumatic events that affect up to 3.8 million athletes per year. The initial diagnosis and management is often instituted on the field of play by coaches, athletic trainers, and team physicians. SRCs are usually transient episodes of neurological dysfunction following a traumatic impact, with most symptoms resolving in 7-10 days; however, a small percentage of patients will suffer protracted symptoms for years after the event and may develop chronic neurodegenerative disease. Rarely, SRCs are associated with complications, such as skull fractures, epidural or subdural hematomas, and edema requiring neurosurgical evaluation. Current standards of care are based on a paradigm of rest and gradual return to play, with decisions driven by subjective and objective information gleaned from a detailed history and physical examination. Advanced imaging techniques such as functional MRI, and detailed understanding of the complex pathophysiological process underlying SRCs and how they affect the athletes acutely and long-term, may change the way physicians treat athletes who suffer a concussion. It is hoped that these advances will allow a more accurate assessment of when an athlete is truly safe to return to play, decreasing the risk of secondary impact injuries, and provide avenues for therapeutic strategies targeting the complex biochemical cascade that results from a traumatic injury to the brain. PMID:27032922

  6. Current Management Strategies for Acute Esophageal Variceal Hemorrhage

    PubMed Central

    Fortune, Brett; Garcia-Tsao, Guadalupe

    2014-01-01

    Acute esophageal variceal hemorrhage is one of the clinical events that define decompensated cirrhosis and is associated with high rates of morbidity and mortality. Although recent treatment strategies have led to improved outcomes, variceal hemorrhage still carries a 6-week mortality rate of 15-20%. Current standards in its treatment include antibiotic prophylaxis, infusion of a vasoactive drug and endoscopic variceal ligation. The placement of a transjugular intrahepatic portosystemic shunt (TIPS) is considered for patients that have treatment failure or recurrent bleeding. Recurrent hemorrhage is prevented with the combination of a non-selective beta-blocker and endoscopic variceal ligation. These recommendations however assume that all patients with cirrhosis are equal. Based on a review of recent evidence, a strategy in which patients are stratified by Child class, the main predictor of outcomes, is proposed. PMID:24955303

  7. Current strategies for the management of aneurysmal subarachnoid hemorrhage.

    PubMed

    Solomon, R A; Fink, M E

    1987-07-01

    Subarachnoid hemorrhage (SAH) from a ruptured intracranial aneurysm represents a major health issue. Although most people who experience an aneurysmal SAH survive to be admitted to a hospital, less than one third of these patients ever return to their premorbid status. Clearly, morbidity of this magnitude demands reevaluation of the clinical approach to this problem. This article reviews the natural history of aneurysmal SAH, and examines the current therapeutic strategies that have been suggested to improve the outcome. Careful evaluation of the existing data suggests that early aneurysm surgery and aggressive postoperative volume expansion therapy constitute the best presently available approach to patients with ruptured intracranial aneurysms. PMID:3297009

  8. Risk definition and management strategies in retinoblastoma: current perspectives

    PubMed Central

    Ghassemi, Fariba; Khodabande, Alireza

    2015-01-01

    This manuscript focuses on high-risk factors of metastatic disease in retinoblastoma and evaluation of the current treatments of retinoblastoma. Presence of histopathologic high-risk factors is associated with a higher risk of local recurrence and systemic metastasis. Currently, globe-sparing therapies, including systemic chemotherapy, intra-arterial chemoreduction, intravitreal chemotherapy, focal consolidation, and combination therapies, are being used and investigated actively. Major advances are being made in the diagnosis and management of retinoblastoma that will lead to improved morbidity and mortality rates in patients with retinoblastoma. By saving the globes, fronting with some high-risk factors for metastasis would be inevitable. International multi-institutional prospective studies could resolve current uncertainties regarding the main tumor treatment regimens for each patient and indications for chemoprophylaxis for high-risk-factor-bearing retinoblastoma cases. PMID:26089630

  9. [Current Conservative Treatment and Management Strategies of Skeletal Muscle Injuries].

    PubMed

    Hotfiel, T; Carl, H-D; Swoboda, B; Heinrich, M; Heiß, R; Grim, C; Engelhardt, M

    2016-06-01

    Muscle injuries frequently occur during sport and are one of the commonest injuries. The diagnosis and treatment of muscle injuries impose high demands on medical treatment, in order to ensure successful regeneration and a rapid return to sport. Most of the injuries can be treated conservatively, as skeletal muscles have a high endogenous capacity for repair and regeneration. Conservative treatment includes initial on-field therapy. This is known as the "RICE" principle and is common and recommended for initial treatment for most sports injuries. The primary therapy target is to reduce pain, swelling and bleeding and thus to limit the initial inflammatory process and prevent further damage. During the first days after injury, brief immobilization helps to reduce the re-injury rate and accelerates the formation of granulation tissue. There are many possible additional treatments, including intramuscular injections, manipulation of the sacroiliac joint or rehabilitation programs, including stretching and strengthening. If the acute treatment phase is complete after 3 to 5 days, more active treatment, including trunk stabilisation, stretching and strengthening, can be started gradually. Despite their high prevalence, there have only been a few studies on the treatment and management of these injuries. The aim of this manuscript is to review the literature on the classification, pathobiology and treatment strategies for muscle injuries. PMID:27351158

  10. Caries management by risk assessment: A review on current strategies for caries prevention and management

    PubMed Central

    Maheswari, S. Uma; Raja, Jacob; Kumar, Arvind; Seelan, R. Gnana

    2015-01-01

    The current trend in treating dental caries is using nondestructive risk-based caries management strategies rather than focusing on the restorative treatment alone. Currently, there have been many changes in understanding of the multifaceted nature of caries process and its management. Caries Management by Risk Assessment (CAMBRA) which is an evidence-based approach focuses on determining many factors causing the expression of disease and take corrective action. The clinicians can ascertain what behaviors are increasing a patient's risk for disease and disease progression by evaluating the current caries risk of a patient. With this modern CAMBRA protocol, a novel treatment plan can be designed to arrest dental caries thereby decreasing the chance of cavitation. After the recognition of the multi factorial nature of caries involving the biofilm, the contemporary approaches focused mainly on the various options to cope with the locally out-of-balance oral biofilm and stop the progression of the disease. The initial caries lesions can be diagnosed with modern diagnostic aids and with the help of CAMBRA, reestablishment of the integrity of the tooth surface early on in the caries process will bring great rewards for patients. This review focuses on the repair of hard tooth tissues using noninvasive strategies. PMID:26538870

  11. Current management strategies and emerging treatments for functional dyspepsia.

    PubMed

    Camilleri, Michael; Stanghellini, Vincenzo

    2013-03-01

    Functional dyspepsia refers to painful and nonpainful symptoms that are perceived to arise in the upper digestive tract but are not secondary to organic, systemic or metabolic diseases. The symptoms of this syndrome often overlap with those of GERD and IBS, making its management far from simple. If Helicobacter pylori infection is diagnosed in patients with functional dyspepsia, it should be treated. In patients with mild or intermittent symptoms, reassurance and lifestyle advice might be sufficient; in patients not responding to these measures, or in those with more severe symptoms, drug therapy should be considered. Both PPIs and prokinetics can be used in initial empirical pharmacotherapy based on symptom patterns--a PPI is more likely to be effective in the presence of retrosternal or epigastric burning or epigastric pain, whereas a prokinetic is more effective in dyspepsia with early satiation or postprandial fullness. Although combinations of PPIs and prokinetics might have additive symptomatic effects, single-drug therapy is initially preferable. Antidepressants or referral to a psychiatrist or psychotherapist can be considered in nonresponders and in those whose symptoms have a marked effect on daily functioning. Despite extensive research, functional dyspepsia treatment often remains unsatisfactory. Better characterization of dyspeptic subgroups and understanding of underlying mechanisms will enable treatment advances to be made in the future. PMID:23381190

  12. Water Utility Management Strategies in Turkey: The current situation and the challenges

    NASA Astrophysics Data System (ADS)

    Alp, E.; Aksoy, M. N.; Koçer, B.

    2013-12-01

    As the effects of climate change becomes more prominent, current challenges related to water and wastewater management is becoming more serious. Providing water that satisfies environmental and safety standards in terms of quantity and quality is needed to maintain human life without compromising the need of future generations. Besides providing safe and affordable water, necessary treatment should be achieved according to several important factors such as receiving body standards, discharge standards, water reuse options. Therefore, management of water becomes more crucial than ever that states have to provide accessibility of safe water with affordable cost to its citizens with the means of effective utility management, including water treatment facilities, wastewater treatment facilities, water supply facilities and water distribution systems. Water utilities encounter with several challenges related to cost, infrastructure, population, legislation, workforce and resource. This study aims to determine the current situation and the necessary strategies to improve utility management in Turkish municipalities in a sustainable manner. US Environment Protection Agency (EPA) has formed a tool on effective utility management that assists utilities to provide a solution for both current and future challenges. In this study, we used EPA's guidelines and developed a survey consists of 60 questions under 10 sub-topics (Product Quality, Employee & Leadership Development, Stakeholder Understanding & Support, Operational Optimization, Infrastructure Stability, Financial Viability, Community Sustainability, Customer Satisfaction, Operational Resiliency, and Water Resource Adequacy). This survey was sent to the managers of 25 metropolitan municipalities in Turkey to assess the current condition of municipalities. After the evaluation of the survey results for each topic, including the importance given by managers, facilities were rated according to their level of achievement

  13. E-waste management challenges in Iran: presenting some strategies for improvement of current conditions.

    PubMed

    Taghipour, Hassan; Nowrouz, Parviz; Jafarabadi, Mohamad Asghari; Nazari, Jalil; Hashemi, Ahmad Asl; Mosaferi, Mohammad; Dehghanzadeh, Reza

    2012-11-01

    E-waste is one of the fastest-growing waste streams in Iran, owing to an increase in consumption of electrical and electronic equipment. Nevertheless, as is the case in some other countries, E-waste management has not received sufficient attention. For the successful implementation of any waste management plan (including an E-waste management plan), the availability of sufficient and accurate information on the quantities and composition of the waste generated and on current management conditions is a fundamental prerequisite. At present, in Iran, there is no available and accurate information that describes the characteristics and generation rate of E-waste or the actual practice of management and handling of the waste. For this initial study, eight electronic products were selected for the determination of their E-waste generation rate in the country, and two cities, Tehran and Tabriz, were selected for assessment of the current condition of E-waste management. The study found that the amount of E-waste generation in the country for the eight selected electronic items alone was 115,286, 112,914 and 115,151 metric tons in 2008, 2009 and 2010, respectively. Of the types of electronic items included in the study, televisions, with an average of 42.42%, and PCs, with an average of 32.66% accounted for the greatest proportions of the total mass of E-waste generated during 2008-2010. Currently, despite the fact that primary legislation for E-waste management (as part of general waste legislation) exists in Iran, this primary legislation has not yet been implemented. In practical terms, there is no definite policy or plan for the allocation of funds to prepare suitable equipment and facilities for the management and recycling of E-waste at the end of the products' useful life. Proposed improvements in current conditions are identified, first by considering other countries' experiences and then suggesting specific practical policies, rules, and regulations that should be

  14. Evidence-Based Medicine in Managed Care: A Survey of Current and Emerging Strategies

    PubMed Central

    Keckley, Paul H

    2004-01-01

    Background Evidence-based medicine is the “conscientious application of scientific best practice by clinicians in concert with patient understanding and values.”[1] Recent studies by the Institute of Medicine, RAND, and others have called attention to the gap between scientifically supported approaches to care and day-to-day practice by clinicians. Compounding the problem of non-adherence by providers, researchers have observed that patient compliance also falls short. As a result, avoidable costs from inappropriate variability in practice patterns coupled with patient noncompliance are a significant focus of managed care. Managed care plans play a key role in the selection of providers by consumers and in the design of benefits programs by employers. Avoidable costs from misuse, overuse, and under-use of care from clinicians is a strategic focus for health plans. The evidence upon which a plan makes coverage decisions and the incorporation of evidence in programs targeting providers, employers, and consumers was a focus of this study. Methodology A Delphi survey and 2-day interactive sessions with 128 clinical program directors and medical officers from 89 health plans were the primary methods used in this descriptive analysis. To test participant applications of evidence-based medicine in health plan medical management strategy, 3 conditions were used for illustrative purpose: managing rheumatoid arthritis, increasing remission in depression, and reducing heart disease among diabetics. Each provided a unique challenge to plans in terms of condition prevalence, strength of evidence, and cost. Key Findings Health plans incorporate evidence-based medicine in 5 areas overseen by medical management: (1) coverage decisions wherein improvements in pharmaceutical and therapeutic review processes are sought, (2) disease management efforts wherein increased attention to secondary prevention is desirable, (3) provider profiling wherein increased use of adherence

  15. Current and emerging strategies in the management of venous thromboembolism: benefit–risk assessment of dabigatran

    PubMed Central

    Fanola, Christina L

    2015-01-01

    Venous thromboembolism (VTE) is a disease state that carries significant morbidity and mortality, and is a known cause of preventable death in hospitalized and orthopedic surgical patients. There are many identifiable risk factors for VTE, yet up to half of VTE incident cases have no identifiable risk factor and carry a high likelihood of recurrence, which may warrant extended therapy. For many years, parenteral unfractionated heparin, low-molecular weight heparin, fondaparinux, and oral vitamin K antagonists (VKAs) have been the standard of care in VTE management. However, limitations in current drug therapy options have led to suboptimal treatment, so there has been a need for rapid-onset, fixed-dosing novel oral anticoagulants in both VTE treatment and prophylaxis. Oral VKAs have historically been challenging to use in clinical practice, with their narrow therapeutic range, unpredictable dose responsiveness, and many drug–drug and drug–food interactions. As such, there has also been a need for novel anticoagulant therapies with fewer limitations, which has recently been met. Dabigatran etexilate is a fixed-dose oral direct thrombin inhibitor available for use in acute and extended treatment of VTE, as well as prophylaxis in high-risk orthopedic surgical patients. In this review, the risks and overall benefits of dabigatran in VTE management are addressed, with special emphasis on clinical trial data and their application to general clinical practice and special patient populations. Current and emerging therapies in the management of VTE and monitoring of dabigatran anticoagulant-effect reversal are also discussed. PMID:26064057

  16. Mycotoxin problem in Africa: current status, implications to food safety and health and possible management strategies.

    PubMed

    Wagacha, J M; Muthomi, J W

    2008-05-10

    Mycotoxins are toxic secondary metabolites of fungal origin and contaminate agricultural commodities before or under post-harvest conditions. They are mainly produced by fungi in the Aspergillus, Penicillium and Fusarium genera. When ingested, inhaled or absorbed through the skin, mycotoxins will cause lowered performance, sickness or death on humans and animals. Factors that contribute to mycotoxin contamination of food and feed in Africa include environmental, socio-economic and food production. Environmental conditions especially high humidity and temperatures favour fungal proliferation resulting in contamination of food and feed. The socio-economic status of majority of inhabitants of sub-Saharan Africa predisposes them to consumption of mycotoxin contaminated products either directly or at various points in the food chain. The resulting implications include immuno-suppression, impaired growth, various cancers and death depending on the type, period and amount of exposure. A synergistic effect between mycotoxin exposure and some important diseases in the continent such as malaria, kwashiorkor and HIV/AIDS have been suggested. Mycotoxin concerns have grown during the last few decades because of their implications to human and animal health, productivity, economics of their management and trade. This has led to development of maximum tolerated limits for mycotoxins in various countries. Even with the standards in place, the greatest recorded fatal mycotoxin-poisoning outbreak caused by contamination of maize with aflatoxins occurred in Africa in 2004. Pre-harvest practices; time of harvesting; handling of produce during harvesting; moisture levels at harvesting, transportation, marketing and processing; insect damage all contribute to mycotoxin contamination. Possible intervention strategies include good agricultural practices such as early harvesting, proper drying, sanitation, proper storage and insect management among others. Other possible interventions

  17. Food protein-induced enterocolitis syndrome (FPIES): current management strategies and review of the literature.

    PubMed

    Järvinen, Kirsi M; Nowak-Węgrzyn, Anna

    2013-01-01

    Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated gastrointestinal food hypersensitivity that manifests as profuse, repetitive vomiting, often with diarrhea, leading to acute dehydration and lethargy or weight loss and failure to thrive if chronic. FPIES is elicited most commonly by milk and soy proteins; however, rice, oat, and other solid foods may also elicit FPIES. Certain FPIES features overlap with food protein-induced enteropathy and proctocolitis, whereas others overlap with anaphylaxis. FPIES is not well recognized among pediatricians and emergency department physicians; the affected children are often mismanaged as having acute viral gastrointestinal illness, sepsis, or surgical disease, delaying diagnosis of FPIES for many months. The aim of this review is to provide case-driven presentation of the features of FPIES. Although randomized clinical trials on management options are missing, the relevant current literature and authors' experience are reviewed in detail. PMID:24565536

  18. Current strategies for reproductive management of gilts and sows in North America.

    PubMed

    Kraeling, Robert R; Webel, Stephen K

    2015-01-01

    Many advances in genetic selection, nutrition, housing and disease control have been incorporated into modern pork production since the 1950s resulting in highly prolific females and practices and technologies, which significantly increased efficiency of reproduction in the breeding herd. The objective of this manuscript is to review the literature and current industry practices employed for reproductive management. In particular the authors focus on assisted reproduction technologies and their application for enhanced productivity. Modern maternal line genotypes have lower appetites and exceptional lean growth potential compared to females of 20 yr ago. Thus, nutrient requirements and management techniques and technologies, which affect gilt development and sow longevity, require continuous updating. Failure to detect estrus accurately has the greatest impact on farrowing rate and litter size. Yet, even accurate estrus detection will not compensate for the variability in the interval between onset of estrus and actual time of ovulation. However, administration of GnRH analogs in weaned sows and in gilts after withdrawal of altrenogest do overcome this variability and thereby synchronize ovulation, which makes fixed-time AI practical. Seasonal infertility, mediated by temperature and photoperiod, is a persistent problem. Training workers in the art of stockmanship is of increasing importance as consumers become more interested in humane animal care. Altrenogest, is used to synchronize the estrous cycle of gilts, to prolong gestation for 2-3 d to synchronize farrowing and to postpone post-weaning estrus. P.G. 600® is used for induction of estrus in pre-pubertal gilts and as a treatment to overcome seasonal anestrous. Sperm cell numbers/dose of semen is significantly less for post cervical AI than for cervical AI. Real-time ultrasonography is used to determine pregnancy during wk 3-5. PGF2α effectively induces farrowing when administered within two d of normal

  19. Concussions: What a neurosurgeon should know about current scientific evidence and management strategies

    PubMed Central

    Neal, Matthew T.; Wilson, Jonathan L.; Hsu, Wesley; Powers, Alexander K.

    2012-01-01

    Background: There has been a tremendous amount of interest focused on the topic of concussions over the past few decades. Neurosurgeons are frequently consulted to manage patients with mild traumatic brain injuries (mTBI) that have radiographic evidence of cerebral injury. These injuries share significant overlap with concussions, injuries that typically do not reveal radiographic evidence of structural injury, in the realms of epidemiology, pathophysiology, outcomes, and management. Further, neurosurgeons often manage patients with extracranial injuries that have concomitant concussions. In these cases, neurosurgeons are often the only “concussion experts” that patients encounter. Results: The literature has been reviewed and data have been synthesized on the topic including sections on historical background, epidemiology, pathophysiology, diagnostic advances, clinical sequelae, and treatment suggestions, with neurosurgeons as the intended target audience. Conclusions: Neurosurgeons should have a fundamental knowledge of the scientific evidence that has developed regarding concussions and be prepared to guide patients with treatment plans. PMID:22439107

  20. Dyslipidemia management in primary prevention of cardiovascular disease: Current guidelines and strategies

    PubMed Central

    Hendrani, Aditya D; Adesiyun, Tolulope; Quispe, Renato; Jones, Steven R; Stone, Neil J; Blumenthal, Roger S; Martin, Seth S

    2016-01-01

    Cardiovascular disease is the leading cause of death in the United States. In 2010, the Centers for Disease Control and Prevention estimated that $444 billion was spent on cardiovascular diseases alone, about $1 of every $6 spent on health care. As life expectancy continues to increase, this annual cost will also increase, making cost-effective primary prevention of cardiovascular disease highly desirable. Because of its role in development of atherosclerosis and clinical events, dyslipidemia management is a high priority in cardiovascular prevention. Multiple major dyslipidemia guidelines have been published around the world recently, four of them by independent organizations in the United States alone. They share the goal of providing clinical guidance on optimal dyslipidemia management, but guidelines differ in their emphasis on pharmacotherapy, stratification of groups, emphasis on lifestyle modification, and use of a fixed target or percentage reduction in low density lipoprotein cholesterol. This review summarizes eight major guidelines for dyslipidemia management and considers the basis for their recommendations. Our primary aim is to enhance understanding of dyslipidemia management guidelines in patient care for primary prevention of future cardiovascular risk. PMID:26981215

  1. Current and Future Strategies in the Diagnosis and Management of Penile Cancer

    PubMed Central

    Lawindy, Samuel M.; Rodriguez, Alejandro R.; Horenblas, Simon; Spiess, Philippe E.

    2011-01-01

    Penile cancer is an uncommon malignancy that has a devastating effect on the patient while also being challenging to diagnose and treat. By implementing preventive measures, we can decrease the incidence of this disease and improve the quality of life of our patients. Early detection plays an important role in disease control and proper diagnostic modalities must be used in order to accurately identify the cancer and its progression. Primary penile lesions should be initially approached when surgically feasible and clinically appropriate with penile preserving surgical techniques. Advances in inguinal lymph node detection and management, has improved the clinical outcome of penile cancer. Advanced penile cancer still portends a poor prognosis and should be approached via a multimodal treatment regimen. In this review, we address the importance of prevention, early detection, and the contemporary management of primary penile lesions, as well as the advances in inguinal lymph node disease detection and surgical treatment, for both localized and advanced disease. PMID:21687574

  2. Current strategies for surgical management and adjuvant treatment of childhood papillary thyroid carcinoma.

    PubMed

    Thompson, Geoffrey B; Hay, Ian D

    2004-12-01

    Childhood papillary thyroid carcinoma is associated with more locally aggressive and more frequent distant disease than its adult counterpart. Recurrence rates tend to be higher in children, but cause-specific mortality remains low. Optimal initial treatment of childhood papillary thyroid carcinoma should include total or near-total thyroidectomy and central compartment node clearance. Modified neck dissections should be performed for biopsy-proven lateral neck disease. Every effort should be made to maintain parathyroid and laryngeal nerve function. Radical neck dissections are to be avoided. Radioiodine remnant ablation (RRA), appropriate thyroid hormone suppressive therapy (THST), and judicious use of therapeutic doses of (131)I are applied to achieve a disease-free status, which is most often confirmed by negative neck ultrasonography, negative whole-body scan (either withdrawal or recombinant human thyroid-stimulating hormone-stimulated), and extremely low levels of serum thyroglobulin. Appropriate utilization of (131)I, THST, repeat surgery, external beam radiotherapy, and rarely chemotherapy may provide long-term palliation and some cures in patients with recurrent/persistent disease. Follow-up should be lifelong, and the care of children after age 17 should subsequently be transferred to adult-care endocrinologists with expertise in managing thyroid neoplasia. Optimal surgical management can be achieved if adequate operations are routinely carried out by "high-volume" thyroid surgeons with expertise in the care of children. Nowhere is a multidisciplinary approach (endocrinologists, surgeons, nuclear medicine physicians, pediatricians, pathologists, oncologists) more critical than in the long-term management of papillary thyroid carcinoma that presents during childhood. PMID:15517490

  3. Assessment and management of pressure ulcers in the elderly: current strategies.

    PubMed

    Jaul, Efraim

    2010-04-01

    Pressure ulcers (pressure sores) continue to be a common health problem, particularly among the physically limited or bedridden elderly. The problem exists within the entire health framework, including hospitals, clinics, long-term care facilities and private homes. For many elderly patients, pressure ulcers may become chronic for no apparent reason and remain so for prolonged periods, even for the remainder of the patient's lifetime. A large number of grade 3 and 4 pressure ulcers become chronic wounds, and the afflicted patient may even die from an ulcer complication (sepsis or osteomyelitis). The presence of a pressure ulcer constitutes a geriatric syndrome consisting of multifactorial pathological conditions. The accumulated effects of impairment due to immobility, nutritional deficiency and chronic diseases involving multiple systems predispose the aging skin of the elderly person to increasing vulnerability. The assessment and management of a pressure ulcer requires a comprehensive and multidisciplinary approach in order to understand the patient with the ulcer. Factors to consider include the patient's underlying pathologies (such as obstructive lung disease or peripheral vascular disease), severity of his or her primary illness (such as an infection or hip fracture), co-morbidities (such as dementia or diabetes mellitus), functional state (activities of daily living), nutritional status (swallowing difficulties), and degree of social and emotional support; focusing on just the wound itself is not enough. An understanding of the physiological and pathological processes of aging skin throws light on the aetiology and pathogenesis of the development of pressure ulcers in the elderly. Each health discipline (nursing staff, aides, physician, dietitian, occupational and physical therapists, and social worker) has its own role to play in the assessment and management of the patient with a pressure ulcer. The goals of treating a pressure ulcer include avoiding any

  4. Narrative review of current context of malaria and management strategies in Uganda (Part I).

    PubMed

    Kassam, Rosemin; Collins, John B; Liow, Eric; Rasool, Nabeela

    2015-12-01

    In accordance with international targets, the Uganda National Malaria Control Strategic Plan established specific targets to be achieved by 2010. For children under five, this included increasing the number of children sleeping under mosquito nets and those receiving a first-line antimalarial to 85%, and decreasing case fatality to 2%. This narrative review offers contextual information relevant to malaria management in Uganda since the advent of artemisinin combination therapy (ACT) as first-line antimalarial treatment in 2004. A comprehensive search using key words and phrases was conducted using the web search engines Google and Google Scholar, as well as the databases of PubMed, ERIC, EMBASE, CINAHL, OvidSP (MEDLINE), PSYC Info, Springer Link, Cochrane Central Register of Controlled Trials (CENTRAL), and Cochrane Database of Systematic Reviews were searched. A total of 147 relevant international and Ugandan literature sources meeting the inclusion criteria were included. This review provides an insightful understanding on six topic areas: global and local priorities, malarial pathology, disease burden, malaria control, treatment guidelines for uncomplicated malaria, and role of the health system in accessing antimalarial medicines. Plasmodium falciparum remains the most common cause of malaria in Uganda, with children under five being most vulnerable due to their underdeveloped immunity. While international efforts to scale up malaria control measures have resulted in considerable decline in malaria incidence and mortality in several regions of sub-Saharan Africa, this benefit has yet to be substantiated for Uganda. At the local level, key initiatives have included implementation of a new antimalarial drug policy in 2004 and strengthening of government health systems and programs. Examples of such programs include removal of user fees, training of frontline health workers, providing free ACT from government systems and subsidized ACT from licensed private

  5. Clinical management of sleep disturbances in Alzheimer’s disease: current and emerging strategies

    PubMed Central

    Urrestarazu, Elena; Iriarte, Jorge

    2016-01-01

    Sleep and circadian disorders in Alzheimer’s disease (AD) are more frequent than in the general population and appear early in the course of the disease. Quality of sleep and quality of life are parallel in these patients, and such disorders also represent a heavy burden for caregivers. Although alterations in melatonin and hypocretins (orexins) seem to play a key role in the origin of these disturbances, the etiology of these disorders is multifactorial, including many factors such as environment, behavior, treatments, and comorbidities, among others. A comprehensive evaluation of sleep in each patient is essential in the design of the treatment that includes nonpharmacological and pharmacological approaches. One particularly interesting point is the possibility of a role of sleep disorders in the pathogenesis of AD, raising the possibility that treating the sleep disorder may alter the course of the disease. In this review, we present an update on the role of sleep disorders in AD, the bidirectional influence of sleep problems and AD, and treatment options. Behavioral measures, bright light therapy (BLT), melatonin, and other drugs are likely well known and correctly managed by the physicians in charge of these patients. In spite of the multiple treatments used, evidence of efficacy is scarce and more randomized double-blind placebo-controlled studies are needed. Future directions for treatment are the establishment of BLT protocols and the development of drugs with new mechanisms of action, especially hypocretin receptor antagonists, melatonin receptor agonists, and molecules that modulate the circadian clock. PMID:26834500

  6. [Current management of epilepsy].

    PubMed

    Mizobuchi, Masahiro

    2013-09-01

    Epilepsy is one of the most common neurological disorders. Global neurological knowledge is essential for differential diagnosis of epileptic syndromes due to the diversity of ictal semiology, causes and syndromes. Neurologists play an important role in planning the medical care for patients with epilepsy, as medication is the most fundamental therapeutic strategy. Some patients with early-onset epilepsy require joint care by pediatric neurologists, those with intractable epilepsy by neurosurgeons, and those with psychological comorbidity by psychiatrists, and neurologists should play a coordinating role. While there is a great need for neurologists to participate in epilepsy care, neurologists in Japan currently do not participate substantially in the epilepsy management system. It is necessary to train more neurologists who can provide epilepsy care and conduct basic and clinical research on epilepsy by providing continuous education on epilepsy for general neurologists as well as pre- and post-graduate medical students. Most of the patients who require long-term treatment experience many medical problems and social handicaps, such as adverse effects of medication, social stigma, educational disadvantages and difficulties in obtaining driver's license. To improve the quality of life of patients with epilepsy, it is desirable to build broad medical-social networks participated by patients, doctors, neurological nurses, psychologists, social workers, school teachers, managers of employment support facilities and care givers. PMID:24018740

  7. Current strategies in dentin remineralization.

    PubMed

    Hernández, Marcela; Cobb, Deborah; Swift, Edward J

    2014-01-01

    Partial caries removal procedures are used clinically in an attempt to conserve tooth structure and prevent pulp damage. Within this approach, the caries-infected dentin is removed, and the partially demineralized caries-affected dentin is preserved and sealed with materials that enhance remineralization. Fluoride-releasing glass ionomers have been commonly used for this purpose. Recent studies have shown potential for other cements and bioactive adhesive materials to promote dentin repair through various strategies. These strategies include ion releasing of Ca-P and the guided tissue remineralization or biomimetic remineralization of dentin. The latter is potentially useful in the remineralization of the demineralized acid-etched dentin that is incompletely infiltrated by adhesives in dentin bonding. The purpose of this Critical Appraisal is to provide the clinician with a summary of current literature that clarifies understanding of the process of dentin remineralization and to describe current strategies in this area. PMID:24612484

  8. Determining heavy metals in spent compact fluorescent lamps (CFLs) and their waste management challenges: Some strategies for improving current conditions

    SciTech Connect

    Taghipour, Hassan; Amjad, Zahra; Jafarabadi, Mohamad Asghari; Gholampour, Akbar; Norouz, Prviz

    2014-07-15

    Highlights: • Heavy metals in spent compact fluorescent lamps (CFLs) determined. • Current waste management condition of CFLs in Iran assessed. • Currently, waste of CFLs is disposed by municipal waste stream in waste landfills. • We propose extended producer responsibility (EPR) for CFLs waste management. - Abstract: From environmental viewpoint, the most important advantage of compact fluorescent lamps (CFLs) is reduction of green house gas emissions. But their significant disadvantage is disposal of spent lamps because of containing a few milligrams of toxic metals, especially mercury and lead. For a successful implementation of any waste management plan, availability of sufficient and accurate information on quantities and compositions of the generated waste and current management conditions is a fundamental prerequisite. In this study, CFLs were selected among 20 different brands in Iran. Content of heavy metals including mercury, lead, nickel, arsenic and chromium was determined by inductive coupled plasma (ICP). Two cities, Tehran and Tabriz, were selected for assessing the current waste management condition of CFLs. The study found that waste generation amount of CFLs in the country was about 159.80, 183.82 and 153.75 million per year in 2010, 2011 and 2012, respectively. Waste generation rate of CFLs in Iran was determined to be 2.05 per person in 2012. The average amount of mercury, lead, nickel, arsenic and chromium was 0.417, 2.33, 0.064, 0.056 and 0.012 mg per lamp, respectively. Currently, waste of CFLs is disposed by municipal waste stream in waste landfills. For improving the current conditions, we propose by considering the successful experience of extended producer responsibility (EPR) in other electronic waste management. The EPR program with advanced recycling fee (ARF) is implemented for collecting and then recycling CFLs. For encouraging consumers to take the spent CFLs back at the end of the products’ useful life, a proportion of

  9. Determining heavy metals in spent compact fluorescent lamps (CFLs) and their waste management challenges: some strategies for improving current conditions.

    PubMed

    Taghipour, Hassan; Amjad, Zahra; Jafarabadi, Mohamad Asghari; Gholampour, Akbar; Norouz, Prviz

    2014-07-01

    From environmental viewpoint, the most important advantage of compact fluorescent lamps (CFLs) is reduction of green house gas emissions. But their significant disadvantage is disposal of spent lamps because of containing a few milligrams of toxic metals, especially mercury and lead. For a successful implementation of any waste management plan, availability of sufficient and accurate information on quantities and compositions of the generated waste and current management conditions is a fundamental prerequisite. In this study, CFLs were selected among 20 different brands in Iran. Content of heavy metals including mercury, lead, nickel, arsenic and chromium was determined by inductive coupled plasma (ICP). Two cities, Tehran and Tabriz, were selected for assessing the current waste management condition of CFLs. The study found that waste generation amount of CFLs in the country was about 159.80, 183.82 and 153.75 million per year in 2010, 2011 and 2012, respectively. Waste generation rate of CFLs in Iran was determined to be 2.05 per person in 2012. The average amount of mercury, lead, nickel, arsenic and chromium was 0.417, 2.33, 0.064, 0.056 and 0.012 mg per lamp, respectively. Currently, waste of CFLs is disposed by municipal waste stream in waste landfills. For improving the current conditions, we propose by considering the successful experience of extended producer responsibility (EPR) in other electronic waste management. The EPR program with advanced recycling fee (ARF) is implemented for collecting and then recycling CFLs. For encouraging consumers to take the spent CFLs back at the end of the products' useful life, a proportion of ARF (for example, 50%) can be refunded. On the other hand, the government and Environmental Protection Agency should support and encourage recycling companies of CFLs both technically and financially in the first place. PMID:24726659

  10. Current management of antenatal hydronephrosis.

    PubMed

    Yamaçake, Kleiton G R; Nguyen, Hiep T

    2013-02-01

    The strategy for the management of children with urinary tract anomalies has changed considerably as a result of the development of ultrasound equipment and techniques that allow for detailed fetal evaluation. Hydronephrosis is the most common urogenital anomaly detected, suggesting that an obstructive process may be potentially present. The goal of postnatal management is to identify and treat those patients whose renal function is at risk, while leaving alone the high percentage of patients who are at no risk of renal damage. This management involves a spectrum of radiological, medical, and surgical interventions for diagnosis, surveillance, and treatment. In this article, we review our current understanding of the natural history of antenatal hydronephrosis and its management. PMID:22836304

  11. Fault Management Design Strategies

    NASA Technical Reports Server (NTRS)

    Day, John C.; Johnson, Stephen B.

    2014-01-01

    Development of dependable systems relies on the ability of the system to determine and respond to off-nominal system behavior. Specification and development of these fault management capabilities must be done in a structured and principled manner to improve our understanding of these systems, and to make significant gains in dependability (safety, reliability and availability). Prior work has described a fundamental taxonomy and theory of System Health Management (SHM), and of its operational subset, Fault Management (FM). This conceptual foundation provides a basis to develop framework to design and implement FM design strategies that protect mission objectives and account for system design limitations. Selection of an SHM strategy has implications for the functions required to perform the strategy, and it places constraints on the set of possible design solutions. The framework developed in this paper provides a rigorous and principled approach to classifying SHM strategies, as well as methods for determination and implementation of SHM strategies. An illustrative example is used to describe the application of the framework and the resulting benefits to system and FM design and dependability.

  12. Medical equipment management strategies.

    PubMed

    Wang, Binseng; Furst, Emanuel; Cohen, Ted; Keil, Ode R; Ridgway, Malcolm; Stiefel, Robert

    2006-01-01

    Clinical engineering professionals need to continually review and improve their management strategies in order to keep up with improvements in equipment technology, as well as with increasing expectations of health care organizations. In the last 20 years, management strategies have evolved from the initial obsession with electrical safety to flexible criteria that fit the individual institution's needs. Few hospitals, however, are taking full advantage of the paradigm shift offered by the evolution of joint Commission standards. The focus should be on risks caused by equipment failure, rather than on equipment with highest maintenance demands. Furthermore, it is not enough to consider risks posed by individual pieces of equipment to individual patients. It is critical to anticipate the impact of an equipment failure on larger groups of patients, especially when dealing with one of a kind, sophisticated pieces of equipment that are required to provide timely and accurate diagnoses for immediate therapeutic decisions or surgical interventions. A strategy for incorporating multiple criteria to formulate appropriate management strategies is provided in this article. PMID:16796335

  13. Current Management of NAFLD

    PubMed Central

    MUNTEANU, MIHAI ALEXANDRU; NAGY, GEORGIANA ANCA; MIRCEA, PETRU ADRIAN

    2016-01-01

    Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in Western countries. It affects about 1 billion individuals worldwide. While people with simple steatosis have no higher risk of death than the general population, people with non-alcoholic steatohepatitis are at increased risk of death compared to general population. Current management for NAFLD includes diet and lifestyle changes, management of underlying metabolic risk factors and pharmacological therapies. The objective of therapy is to prevent the complications. The problem with dietary and lifestyle interventions is that they are hard to implement. Compliance is the key. Until now, there is still no approved drug for the treatment of NAFLD. Insulin resistance is the main target of pharmacological therapy, but the question that we ask ourselves as physicians is who should receive medical treatment among NAFLD patients and for how long. PMID:27004021

  14. Brain abscess: Current management

    PubMed Central

    Alvis Miranda, Hernando; Castellar-Leones, Sandra Milena; Elzain, Mohammed Awad; Moscote-Salazar, Luis Rafael

    2013-01-01

    Brain abscess (BA) is defined as a focal infection within the brain parenchyma, which starts as a localized area of cerebritis, which is subsequently converted into a collection of pus within a well-vascularized capsule. BA must be differentiated from parameningeal infections, including epidural abscess and subdural empyema. The BA is a challenge for the neurosurgeon because it is needed good clinical, pharmacological, and surgical skills for providing good clinical outcomes and prognosis to BA patients. Considered an infrequent brain infection, BA could be a devastator entity that easily left the patient into dead. The aim of this work is to review the current concepts regarding epidemiology, pathophysiology, etiology, clinical presentation, diagnosis, and management of BA. PMID:24174804

  15. Brain abscess: Current management.

    PubMed

    Alvis Miranda, Hernando; Castellar-Leones, Sandra Milena; Elzain, Mohammed Awad; Moscote-Salazar, Luis Rafael

    2013-08-01

    Brain abscess (BA) is defined as a focal infection within the brain parenchyma, which starts as a localized area of cerebritis, which is subsequently converted into a collection of pus within a well-vascularized capsule. BA must be differentiated from parameningeal infections, including epidural abscess and subdural empyema. The BA is a challenge for the neurosurgeon because it is needed good clinical, pharmacological, and surgical skills for providing good clinical outcomes and prognosis to BA patients. Considered an infrequent brain infection, BA could be a devastator entity that easily left the patient into dead. The aim of this work is to review the current concepts regarding epidemiology, pathophysiology, etiology, clinical presentation, diagnosis, and management of BA. PMID:24174804

  16. Multi-centre European study of breakthrough cancer pain: pain characteristics and patient perceptions of current and potential management strategies.

    PubMed

    Davies, Andrew; Zeppetella, Giovambattista; Andersen, Steen; Damkier, Anette; Vejlgaard, Tove; Nauck, Friedemann; Radbruch, Lukas; Sjolund, Karl-Frederik; Stenberg, Mariann; Buchanan, Alison

    2011-08-01

    This study involved 320 cancer patients from four Northern European countries. Patients with breakthrough pain were questioned about the characteristics of their pain, the current management of their pain, and the acceptability/utility of alternative routes of administration. The median number of episodes was 3/day. Forty-four percent patients reported incident-type pain, 39% spontaneous-type pain, and 17% a combination of these pains. The median duration was 60 min, and the median time to peak intensity was 15 min. Three percent patients reported "mild" pain, 37% "moderate" pain, and 60% "severe" pain. Ninety percent patients stated that the pain interfered with their daily activities. All patients were using opioids as rescue medication (mainly oral morphine/oxycodone), whilst 28% patients were using non-opioids, and 50% patients were using non-pharmacological interventions. Only 55% patients took rescue medication every time they experienced breakthrough pain. Sixty-five percent patients would definitely consider using an oral transmucosal product; patients from Denmark were less likely to answer positively, and a positive response was associated with previous use of the route for breakthrough pain. Seventy-three percent patients reported regular oral problems. Forty-two percent patients would definitely consider using an intranasal product, with 26% patients stating they would definitely not use such a preparation; patients from Denmark and Sweden were less likely to answer positively, and a positive response was associated with male gender, and previous use of the route. Forty-four percent patients reported regular nasal problems. Sixty percent patients would definitely consider using a subcutaneous product, and 44% patients would definitely consider using an intrapulmonary product. PMID:21251860

  17. Using Rewards and Sanctions in the Classroom: Pupils' Perceptions of Their Own Responses to Current Behaviour Management Strategies

    ERIC Educational Resources Information Center

    Payne, Ruth

    2015-01-01

    The use of systems of rewards and sanctions within behaviour policies has now been adopted formally in UK schools. Such systems potentially represent competing theoretical ideas when considered alongside current approaches to teaching and learning. There is also opportunity for inconsistent use of rewards and sanctions resulting from the absence…

  18. Relapsed Hodgkin Lymphoma: Management Strategies

    PubMed Central

    Montanari, Francesca; Diefenbach, Catherine

    2016-01-01

    Although Hodgkin lymphoma (HL) is largely curable with first-line therapy, approximately one-third of patients will not have a complete response to frontline treatment or will subsequently relapse. Only 50 % of these patients will be effectively salvaged with conventional therapies. The prognosis is particularly poor for those patients with chemotherapy refractory disease, who are unable to obtain even transient disease control, and for patients who relapse following high dose chemotherapy and autologous stem cell transplant. In this review, we summarize the most recent updates on the management of patients with relapsed HL, the role of novel therapies such as brentuximab vedotin, and an overview of promising new agents currently under investigation. We also discuss the role of consolidation strategies such as high-dose chemotherapy and autologous stem cell transplant, and reduced-intensity allogeneic hematopoietic stem cell transplant, and the need for new strategies in the elderly patient population. PMID:24942298

  19. Current management of diverticulitis.

    PubMed

    McCafferty, Michael H; Roth, Leslie; Jorden, Jeffrey

    2008-11-01

    Diverticulitis is classified as uncomplicated or complicated, i.e., associated with perforation, fistula, or obstruction. CT allows more reliable characterization of an acute attack of diverticulitis. Medical management is reserved for uncomplicated diverticulitis and the initial phase of treatment of diverticulitis associated with abscess formation. Percutaneous abscess drainage is a major advance, which permits one-stage resection in a majority of cases. Diverticulitis associated with free perforation can be selectively managed with resection and primary anastomosis, although a Hartmann resection is likely to be performed. A fistula associated with diverticulitis can usually be managed with a one-stage resection. Obstruction can be managed selectively with resection with on-table bowel preparation, primary anastomosis, and proximal diversion. Laparoscopic techniques permit successful performance of elective resections most of the time. Hand assistance is of particular value when the patient has dense fibrosis. PMID:19062658

  20. Current and emerging strategies for the treatment and management of systemic lupus erythematosus based on molecular signatures of acute and chronic inflammation

    PubMed Central

    Das, Undurti N

    2010-01-01

    Lupus is a chronic, systemic inflammatory condition in which eicosanoids, cytokines, nitric oxide (NO), a deranged immune system, and genetics play a significant role. Our studies revealed that an imbalance in the pro- and antioxidants and NO and an alteration in the metabolism of essential fatty acids exist in lupus. The current strategy of management includes administration of nonsteroidal anti-inflammatory drugs such as hydroxychloroquine and immunosuppressive drugs such as corticosteroids. Investigational drugs include the following: 1) belimumab, a fully human monoclonal antibody that specifically recognizes and inhibits the biological activity of B-lymphocyte stimulator, also known as B-cell-activation factor of the TNF family; 2) stem cell transplantation; 3) rituximab, a chimeric monoclonal antibody against CD20, which is primarily found on the surface of B-cells and can therefore destroy B-cells; and 4) IL-27, which has potent anti-inflammatory actions. Our studies showed that a regimen of corticosteroids and cyclophosphamide, and methods designed to enhance endothelial NO synthesis and augment antioxidant defenses, led to induction of long-lasting remission of the disease. These results suggest that methods designed to modulate molecular signatures of the disease process and suppress inflammation could be of significant benefit in lupus. Some of these strategies could be vagal nerve stimulation, glucose–insulin infusion, and administration of lipoxins, resolvins, protectins, and nitrolipids by themselves or their stable synthetic analogs that are known to suppress inflammation and help in the resolution and healing of the inflammation-induced damage. These strategies are likely to be useful not only in lupus but also in other conditions, such as rheumatoid arthritis, scleroderma, ischemia-reperfusion injury to the myocardium, ischemic heart disease, and sepsis. PMID:22096364

  1. Oncoplastic breast surgery: current strategies

    PubMed Central

    Piper, Merisa; Peled, Anne Warren

    2015-01-01

    The surgical management of breast cancer has dramatically evolved over the past 20 years, with oncoplastic surgery gaining increased popularity. This field of breast surgery allows for complete resection of tumor, preservation of normal parenchyma tissue, and the use of local or regional tissue for immediate breast reconstruction at the time of partial mastectomy. These techniques extend the options for breast conservation surgery, improve aesthetic outcomes, have high patient satisfaction and result in better control of tumor margins. This article will detail the approach to evaluating and treating patients undergoing oncoplastic reconstruction. Different oncoplastic approaches will be described and applied to an oncoplastic reconstructive algorithm. Surgical complications, oncologic outcomes and aesthetic outcomes are reviewed. PMID:26005647

  2. Management: A Strategy for Change.

    ERIC Educational Resources Information Center

    White, Herbert S.

    1978-01-01

    Traces the recent history of libraries and mentions loss of status, insufficient funds, insufficient evaluation methods, and unspecified goals as major contributors to contemporary management problems. Also outlined is a management strategy, which includes public relations, long-range and short-range goals, and budget and financing. (JVP)

  3. The office of strategy management.

    PubMed

    Kaplan, Robert S; Norton, David P

    2005-10-01

    There is a disconnect in most companies between strategy formulation and strategy execution. On average, 95% of a company's employees are unaware of, or do not understand, its strategy. If employees are unaware of the strategy, they surely cannot help the organization implement it effectively. It doesn't have to be like this. For the past 15 years, the authors have studied companies that achieved performance breakthroughs by adopting the Balanced Scorecard and its associated tools to help them better communicate strategy to their employees and to guide and monitor the execution of that strategy. Some companies, of course, have achieved better, longer-lasting improvements than others. The organizations that have managed to sustain their strategic focus have typically established a new corporate-level unit to oversee all activities related to strategy: an office of strategy management (OS M). The OSM, in effect, acts as the CEO's chief of staff. It coordinates an array of tasks: communicating corporate strategy; ensuring that enterprise-level plans are translated into the plans of the various units and departments; executing strategic initiatives to deliver on the grand design; aligning employees' plans for competency development with strategic objectives; and testing and adapting the strategy to stay abreast of the competition. The OSM does not do all the work, but it facilitates the processes so that strategy is executed in an integrated fashion across the enterprise. Although the companies that Kaplan and Norton studied use the Balanced Scorecard as the framework for their strategy management systems, the authors say the lessons of the OSM are applicable even to companies that do not use it. PMID:16250626

  4. Knowledge management: an innovative risk management strategy.

    PubMed

    Zipperer, Lorri; Amori, Geri

    2011-01-01

    Knowledge management effectively lends itself to the enterprise risk process. The authors introduce the concept of knowledge management as a strategy to drive innovation and support risk management. They align this work with organizational efforts to improve patient safety and quality through the effective sharing of experience and lessons learned. The article closes with suggestions on how to develop a knowledge management initiative at an organization, who should be on the team, and how to sustain this effort and build the culture it requires to drive success. PMID:21506198

  5. Strategies for managing margins.

    PubMed

    2012-08-01

    Potential Medicare and Medicaid reimbursement cuts have made it critical for home health agencies to manage their gross and net operating profit margins. Agencies need to develop tools to analyze their margins and make sure they are following best practices. Try as you may, your agency might still face the question, "Why am I not meeting my budget?" Get some answers in this session from David Berman and Andrea L. Devoti. Berman is a principal at Simione Healthcare Consultants in Hamden, CT, where he is responsible for merchant acquisitions, business valuation due diligence, and oversight of the financial monitor benchmarking tool besides serving as interim chief financial officer. Devoti is chairman of the NAHC board and President & CEO of Neighborhood Health Visiting Nurse Association in West Chester PA. PMID:23074756

  6. Managing incontinence: women's normalizing strategies.

    PubMed

    Skoner, M M; Haylor, M J

    1993-01-01

    Women's strategies for managing urinary incontinence were examined in a grounded-theory study. The women's basic social concern was dealing with incontinence in a manner that enabled them to feel normal. Feeling normal meant being able to do what they wanted to do and needed to do to have a normal life-style as they perceived it. This goal was accomplished by normalizing incontinence and its management. Normalization was achieved by directing its course through self-management, accounting for it in terms of personal history and life experiences, and delaying medical counsel. These strategies are described. The findings provide fresh insights about women's response to incontinence and their practice of self-managing its consequences. PMID:8138472

  7. Suicide Gene Therapy for Cancer - Current Strategies.

    PubMed

    Zarogoulidis, Paul; Darwiche, Kaid; Sakkas, Antonios; Yarmus, Lonny; Huang, Haidong; Li, Qiang; Freitag, Lutz; Zarogoulidis, Konstantinos; Malecki, Marek

    2013-08-01

    Current cancer treatments may create profound iatrogenic outcomes. The adverse effects of these treatments still remain, as the serious problems that practicing physicians have to cope with in clinical practice. Although, non-specific cytotoxic agents constitute an effective treatment modality against cancer cells, they also tend to kill normal, quickly dividing cells. On the other hand, therapies targeting the genome of the tumors are both under investigation, and some others are already streamlined to clinical practice. Several approaches have been investigated in order to find a treatment targeting the cancer cells, while not affecting the normal cells. Suicide gene therapy is a therapeutic strategy, in which cell suicide inducing transgenes are introduced into cancer cells. The two major suicide gene therapeutic strategies currently pursued are: cytosine deaminase/5-fluorocytosine and the herpes simplex virus/ganciclovir. The novel strategies include silencing gene expression, expression of intracellular antibodies blocking cells' vital pathways, and transgenic expression of caspases and DNases. We analyze various elements of cancer cells' suicide inducing strategies including: targets, vectors, and mechanisms. These strategies have been extensively investigated in various types of cancers, while exploring multiple delivery routes including viruses, non-viral vectors, liposomes, nanoparticles, and stem cells. We discuss various stages of streamlining of the suicide gene therapy into clinical oncology as applied to different types of cancer. Moreover, suicide gene therapy is in the center of attention as a strategy preventing cancer from developing in patients participating in the clinical trials of regenerative medicine. In oncology, these clinical trials are aimed at regenerating, with the aid of stem cells, of the patients' organs damaged by pathologic and/or iatrogenic factors. However, the stem cells carry the risk of neoplasmic transformation. We discuss

  8. Dietary strategies for weight management.

    PubMed

    Rolls, Barbara J

    2012-01-01

    In an 'obesogenic' environment, getting people to eat appropriate amounts is challenging. Several food-based strategies have the potential to promote satiety and moderate energy intake. Components of foods such as macronutrients and functional ingredients can affect satiety; however, for weight management a more comprehensive approach is needed that emphasizes behavioral strategies to improve the overall diet. Research shows that large portions of energy-dense foods facilitate overconsumption and that reductions in portion size and energy density are associated with reduced energy intake. While this suggests that people should eat smaller portions, recent data show that if people lower the energy density of their diet, they can continue to eat their usual amount of food while limiting calories. Furthermore, serving larger portions of low-energy-dense foods can be used strategically to encourage their consumption and reduce dietary energy density, and this has been shown to be associated with decreased energy intake while maintaining satiety. This new understanding of how portion size can be used positively to manage energy intake has the potential to help people achieve sustainable improvements in their energy intake and bodyweight. Science-based strategies that increase the availability of affordable nutrient-rich, lower energy-dense foods are urgently needed. PMID:23128764

  9. Managing human resources for successful strategy execution.

    PubMed

    Arnold, Edwin

    2010-01-01

    Managers face difficult challenges when they implement organizational strategies to achieve important goals. Execution of strategy has become more dependent upon the effective management of human resources. This article suggests how people can be managed more effectively to facilitate the execution of strategies and improve organizational performance. PMID:20436334

  10. Current imaging strategies in rheumatoid arthritis

    PubMed Central

    Zeman, Merissa N; Scott, Peter JH

    2012-01-01

    As remission has now become a realistic therapeutic goal in the clinical management of RA due to the introduction and widespread adoption of biologic agents, there is a greater need for earlier diagnoses and objective methods for evaluating disease activity and response to treatment. In this capacity, advanced imaging strategies are assuming an expansive clinical role, particularly as they take advantage of newer imaging technologies and the shift toward imaging at the molecular level. Molecular imaging utilizes target-specific probes to non-invasively visualize molecular, cellular, and physiological perturbations in response to the underlying pathology. Probes for nuclear and MR imaging have been and are being developed that react with discrete aspects of inflammatory and destructive pathways specific to RA. These probes in addition to new MR sequences and contrast agents have the potential to provide an earlier and more reliable assessment of clinical outcome, disease activity, severity, and location, and therapeutic response. Furthermore, these imaging strategies may enable a more fundamental understanding of critical pathophysiological processes and the advent of new molecular therapies. This review will discuss these advances in both nuclear medicine and MRI strategies for imaging RA with a particular emphasis on molecular imaging. PMID:23133812

  11. Current data and strategy in glioblastoma multiforme

    PubMed Central

    Dinca, EB

    2009-01-01

    Glioblastoma multiforme (GBM) or astrocytoma grade Ⅳ on WHO classification is the most aggressive and the most frequent of all primary brain tumors. Glioblastoma is multiforme , resistant to therapeutic interventions illustrating the heterogeneity exhibited by this tumor in its every aspect, including clinical presentation, pathology, genetic signature. Current data and treatment strategy in GBM are presented focusing on basic science data and key clinical aspects like surgery, including personal experience; adjuvant modalities: radiotherapy, chemotherapy, but also for experimental approaches. Therapeutic attitude in recurrent GBM is also widely discussed. PMID:20108752

  12. Current Management of Urethral Stricture

    PubMed Central

    Lee, Young Ju

    2013-01-01

    The surgical treatment of urethral stricture diseases is continually evolving. Although various surgical techniques are available for the treatment of anterior urethral stricture, no one technique has been identified as the method of choice. This article provides a brief updated review of the surgical options for the management of different sites and different types of anterior urethral stricture. This review also covers present controversies in urethral reconstruction. Among the various procedures available for treating urethral stricture, one-stage buccal mucosal graft urethroplasty is currently widely used. The choice of technique for urethroplasty for an individual case largely depends on the expertise of the surgeon. Therefore, urologists working in this field should keep themselves updated on the numerous surgical techniques to deal with any condition of the urethra that might surface at the time of surgery. PMID:24044088

  13. HEPATOCELLULAR CARCINOMA: CURRENT AND PROSPECTIVE IMMUNOTHERAPEUTIC STRATEGIES.

    PubMed

    Kikodze, N; Mazmishvili, K; Iobadze, M; Rekhviashvili, Kh; Nanava, N; Pantsulaia, I; Mizandari, M; Janikashvili, N; Chikovani, T

    2015-09-01

    Hepatocellular carcinoma (HCC) is a highly lethal and the most common primary liver cancer with increasing worldwide incidence. Pathogenesis of HCC is immune mediated, however, not completely understood. Chronic low-grade inflammation alters both innate and adaptive immune responses. As a result tolerogenic environment is established in damaged organ. Up to date, incomplete understanding of HCC pathogenesis and the extend of biomarker variability among patients represent the major obstacle for early diagnosis and for the choice of effective treatment. Among current treatment options for HCC, thermal ablation strategy, which in addition to cancer eradication provides adjuvant/"danger"signal to the patient's immune cells, has demonstrated its active immunotherapeutic effect. In ongoing phase I/II clinical trials, tumor antigen loaded dendritic cell (DC)-based vaccines as well as tumor-specific cytotoxic T cells are being tested. Genetically redirected T cell therapy and more refined autologous vaccines are still awaiting approaches in HCC. The topic of this review focuses on current and bench-to-bedside immunotherapeutic strategies for HCC and discusses their advantages and limitations in clinic. We also weight up several prospective immunotherapeutic approaches which in theory have the potential for further implication in HCC. Combination of the induction of effective antitumor immunity with the inhibition of the mechanisms of tumor-induced immunosuppression ought to be a key objective in these future developments. PMID:26355320

  14. Molecular Imaging: Current Status and Emerging Strategies

    PubMed Central

    Pysz, Marybeth A.; Gambhir, Sanjiv S.; Willmann, Jürgen K.

    2011-01-01

    In vivo molecular imaging has a great potential to impact medicine by detecting diseases in early stages (screening), identifying extent of disease, selecting disease- and patient-specific therapeutic treatment (personalized medicine), applying a directed or targeted therapy, and measuring molecular-specific effects of treatment. Current clinical molecular imaging approaches primarily use PET- or SPECT-based techniques. In ongoing preclinical research novel molecular targets of different diseases are identified and, sophisticated and multifunctional contrast agents for imaging these molecular targets are developed along with new technologies and instrumentation for multimodality molecular imaging. Contrast-enhanced molecular ultrasound with molecularly-targeted contrast microbubbles is explored as a clinically translatable molecular imaging strategy for screening, diagnosing, and monitoring diseases at the molecular level. Optical imaging with fluorescent molecular probes and ultrasound imaging with molecularly-targeted microbubbles are attractive strategies since they provide real-time imaging, are relatively inexpensive, produce images with high spatial resolution, and do not involve exposure to ionizing irradiation. Raman spectroscopy/microscopy has emerged as a molecular optical imaging strategy for ultrasensitive detection of multiple biomolecules/biochemicals with both in vivo and ex vivo versatility. Photoacoustic imaging is a hybrid of optical and ultrasound modalities involving optically-excitable molecularly-targeted contrast agents and quantitative detection of resulting oscillatory contrast agent movement with ultrasound. Current preclinical findings and advances in instrumentation such as endoscopes and microcatheters suggest that these molecular imaging modalities have numerous clinical applications and will be translated into clinical use in the near future. PMID:20541650

  15. Overview of current immunotherapeutic strategies for glioma

    PubMed Central

    Calinescu, Anda-Alexandra; Kamran, Neha; Baker, Gregory; Mineharu, Yohei; Pedro Ricardo, Lowenstein; Maria Graciela, Castro

    2015-01-01

    In the last decade, numerous studies of immunotherapy for malignant glioma (glioblastoma multiforme) have brought new knowledge and new hope for improving the prognosis of this incurable disease. Some clinical trials have reached Phase III, following positive outcomes in Phase I and II, with respect to safety and immunological end points. Results are encouraging especially when considering the promise of sustained efficacy by inducing antitumor immunological memory. Progress in understanding the mechanisms of tumor-induced immune suppression led to the development of drugs targeting immunosuppressive checkpoints, which are used in active clinical trials for glioblastoma multiforme. Insights related to the heterogeneity of the disease bring new challenges for the management of glioma and underscore a likely cause of therapeutic failure. An emerging therapeutic strategy is represented by a combinatorial, personalized approach, including the standard of care: surgery, radiation, chemotherapy with added active immunotherapy and multiagent targeting of immunosuppressive checkpoints. PMID:26598957

  16. Configuration Management Process Assessment Strategy

    NASA Technical Reports Server (NTRS)

    Henry, Thad

    2014-01-01

    Purpose: To propose a strategy for assessing the development and effectiveness of configuration management systems within Programs, Projects, and Design Activities performed by technical organizations and their supporting development contractors. Scope: Various entities CM Systems will be assessed dependent on Project Scope (DDT&E), Support Services and Acquisition Agreements. Approach: Model based structured against assessing organizations CM requirements including best practices maturity criteria. The model is tailored to the entity being assessed dependent on their CM system. The assessment approach provides objective feedback to Engineering and Project Management of the observed CM system maturity state versus the ideal state of the configuration management processes and outcomes(system). center dot Identifies strengths and risks versus audit gotcha's (findings/observations). center dot Used "recursively and iteratively" throughout program lifecycle at select points of need. (Typical assessments timing is Post PDR/Post CDR) center dot Ideal state criteria and maturity targets are reviewed with the assessed entity prior to an assessment (Tailoring) and is dependent on the assessed phase of the CM system. center dot Supports exit success criteria for Preliminary and Critical Design Reviews. center dot Gives a comprehensive CM system assessment which ultimately supports configuration verification activities.*

  17. Managing Conflict: 50 Strategies for School Leaders

    ERIC Educational Resources Information Center

    Edmonson, Stacey; Combs, Julie; Harris, Sandra

    2008-01-01

    This book offers 50 easy-to-read strategies for managing conflicts in your school involving students, parents, and teachers. Individually, these strategies provide specific insights into conflict resolution, reduction, and management. As a whole, the 50 strategies provide a comprehensive method to lead constructive change in your school. With…

  18. Quality management under current conditions

    NASA Astrophysics Data System (ADS)

    Vasiliev, V. A.; Aleksandrova, S. V.

    2015-12-01

    The diversity of the concept of quality is defined. Modern quality management methods and tools are considered. The global components of quality management and quality management system ISO 9000 are discussed. Education requirements for specialists in the field of quality are formulated.

  19. DETERMINANTS OF NETWORK OUTCOMES: THE IMPACT OF MANAGEMENT STRATEGIES

    PubMed Central

    YSA, TAMYKO; SIERRA, VICENTA; ESTEVE, MARC

    2014-01-01

    The literature on network management is extensive. However, it generally explores network structures, neglecting the impact of management strategies. In this article we assess the effect of management strategies on network outcomes, providing empirical evidence from 119 urban revitalization networks. We go beyond current work by testing a path model for the determinants of network outcomes and considering the interactions between the constructs: management strategies, trust, complexity, and facilitative leadership. Our results suggest that management strategies have a strong effect on network outcomes and that they enhance the level of trust. We also found that facilitative leadership has a positive impact on network management as well as on trust in the network. Our findings also show that complexity has a negative impact on trust. A key finding of our research is that managers may wield more influence on network dynamics than previously theorized. PMID:25520529

  20. Novel strategies for managing pancreatic cancer

    PubMed Central

    Loc, Welley S; Smith, Jill P; Matters, Gail; Kester, Mark; Adair, James H

    2014-01-01

    With the incidence reports of pancreatic cancer increasing every year, research over the last several decades has been focused on the means to achieve early diagnosis in patients that are at a high risk of developing the malignancy. This review covers current strategies for managing pancreatic cancer and further discusses efforts in understanding the role of early onset symptoms leading to tumor progression. Recent investigations in this discussion include type 3c diabetes, selected biomarkers and pathways related to pancreatic intraepithelial neoplasia lesions, drug resistance, and advances in nanomedicine which may provide significant solutions for improving early detection and treatments in future medicine. PMID:25356034

  1. Stereotactic body radiotherapy: current strategies and future development

    PubMed Central

    2016-01-01

    Stereotactic body radiotherapy (SBRT) has emerged as the standard treatment for medically inoperable early-staged non-small cell lung cancer (NSCLC). The local control rate after SBRT is over 90%. Some forms of tumour motion management and image-guided radiation delivery techniques are the prerequisites for fulfilment of its goal to deliver a high radiation dose to the tumour target without overdosing surrounding normal tissues. In this review, the current strategies of tumour motion management will be discussed, followed by an overview of various image-guided radiotherapy (RT) systems and devices available for clinical practice. Besides medically inoperable stage I NSCLC, SBRT has also been widely adopted for treatment of oligometastasis involving the lungs. Its possible applications in various other cancer illnesses are under extensive exploration. The progress of SBRT is critically technology-dependent. With advancement of technology, the ideal of personalised, effective and yet safe SBRT is already on the horizon. PMID:27606082

  2. Stereotactic body radiotherapy: current strategies and future development.

    PubMed

    Tsang, Maverick W K

    2016-07-01

    Stereotactic body radiotherapy (SBRT) has emerged as the standard treatment for medically inoperable early-staged non-small cell lung cancer (NSCLC). The local control rate after SBRT is over 90%. Some forms of tumour motion management and image-guided radiation delivery techniques are the prerequisites for fulfilment of its goal to deliver a high radiation dose to the tumour target without overdosing surrounding normal tissues. In this review, the current strategies of tumour motion management will be discussed, followed by an overview of various image-guided radiotherapy (RT) systems and devices available for clinical practice. Besides medically inoperable stage I NSCLC, SBRT has also been widely adopted for treatment of oligometastasis involving the lungs. Its possible applications in various other cancer illnesses are under extensive exploration. The progress of SBRT is critically technology-dependent. With advancement of technology, the ideal of personalised, effective and yet safe SBRT is already on the horizon. PMID:27606082

  3. [Current options to manage clopidogrel poor responsiveness].

    PubMed

    Fileti, Luca; Campo, Gianluca; Valgimigli, Marco; Marchesini, Jlenia; Ferrari, Roberto

    2010-12-01

    Antiplatelet therapy (aspirin + clopidogrel) is the cornerstone of treatment for patients with acute coronary syndromes and/or undergoing percutaneous coronary interventions (PCI). More than 40 million patients worldwide receive clopidogrel, but about 20% of them are nonresponders or poor responders. Many studies using different techniques, platelet agonists and definitions have shown that patients who are poor responders to clopidogrel have an increased risk of death, reinfarction and stent thrombosis. The mechanisms leading to poor responsiveness are not fully elucidated and are likely multifactorial: genetic factors, accelerated platelet turnover, up-regulation of the P2Y12 pathways, high baseline platelet reactivity, poor compliance, underdosing and drug-drug interactions. The management of these patients is very difficult, but evidence does exist showing that a strategy of higher maintenance dose or switch to different thienopyridines (e.g. ticlopidine or prasugrel) or use of glycoprotein IIb/IIIa inhibitors during PCI may be helpful to overcome poor responsiveness and improve the long-term clinical outcome. This review describes the impact of poor responsiveness to clopidogrel on clinical outcomes, the mechanisms leading to poor effect, and the different assays to assess it. Finally, current and future options for its management are discussed. PMID:21355335

  4. Current Management of Fecal Incontinence

    PubMed Central

    Wang, Jennifer Y; Abbas, Maher A

    2013-01-01

    Objective: To review the management of fecal incontinence, which affects more than 1 in 10 people and can have a substantial negative impact on quality of life. Methods: The medical literature between 1980 and April 2012 was reviewed for the evaluation and management of fecal incontinence. Results: A comprehensive history and physical examination are required to help understand the severity and type of symptoms and the cause of incontinence. Treatment options range from medical therapy and minimally invasive interventions to more invasive procedures with varying degrees of morbidity. The treatment approach must be tailored to each patient. Many patients can have substantial improvement in symptoms with dietary management and biofeedback therapy. For younger patients with large sphincter defects, sphincter repair can be helpful. For patients in whom biofeedback has failed, other options include injectable medications, radiofrequency ablation, or sacral nerve stimulation. Patients with postdefecation fecal incontinence and a rectocele can benefit from rectocele repair. An artificial bowel sphincter is reserved for patients with more severe fecal incontinence. Conclusion: The treatment algorithm for fecal incontinence will continue to evolve as additional data become available on newer technologies. PMID:24355892

  5. Cystinuria: current diagnosis and management.

    PubMed

    Saravakos, Panagiotis; Kokkinou, Vasiliki; Giannatos, Evangelos

    2014-04-01

    Cystinuria is an inherited disorder of the dibasic amino acid transport system in the proximal tubule and the small intestine. Two responsible genes have been identified, the SLC3A1 on chromosome 2 and the SLC7A9 on chromosome 19. The inability of renal tubules to reabsorb cystine and the relative insolubility of cystine at physiological urine pH lead to stone formation. Cornerstone of the treatment remains stone prevention with hyperhydration, urinary alkalization, and pharmacologic therapy. Repeated stone formation necessitates urologic interventions, which mainly include minimally invasive procedures. The appropriate management of cystinuria is often challenging and requires close follow-up of the patient. PMID:24246330

  6. Leadership Strategies for Managing Conflict.

    ERIC Educational Resources Information Center

    Kormanski, Chuck

    1982-01-01

    Discusses the impact of conflict in small group development theory. Views conflict as a positive, normally occurring behavior and presents leadership strategies involving withdrawal, suppression, integration, compromise, and power. Examines situational contingencies and presents a rationale for strategy selection and intervention. (Author)

  7. Current management of hepatocellular carcinoma

    PubMed Central

    Tabrizian, Parissa; Roayaie, Sasan; Schwartz, Myron E

    2014-01-01

    Hepatocellular carcinoma (HCC) is the sixth most common cancer worldwide and leading cause of death among patients with cirrhosis. Treatment guidelines are based according to the Barcelona Clinic Liver Cancer staging system. The choice among therapeutic options that include liver resection, liver transplantation, locoregional, and systemic treatments must be individualized for each patient. The aim of this paper is to review the outcomes that can be achieved in the treatment of HCC with the heterogeneous therapeutic options currently available in clinical practice. PMID:25132740

  8. Current Management of Hepatocellular Carcinoma

    PubMed Central

    Crissien, Ana Maria

    2014-01-01

    Hepatocellular carcinoma (HCC) is the most common primary liver malignancy. Despite efforts for prevention and screening as well as development of new technologies for diagnosis and treatment, the incidence of HCC has doubled, and mortality rates have increased in recent decades. A variety of important risk factors are associated with the development of HCC, with any type of cirrhosis, regardless of etiology, being the major contributor. Hepatitis C virus infection with bridging fibrosis or cirrhosis and hepatitis B virus infection are independent risk factors. The diagnosis of HCC is made without liver biopsy in over 90% of cases. Screening with ultrasound and alpha-fetoprotein (AFP) at 6-month intervals is advised; however, it is not adequate for patients on the orthotopic liver transplantation (OLT) list. Triple-phase computed tomography and/or magnetic resonance imaging are used in combination with the detection of AFP, AFP-L3%, and/or des-gamma-carboxy prothrombin due to their superior sensitivities and specificities. Several treatment modalities are available, but only surgical resection and OLT are curative. OLT is available only for patients who meet or are downstaged into Milan or University of California, San Francisco criteria. Other treatment options include radiofrequency ablation, microwave ablation, percutaneous ethanol injection, transarterial chemoembolization, radioembolization, cryoablation, radiation therapy, stereotactic radiotherapy, systemic chemotherapy, and molecularly targeted therapies. The management of HCC is based on tumor size and location, extrahepatic spread, and underlying liver function. Given the complexity of the disease, patients are often best served in centers with experience in HCC management, where a multi-disciplinary approach can take place. PMID:24829542

  9. Disease management as a performance improvement strategy.

    PubMed

    McClatchey, S

    2001-11-01

    Disease management is a strategy of organizing care and services for a patient population across the continuum. It is characterized by a population database, interdisciplinary and interagency collaboration, and evidence-based clinical information. The effectiveness of a disease management program has been measured by a combination of clinical, financial, and quality of life outcomes. In early 1997, driven by a strategic planning process that established three Centers of Excellence (COE), we implemented disease management as the foundation for a new approach to performance improvement utilizing five key strategies. The five implementation strategies are outlined, in addition to a review of the key elements in outcome achievement. PMID:11761788

  10. Orofacial pain management: current perspectives.

    PubMed

    Romero-Reyes, Marcela; Uyanik, James M

    2014-01-01

    Some of the most prevalent and debilitating pain conditions arise from the structures innervated by the trigeminal system (head, face, masticatory musculature, temporomandibular joint and associated structures). Orofacial pain (OFP) can arise from different regions and etiologies. Temporomandibular disorders (TMD) are the most prevalent orofacial pain conditions for which patients seek treatment. Temporomandibular disorders include a number of clinical problems that involve the masticatory musculature, the temporomandibular joint (TMJ) or both. Trigeminal neuropathic pain conditions can arise from injury secondary to dental procedures, infection, neoplasias, or disease or dysfunction of the peripheral and/or central nervous system. Neurovascular disorders, such as primary headaches, can present as chronic orofacial pain, such as in the case of facial migraine, where the pain is localized in the second and third division of the trigeminal nerve. Together, these disorders of the trigeminal system impact the quality of life of the sufferer dramatically. A multidisciplinary pain management approach should be considered for the optimal treatment of orofacial pain disorders including both non-pharmacological and pharmacological modalities. PMID:24591846

  11. Orofacial pain management: current perspectives

    PubMed Central

    Romero-Reyes, Marcela; Uyanik, James M

    2014-01-01

    Some of the most prevalent and debilitating pain conditions arise from the structures innervated by the trigeminal system (head, face, masticatory musculature, temporomandibular joint and associated structures). Orofacial pain (OFP) can arise from different regions and etiologies. Temporomandibular disorders (TMD) are the most prevalent orofacial pain conditions for which patients seek treatment. Temporomandibular disorders include a number of clinical problems that involve the masticatory musculature, the temporomandibular joint (TMJ) or both. Trigeminal neuropathic pain conditions can arise from injury secondary to dental procedures, infection, neoplasias, or disease or dysfunction of the peripheral and/or central nervous system. Neurovascular disorders, such as primary headaches, can present as chronic orofacial pain, such as in the case of facial migraine, where the pain is localized in the second and third division of the trigeminal nerve. Together, these disorders of the trigeminal system impact the quality of life of the sufferer dramatically. A multidisciplinary pain management approach should be considered for the optimal treatment of orofacial pain disorders including both non-pharmacological and pharmacological modalities. PMID:24591846

  12. Multiple Strategies for Teaching Current Events.

    ERIC Educational Resources Information Center

    Haas, Mary E.; Laughlin, Margaret A.

    Teacher members of the National Council for the Social Studies (NCSS) describe the study of current events as essential or very important to the social studies curriculum. Most teachers indicated using current events to provide contemporary examples of abstract historical, social, economic, and political concepts or to illustrate the continuity of…

  13. Time management strategies for research productivity.

    PubMed

    Chase, Jo-Ana D; Topp, Robert; Smith, Carol E; Cohen, Marlene Z; Fahrenwald, Nancy; Zerwic, Julie J; Benefield, Lazelle E; Anderson, Cindy M; Conn, Vicki S

    2013-02-01

    Researchers function in a complex environment and carry multiple role responsibilities. This environment is prone to various distractions that can derail productivity and decrease efficiency. Effective time management allows researchers to maintain focus on their work, contributing to research productivity. Thus, improving time management skills is essential to developing and sustaining a successful program of research. This article presents time management strategies addressing behaviors surrounding time assessment, planning, and monitoring. Herein, the Western Journal of Nursing Research editorial board recommends strategies to enhance time management, including setting realistic goals, prioritizing, and optimizing planning. Involving a team, problem-solving barriers, and early management of potential distractions can facilitate maintaining focus on a research program. Continually evaluating the effectiveness of time management strategies allows researchers to identify areas of improvement and recognize progress. PMID:22868990

  14. Current Management of Pediatric Vitiligo.

    PubMed

    Van Driessche, Freya; Silverberg, Nanette

    2015-08-01

    Vitiligo is a common inflammatory disorder with worldwide prevalence of 0.4-2 % of the population, with half of cases beginning in childhood. The management of childhood vitiligo should be tailored to avoid negative effects on the overall growth and psychological development of the patient. Therapy of vitiligo in childhood is chosen based on the location of the lesions, lesion age, and extent of lesions in the context of the child's age and the developmental status of the child. There are four age categories in childhood vitiligo: [1] infantile and toddler (rare) (ages 0-3 years), [2] ages 4-8 years, [3] ages 9-12 years, and [4] 13+ years of age, based on developmental stage, psychological maturation, and ability to comply or participate in therapy. These categories are also differentiated psychologically by susceptibility to bullying, self-image development, and personal concern with lesion appearance, which increases with time. Intervention is advisable in cases with facial and leg involvement due to prominence of lesions and cosmetic defect. Medical interventions are largely the usage of topical therapies including corticosteroids and calcineurin inhibitors, some vitamin therapy (oral and topical vitamin D), and judicious introduction of phototherapy sources based on age and severity. Screening and appropriate subspecialist referral for co-morbidities (e.g., thyroid disease, celiac disease, psychological distress, and vitamin D deficiency) may enhance overall health. Cosmesis and camouflage are generally safe in childhood and have been noted to improve overall quality of life in this grouping. Genetic transmission of vitiligo is minimal at 5-6 % in first-degree relatives. This article reviews the therapeutics of pediatric vitiligo from the perspective of developmental stages and response to therapy. PMID:26022363

  15. Epidemiology of MRSA and current strategies in Europe and Japan

    PubMed Central

    Kramer, Axel; Wagenvoort, Hans; Åhrén, Christina; Daniels-Haardt, Inka; Hartemann, Philippe; Kobayashi, Hiro; Kurcz, Andrea; Picazo, Juan; Privitera, Gaetano; Assadian, Ojan

    2010-01-01

    The prevalence of health-care associated infections caused by multi-drug resistant organisms has significantly increased over the past decade. Among these organisms, Methicillin-resistant Staphylococcus aureus (MRSA) plays a prominent and increasing role. Because of consequences for patients and the economic burden in course of prolonged treatment following MRSA infections and additional indirect costs for e.g. isolation or antiseptic treatment, this trend will further damage European health-care systems. In 2006, a workshop was initiated at the 8th International Congress of the German Society of Hospital Hygiene held in Berlin. The aim of this workshop was to give an overview of the current situation of MRSA in selected European countries and to elaborate on potential strategies to prevent MRSA-infections and dissemination. A questionnaire encompassing 20 questions addressed topics such as epidemiology, current measures and future prospects was distributed to representatives from various European countries and Japan. A variety of widely different answers was obtained. It was shown that in all countries prevalence of MRSA is on a rising tide. This trend is observable in all European countries, albeit less strong in The Netherlands, Slovenia, France, Austria and Scandinavian countries. It was conclude that prevention strategies in a united and expanding European Community will become of utmost importance and that rapid screening strategies, e.g. PCR, might be of assistance in such an approach. A potential strategy to improve infection control measures could be the requirement of health-insurance providers to sign contracts only with hospitals able to proof having an infection control management in place. PMID:20204100

  16. Overweight and obesity management strategies.

    PubMed

    Kahan, Scott

    2016-06-01

    Comprehensive lifestyle interventions, including nutrition, physical activity, and behavioral therapy, are the foundation for clinical obesity management. New tools and treatment approaches help clinicians provide these interventions and support weight management in the primary care setting. Escalating treatment, such as using pharmacotherapy, medical devices, or bariatric surgery, are important considerations for appropriate patients who do not respond to lifestyle counseling. This article provides a review of obesity treatment in primary care and managed care settings. Principles of lifestyle changes for weight management, behavioral counseling, and options for pharmacotherapy, medical devices, and bariatric surgery are discussed. PMID:27356116

  17. Speed Management Strategies; A Systematic Review

    PubMed Central

    Sadeghi-Bazargani, Homayoun; Saadati, Mohammad

    2016-01-01

    Objective: To systematically identify the various methods of speed management and their effects. Methods: A systematic search was performed in Science Direct, Ovid Medline, Scopus, PubMed and ProQuest databases from April to June 2015. Hand searching and reference of selected articles were used to improve article identification. Articles published after 1990 which had reported on efficacy/effectiveness of speed management strategies were included. Data were extracted using pre-defined extraction table. Results: Of the 803 retrieved articles, 22 articles were included in this review. Most of the included articles (63%) had before-after design and were done in European countries. Speed cameras, engineering schemes, intelligent speed adaption (ISA), speed limits and zones, vehicle activated sign and integrated strategies were the most common strategies reported in the literature. Various strategies had different effects on mean speed of the vehicles ranging from 1.6 to 10 km/h. Moreover, 8-65% and 11-71% reduction was reported in person injured accidents and fatal accidents, respectively as a result of employing various strategies. Conclusion: Literature revealed positive effects of various speed management strategies. Using various strategies was mostly dependent on road characteristics, driver’s attitude about the strategy as well as economic and technological capabilities of the country. Political support is considered as a main determinant in selecting speed management strategies. PMID:27540546

  18. What's your strategy for managing knowledge?

    PubMed

    Hansen, M T; Nohria, N; Tierney, T

    1999-01-01

    The rise of the computer and the increasing importance of intellectual assets have compelled executives to examine the knowledge underlying their businesses and how it is used. Because knowledge management as a conscious practice is so young, however, executives have lacked models to use as guides. To help fill that gap, the authors recently studied knowledge management practices at management consulting firms, health care providers, and computer manufacturers. They found two very different knowledge management strategies in place. In companies that sell relatively standardized products that fill common needs, knowledge is carefully codified and stored in databases, where it can be accessed and used--over and over again--by anyone in the organization. The authors call this the codification strategy. In companies that provide highly customized solutions to unique problems, knowledge is shared mainly through person-to-person contacts; the chief purpose of computers is to help people communicate. They call this the personalization strategy. A company's choice of knowledge management strategy is not arbitrary--it must be driven by the company's competitive strategy. Emphasizing the wrong approach or trying to pursue both can quickly undermine a business. The authors warn that knowledge management should not be isolated in a functional department like HR or IT. They emphasize that the benefits are greatest--to both the company and its customers--when a CEO and other general managers actively choose one of the approaches as a primary strategy. PMID:10387767

  19. [Current strategy in colorectal cancer screening].

    PubMed

    Lefter, L P; Dajbog, Elena; Scripcariu, V; Dragomir, Cr

    2005-01-01

    Screening programs should begin by classifying the individual patient's level of risk based on personal, family, and medical history, which will determine the appropriate approach for each subject. The individual's risk status determines when screening should be initiated and what tests and frequency are appropriate. To achieve these aims, care systems should establish standards and operating procedures. This review focuses on colorectal cancer screening methodology highlighting the latest available strategies. PMID:16610172

  20. Prioritizing invasive plant management strategies

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Invasive plants are seriously impacting rangelands by displacing desirable species. Management of these species is expensive and careful allocation of scarce dollars is necessary. Ecologically-based invasive plant management (EBIPM) has the potential to provide an improved decision-making process ...

  1. Comprehensive Self-Management Strategies.

    PubMed

    Bourbeau, J; Lavoie, K L; Sedeno, M

    2015-08-01

    In this article, we provide a review of the literature on self-management interventions and we are giving some thought to how, when, and by whom they should be offered to patients. The present literature based on randomized clinical trials has demonstrated benefits (reduced hospital admissions and improved health status) for chronic obstructive pulmonary disease (COPD) patients undergoing self-management interventions, although there are still problems with the heterogeneity among interventions, study populations, follow-up time, and outcome measures that make generalization difficult in real life. Key to the success, self-management intervention has to target behavior change. Proper self-management support is a basic prerequisite, for example, techniques and skills used by health care providers "case manager" to instrument patients with the knowledge, confidence, and skills required to effectively self-manage their disease. To improve health behaviors and engagement in self-management, self-management interventions need to target enhancing intrinsic motivation to change. This will best be done using client-centered communication (motivational communication) that encourages patients to express what intrinsically motivates them (e.g., consistent with their values or life goals) to adopt certain health behavior, with the goal of helping them overcome their ambivalence about change. Finally, if we want to be able to design and implement self-management interventions that are integrated, coherent, and have a strong likelihood of success, we need to take a more careful look and give more attention at the case manager, the patient (patient evaluation), and the quality assurance. PMID:26238647

  2. Management strategy 3: fixed rate fertilizer applications

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Previous chapters outlined management strategies for pond fertilization that take into account specific individual pond nutrient needs. Those methods would most likely be more ecologically efficient than a pre-determined fixed-rate nutrient addition strategy. However, the vast majority of available ...

  3. Winning Strategies for Classroom Management.

    ERIC Educational Resources Information Center

    Cummings, Carol

    This book offers advice on arranging classrooms, diagnosing student behavior, and responding to students' emotional needs, examining intellectual, emotional, and physical challenges students face and providing strategies which help teachers create communities of learners, design classrooms, diagnose student behavior, and respond to student needs.…

  4. Current Treatment Strategies in Pediatric Alopecia Areata

    PubMed Central

    Wang, Etienne; Lee, Joyce SS; Tang, Mark

    2012-01-01

    Alopecia areata (AA) is a non-scarring autoimmune disease of the hair follicle that can present at any age. Pediatric cases are commonly seen in a dermatology clinic, and management can potentially be challenging, with a small proportion of cases experiencing a chronic relapsing course marked by distressing hair loss that can bring about significant psychosocial morbidity. We review the established treatments for pediatric alopecia areata, alongside second and third line therapies that have shown to be efficacious. We also offer a treatment algorithm as a guide to the treatment of pediatric AA. PMID:23248364

  5. Therapeutic strategies for cancer pain management.

    PubMed Central

    Miller, T. W.; Spiro, K.; Jay, L. L.

    1990-01-01

    Clinical issues related to treating the oncology pain patient have gained considerable attention in the medical and health care literature. Addressed are management strategies which focus specifically on cognitive-behavioral, psychosocial, and pharmacologic approaches to treating the oncology pain patient. Each strategy possesses unique qualities that can benefit the care and management of the cancer patient and provide a better understanding of the disease entity and the patient's ability to develop coping strategies that may be effective in understanding and confronting pain associated with cancer. PMID:2097904

  6. Strategies for managing a busy emergency department.

    PubMed

    Campbell, Samuel G; Sinclair, Douglas E

    2004-07-01

    In a time of increased patient loads and emergency department (ED) exit block, the need for strategies to manage patient flow in the ED has become increasingly important. In March 2002 we contacted all 1282 members of the Canadian Association of Emergency Physicians and asked them to delineate strategies for enhancing ED patient flow and ED productivity without increasing stress levels, reducing care standards or compromising patient safety. Thirty physicians responded. Their suggested flow management strategies, which ranged from clinical decision-making to communication to choreography of time, space and personnel, are summarized here. PMID:17382005

  7. Action Learning: A Strategy for Empowering Managers.

    ERIC Educational Resources Information Center

    Marsick, Victoria J.

    Action learning is a potentially empowering management development strategy--empowering to managers and through them to employees. The core of the action learning process is similar to the empowerment process identified by Freire (1973), although the context of these approaches is very different: praxis. Praxis involves critical reflection on…

  8. Internationalisation Strategies for Management Education.

    ERIC Educational Resources Information Center

    Howe, W. Stewart; Martin, Graeme

    1998-01-01

    A literature review and case study of a British business school examined these areas: (1) competing rationales for internationalizing management education; (2) transfer of best practice from the west; and (3) problems that parent and host countries face in joint ventures. (SK)

  9. [Current therapeutic strategies in smoking cessation].

    PubMed

    Borgne, Anne; Aubin, Henri-Jean; Berlin, Ivan

    2004-11-15

    Smoking is a behaviour maintained and enhanced by a dependence mainly induced by nicotine. Despite awareness and knowledge of the associated health risks many smokers find it considerably difficult to quit. The untoward effects of nicotine withdrawal such as apparition of depressive mood, or weight gain, etc. justify the numerous unsuccessful attempts to quit smoking. Treatments with demonstrated efficacy are available and international evidence-based recommendations for cessation interventions have been established. These are: brief advice, assessing the smoking status of each patient and encouraging cessation; nicotine replacement therapies (NRT) [transdermal patch, gum, sublingual tablet or inhalator to be used at sufficiently individualised doses combining, if necessary, two or more NRT products]; bupropion, a more recent treatment: psychotropic drug, a noradrenaline and dopamine re-uptake inhibitor more recently approved for marketing; behavioural and cognitive therapies on their own or combined with pharmacotherapy. Measuring nicotine dependence using the Fagerström Test for Nicotine Dependence may help to define the therapeutic strategy. It is obvious that therapies can only work for smokers who are motivated to stop smoking. Before reaching the decision to quit, the smoker goes through a process in the course of which the role of health professionals' advice is paramount. PMID:15655912

  10. Selecting habitat management strategies on refuges

    USGS Publications Warehouse

    Schroeder, Richard L.; King, Wayne J.; Cornely, John E.

    1998-01-01

    This report is a joint effort of the Biological Resources Division, U.S. Geological Survey and the U.S. Fish and Wildlife Service (FWS) to provide National Wildlife Refuge (NWR) managers guidance on the selection and evaluation of habitat management strategies to meet stated objectives. The FWS recently completed a handbook on writing refuge management goals and objectives (U.S. Fish and Wildlife Service 1996a). the National Wildlife Refuge System Improvement Act of 1997 requires that National Wildlife Refuge System (NWRS) lands be managed according to approved Comprehensive Conservation Plans to guide management decisions and devise strategies for achieving refuge unit purposes and meeting the NWRS mission. It is expected that over the next several years most refuges will develop new or revised refuge goals and objectives for directing their habitat management strategies. This paper outlines the steps we recommend in selecting and evaluating habitat management strategies to meet specific refuge habitat objectives. We selected two examples to illustrate the process. Although each refuge is unique and will require specific information and solutions, these two examples can be used as guidance when selecting and evaluating habitat management strategies for other refuge resources: Example 1. Management of floodplain woods habitat for forest interior birds. The biological recourse of concern is the quality and quantity of floodplain woods habitat for eastern forest interior birds in the Cypress Creek NWR (U.S. Fish and Wildlife Service 1996b). Example 2. Management of habitat for biodiversity: Historical landscape proportions. The biological resource of concern is the change in diversity associated with man-induced changes in the distribution and abundance of habitat types at the Minnesota Valley NWR (U.S. Fish and Wildlife Service 1996c).

  11. Osteoporosis: Prevention and Management Strategies

    PubMed Central

    Evers, Susan; Myers, Anita

    1987-01-01

    Osteoporosis is a major cause of morbidity in post-menopausal women. Strategies to prevent or delay bone loss in normal post-menopausal women and to reduce the risk of fractures in women with osteoporosis are within the scope of family practice. Certain factors, such as inadequate calcium intake, estrogen deficiency, cigarette smoking and lack of physical activity can be modified in peri- and post-menopausal women. For patients with osteoporosis, there is potential for lowering the risk of fractures by means of calcium supplements or other therapies, physical training and rehabilitation, and modification of factors associated with risk of falling. PMID:21267348

  12. Current surgical strategies for malignant pleural mesothelioma.

    PubMed

    Takuwa, Teruhisa; Hasegawa, Seiki

    2016-08-01

    Malignant pleural mesothelioma (MPM) is associated with a poor prognosis. The main components of multimodality treatment include surgery, chemotherapy, and radiation therapy. Surgery remains controversial. Two procedures are currently offered: extrapleural pneumonectomy (EPP) and pleurectomy/decortication (P/D). The recent scientific literature suggests that P/D is a well-tolerated procedure, with the potential of becoming a default procedure in multimodality regimens. However, the precise treatment schemes and surgical procedures are yet to be established. In our study, we review the advantages and disadvantages of EPP and P/D, summarize the post-EPP and post-P/D observations (including mortality, morbidity, and median survival time), and discuss the choice of surgical technique (EPP vs. P/D). Moreover, we highlight the aspects of the multimodality treatments that are offered to MPM patients, including chemotherapy, radiotherapy, intensity-modulated radiation therapy, and other types of therapy. PMID:26590581

  13. Heat Management Strategy Trade Study

    SciTech Connect

    Nick Soelberg; Steve Priebe; Dirk Gombert; Ted Bauer

    2009-09-01

    This Heat Management Trade Study was performed in 2008-2009 to expand on prior studies in continued efforts to analyze and evaluate options for cost-effectively managing SNF reprocessing wastes. The primary objective was to develop a simplified cost/benefit evaluation for spent nuclear fuel (SNF) reprocessing that combines the characteristics of the waste generated through reprocessing with the impacts of the waste on heating the repository. Under consideration were age of the SNF prior to reprocessing, plutonium and minor actinide (MA) separation from the spent fuel for recycle, fuel value of the recycled Pu and MA, age of the remaining spent fuel waste prior to emplacement in the repository, length of time that active ventilation is employed in the repository, and elemental concentration and heat limits for acceptable glass waste form durability. A secondary objective was to identify and qualitatively analyze remaining issues such as (a) impacts of aging SNF prior to reprocessing on the fuel value of the recovered fissile materials, and (b) impact of reprocessing on the dose risk as developed in the Yucca Mountain Total System Performance Assessment (TSPA). Results of this study can be used to evaluate different options for managing decay heat in waste streams from spent nuclear fuel.

  14. Managing Work and Family: Do Control Strategies Help?

    ERIC Educational Resources Information Center

    Versey, H. Shellae

    2015-01-01

    How can we effectively manage competing obligations from work and family without becoming overwhelmed? This question inspires the current study by examining control strategies that may facilitate better work-life balance, with a specific focus on the role of lowered aspirations and positive reappraisals, attitudes that underlie adaptive coping…

  15. Tissue engineering: current strategies and future directions.

    PubMed

    Olson, Jennifer L; Atala, Anthony; Yoo, James J

    2011-04-01

    Novel therapies resulting from regenerative medicine and tissue engineering technology may offer new hope for patients with injuries, end-stage organ failure, or other clinical issues. Currently, patients with diseased and injured organs are often treated with transplanted organs. However, there is a shortage of donor organs that is worsening yearly as the population ages and as the number of new cases of organ failure increases. Scientists in the field of regenerative medicine and tissue engineering are now applying the principles of cell transplantation, material science, and bioengineering to construct biological substitutes that can restore and maintain normal function in diseased and injured tissues. In addition, the stem cell field is a rapidly advancing part of regenerative medicine, and new discoveries in this field create new options for this type of therapy. For example, new types of stem cells, such as amniotic fluid and placental stem cells that can circumvent the ethical issues associated with embryonic stem cells, have been discovered. The process of therapeutic cloning and the creation of induced pluripotent cells provide still other potential sources of stem cells for cell-based tissue engineering applications. Although stem cells are still in the research phase, some therapies arising from tissue engineering endeavors that make use of autologous, adult cells have already entered the clinical setting, indicating that regenerative medicine holds much promise for the future. PMID:22111050

  16. Current diagnosis and management of cardiac myxomas.

    PubMed

    Jain, Sonia; Maleszewski, Joseph J; Stephenson, Christopher R; Klarich, Kyle W

    2015-04-01

    Cardiac myxoma is the most common cardiac neoplasm. In the majority of cases, it is isolated (non-syndromic) and located in the left atrium. In up to 10% cases, it is seen in syndromic association with the Carney complex where it is encountered in younger patients, with atypical and multiple locations, such as the right atrium or ventricles, and carries a high risk of recurrence. Imaging is pivotal in the diagnosis, management guidance and surveillance. Surgical excision is the established definitive treatment. Further research should address management strategies in incidentally discovered small myxomas in asymptomatic patients and the role of genetic testing and screening in syndromic myxomas. PMID:25797902

  17. Current management of DCIS: a review.

    PubMed

    Patani, Neill; Cutuli, Bruno; Mokbel, Kefah

    2008-09-01

    Ductal carcinoma in-situ (DCIS) is a heterogeneous disease, in terms of its radiological characteristics, histological morphology and molecular attributes. This diversity is reflected in its natural history and influences optimal treatment strategy. A significant proportion of DCIS lesions behave in a clinically benign fashion and do not progress to invasive disease. Reliable identification of these patients could allow treatment to be less radical or safely omitted. Management should be tailored to the individual within the context of a multidisciplinary team. Approaches such as biological profiling and molecular analysis represent an opportunity to improve our understanding of the tumour biology of this condition and rationalise its treatment. This article reviews the management strategies for DCIS in the context of recent randomized trials, including the role of sentinel lymph node biopsy, adjuvant radiotherapy and tamoxifen. PMID:17902049

  18. [Global brain metastases management strategy: a multidisciplinary-based approach].

    PubMed

    Métellus, P; Tallet, A; Dhermain, F; Reyns, N; Carpentier, A; Spano, J-P; Azria, D; Noël, G; Barlési, F; Taillibert, S; Le Rhun, É

    2015-02-01

    Brain metastases management has evolved over the last fifteen years and may use varying strategies, including more or less aggressive treatments, sometimes combined, leading to an improvement in patient's survival and quality of life. The therapeutic decision is subject to a multidisciplinary analysis, taking into account established prognostic factors including patient's general condition, extracerebral disease status and clinical and radiological presentation of lesions. In this article, we propose a management strategy based on the state of current knowledge and available therapeutic resources. PMID:25649388

  19. Initial management strategies for follicular lymphoma

    PubMed Central

    Chen, Qiushi; Ayer, Turgay; Nastoupil, Loretta J; Seward, Miray; Zhang, Hongzheng; Sinha, Rajni; Flowers, Christopher R

    2013-01-01

    SUMMARY Follicular lymphoma (FL) can vary markedly in its initial presentation, and no single standard approach for its initial management has been adopted. Available options for the initial management of FL include watchful waiting, radiation, single-agent rituximab and combination of rituximab and chemotherapy with strategies segregated for patients who have low and high tumor burden disease based on established criteria. However, marked debate occurs regarding the role of watchful waiting in the modern era for low tumor burden, asymptomatic patients, the optimal timing of rituximab, the selection of chemotherapy regimen to partner with rituximab in high tumor burden patients, and strategies for the management of relapsed disease. We provide an evidence-based discussion on these and other issues regarding the management of FL, and propose a mathematical modeling approach for addressing some of these questions. PMID:23476737

  20. Management strategies for infectious diseases in pregnancy.

    PubMed

    Guerina, N G

    1994-08-01

    This review presented the clinical manifestations, diagnostic and therapeutic options, and preventive strategies for several congenital infections. The infections discussed show the spectrum of modes of vertical transmission and severity of fetal disease encountered, in addition to the successes and limitations of the current medical interventions. Further improvements in diagnostic techniques and therapies for managing the infected fetus are likely to occur during the next decade. Similarly, the widespread adaptation of new and sensitive diagnostic assays, such as the polymerase chain reaction, is likely to further improve our ability to identify infectious agents as the primary cause of certain abnormal fetal conditions. Where specific diagnostic tests and therapies have proven successful in preventing or treating fetal infections, universal screening programs should be given serious consideration. Of paramount importance, however, is the active research on the development of preventive interventions designed to prevent maternal infections and vertical transmission. Although specific immunotherapies, vaccines, and drug therapies hold great promise for controlling the spread of some infections, it cannot be overemphasized that some serious infectious complications of pregnancy may be avoided by simple preconception or early antenatal maternal counseling. PMID:7985043

  1. Strategies for Managing a Multigenerational Workforce

    NASA Astrophysics Data System (ADS)

    Iden, Ronald

    The multigenerational workforce presents a critical challenge for business managers, and each generation has different expectations. A human resource management study of organizations with more than 500 employees reported 58% of the managers experiencing conflict between younger and older workers. The purpose of this single case study was to explore the multigenerational strategies used by 3 managers from a Franklin County, Ohio manufacturing facility with a population size of 6 participants. The conceptual framework for this study was built upon generational theory and cohort group theory. The data were collected through face-to-face semistructured interviews, company documents, and a reflexive journal. Member checking was completed to strengthen the credibility and trustworthiness of the interpretation of participants' responses. A modified van Kaam method enabled separation of themes following the coding of data. Four themes emerged from the data: (a) required multigenerational managerial skills, (b) generational cohort differences, (c) most effective multigenerational management strategies, and (d) least effective multigenerational management strategies. Findings from this study may contribute to social change through better understanding, acceptance, and appreciation of the primary generations in the workforce, and, in turn, improve community relationships.

  2. Evolutionary space station fluids management strategies

    NASA Technical Reports Server (NTRS)

    1989-01-01

    Results are summarized for an 11-month study to define fluid storage and handling strategies and requirements for various specific mission case studies and their associated design impacts on the Space Station. There are a variety of fluid users which require a variety of fluids and use rates. Also, the cryogenic propellants required for NASA's STV, Planetary, and Code Z missions are enormous. The storage methods must accommodate fluids ranging from a high pressure gas or supercritical state fluid to a sub-cooled liquid (and superfluid helium). These requirements begin in the year 1994, reach a maximum of nearly 1800 metric tons in the year 2004, and trail off to the year 2018, as currently planned. It is conceivable that the cryogenic propellant needs for the STV and/or Lunar mission models will be met by LTCSF LH2/LO2 tanksets attached to the SS truss structure. Concepts and corresponding transfer and delivery operations have been presented for STV propellant provisioning from the SS. A growth orbit maneuvering vehicle (OMV) and associated servicing capability will be required to move tanksets from delivery launch vehicles to the SS or co-orbiting platforms. Also, appropriate changes to the software used for OMV operation are necessary to allow for the combined operation of the growth OMV. To support fluid management activities at the Space Station for the experimental payloads and propellant provisioning, there must be truss structure space allocated for fluid carriers and propellant tanksets, and substantial beam strengthening may be required. The Station must have two Mobile Remote Manipulator Systems (MRMS) and the growth OMV propellant handling operations for the STV at the SS. Propellant needs for the Planetary Initiatives and Code Z mission models will most likely be provided by co-orbiting propellant platform(s). Space Station impacts for Code Z mission fluid management activities will be minimal.

  3. Cancer pain management-current status

    PubMed Central

    Thapa, Deepak; Rastogi, V; Ahuja, Vanita

    2011-01-01

    Cancer pain is still one of the most feared entities in cancer and about 75% of these patients require treatment with opioids for severe pain.The cancer pain relief is difficult to manage in patients with episodic or incidental pain, neuropathic pain, substance abuse and with impaired cognitive or communication skills. This non-systematic review article aims to discuss reasons for under treatment, tools of pain assessment, cancer pain and anxiety and possibly carve new approaches for cancer pain management in future. The current status of World Health Organization analgesic ladder has also been reviewed. A thorough literature search was carried out from 1998 to 2010 for current status in cancer pain management in MEDLINE, WHO guidelines and published literature and relevant articles have been included. PMID:21772673

  4. Current and Future Parts Management at NASA

    NASA Technical Reports Server (NTRS)

    Sampson, Michael J.

    2011-01-01

    This presentation provides a high level view of current and future electronic parts management at NASA. It describes a current perspective of the new human space flight direction that NASA is beginning to take and how that could influence parts management in the future. It provides an overview of current NASA electronic parts policy and how that is implemented at the NASA flight Centers. It also describes some of the technical challenges that lie ahead and suggests approaches for their mitigation. These challenges include: advanced packaging, obsolescence and counterfeits, the global supply chain and Commercial Crew, a new direction by which NASA will utilize commercial launch vehicles to get astronauts to the International Space Station.

  5. Seeking sustainability: Israel's evolving water management strategy.

    PubMed

    Tal, Alon

    2006-08-25

    The water management policies adopted to address Israel's chronic scarcity have not been without environmental consequences. Yet, through a trial-and-error process, a combined strategy of water transport, rainwater harvesting, and wastewater reuse and desalination, along with a variety of water conservation measures, have put the country on a more sustainable path for the future. PMID:16931752

  6. Crop Management Strategies for Low Water Availability

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The High Plains is a temperate semi-arid region with highly variable rainfall. Extended periods of drought are common. In general, crop management strategies attempt to maximize the total water available to the crop and to maximize transpiration by minimizing soil evaporation. Summer fallow, the pra...

  7. Strategies for Managing When Resources are Unpredictable.

    ERIC Educational Resources Information Center

    Chaffee, Ellen Earle; Krakower, Jack Y.

    The effect of unpredictable resources on organizational performance in higher education was examined, along with whether some management strategies are more successful under conditions of relative predictability or unpredictability. Perceptions of administrators about institutional resources and performance were studied, along with the effects of…

  8. Management Strategies for Promoting Teacher Collective Learning

    ERIC Educational Resources Information Center

    Cheng, Eric C. K.

    2011-01-01

    This paper aims to validate a theoretical model for developing teacher collective learning by using a quasi-experimental design, and explores the management strategies that would provide a school administrator practical steps to effectively promote collective learning in the school organization. Twenty aided secondary schools in Hong Kong were…

  9. Classroom Management Strategies for Students with Autism

    ERIC Educational Resources Information Center

    Valdivia, Joe S.

    2007-01-01

    Classroom management strategies designed to improve problem behavior directly affect student achievement. Researchers have demonstrated positive behavior supports (PBS) can reduce problem behavior. However, researchers have also found evidence that PBS may not always be successful and further studies are needed to improve the use of PBS as a…

  10. Patient education. Behaviour management strategies in ADHD.

    PubMed

    Mitchell, G; Shaw, K

    2000-12-01

    Attention deficit hyperactivity disorder or ADHD is a condition characterised by inattention, hyperactivity and impulsiveness. It is often managed by a combination of medication and behaviour modification techniques. This sheet outlines some useful strategies parents and teachers may undertake. PMID:11140223

  11. [The management evolution for vestibular schwannoma: history and current situation].

    PubMed

    Hu, L Y; Wang, Z Y; Hua, Q Q

    2016-06-01

    It has been over 200 years since the acoustic neuroma(AN) was firstly reported. From simply describing its symptoms to the decline of surgical mortality, the protection of facial and acoustic nerve function, as well as the improvement of the patients' quality of life. Physicians made efforts on evolving the diagnostic techniques and treatment strategies, and a better understanding of AN's development. The current major managements of AN are microsurgery, stereotactic radiosurgery, and follow-up. We reviewed the AN's history and prospected its future managements. PMID:27345891

  12. Current concepts in management of slipped capital femoral epiphysis.

    PubMed

    Bittersohl, Bernd; Hosalkar, Harish S; Zilkens, Christoph; Krauspe, Rüdiger

    2015-01-01

    Slipped capital femoral epiphysis (SCFE) is a common hip condition that can be disabling. In this review, we provide an orientation on current trends in the clinical management of SCFE including conventional procedures and specialised surgical developments. Different methods of fixation of the epiphysis, risks of complications, and the rationale of addressing deformity, primarily or secondarily, are presented. Although improved understanding of the anatomy, vascularity and implications of residual deformity have changed management strategies, the best modality of treatment that would restore complete vascularity to the femoral head and prevent any residual deformity, impingement and early osteoarthritis remains elusive. PMID:25362879

  13. Managing the Chronically Overworked Team: Twenty Strategies.

    PubMed

    Hills, Laura

    2015-01-01

    Overwork, at first glance, seems like a problem that affects only the employee. But for medical practices and those who manage them, the problem is far greater than that. Chronically overworked employees may not be meeting their goals. They may be making more mistakes and letting things slip through the cracks. Ultimately, patients may have less-than-ideal experiences in a practice where the employees are stretched thin. And turnover may skyrocket in practices where employees are chronically overworked. This article offers practice managers 20 practical and affordable strategies they can use to manage a chronically overworked medical practice team. It suggests an effective technique they can use to tell their bosses that their employees are overworked. This article also suggests the costs to the practice of a chronically overworked staff, including a hidden cost many people overlook. It provides four coping strategies practice managers can teach to their overworked employees. It summarizes research exploring how overwork affects employees' sleep and eating habits, and additional research linking long hours of overwork to diminished productivity. Finally, this article provides five strategies practice managers can use to make their overworked employees feel valued. PMID:26182704

  14. Ocular onchocerciasis: current management and future prospects

    PubMed Central

    Babalola, Olufemi Emmanuel

    2011-01-01

    This paper reviews the current management of onchocerciasis and its future prospects. Onchocerciasis is a disease affecting millions of people in Africa, South and Central America, and Yemen. It is spread by the blackfly as a vector and caused by the filarial nematode, Onchocerca volvulus. A serious attempt was made by the Onchocerciasis Control Program between 1975 and 2002 to eliminate the vector in eleven of the endemic countries in West Africa, and with remarkable success. Formerly, the treatment was with diethyl carbamazine for the microfilaria and suramin for the adult worm. These drugs are now known to be toxic and unsuitable for mass distribution. In particular, they precipitate optic nerve disease. With the discovery of ivermectin, a much safer microfilaricide, and the decision of Merck to distribute the drug free of charge for as long as needed, the strategy of control switched to mass drug administration through community-directed treatment with ivermectin. So far, millions have received this annual or biannual treatment through the African Program for Onchocerciasis Control and the Onchocerciasis Elimination Program for the Americas. However, the problem with ivermectin is that it is a monotherapy microfilaricide which has limited effect on the adult worm, and thus will need to be continued for the life span of the adult worm, which may last up to 15 years. There are also early reports of resistance. Serious encephalopathy and death may occur when ivermectin is used in subjects heavily infested with loiasis. It seems unlikely that a break in transmission will occur with community-directed treatment with ivermectin in Africa because of population migrations and the highly efficient vector, but in the Americas some countries such as Columbia and the Oaxaca focus in Mexico have reported eradication. Vector control is only now applicable in selected situations, and particularly to control the nuisance value of the blackfly. Trials are ongoing for

  15. Assessing Fishers' Support of Striped Bass Management Strategies.

    PubMed

    Murphy, Robert D; Scyphers, Steven B; Grabowski, Jonathan H

    2015-01-01

    Incorporating the perspectives and insights of stakeholders is an essential component of ecosystem-based fisheries management, such that policy strategies should account for the diverse interests of various groups of anglers to enhance their efficacy. Here we assessed fishing stakeholders' perceptions on the management of Atlantic striped bass (Morone saxatilis) and receptiveness to potential future regulations using an online survey of recreational and commercial fishers in Massachusetts and Connecticut (USA). Our results indicate that most fishers harbored adequate to positive perceptions of current striped bass management policies when asked to grade their state's management regime. Yet, subtle differences in perceptions existed between recreational and commercial fishers, as well as across individuals with differing levels of fishing experience, resource dependency, and tournament participation. Recreational fishers in both states were generally supportive or neutral towards potential management actions including slot limits (71%) and mandated circle hooks to reduce mortality of released fish (74%), but less supportive of reduced recreational bag limits (51%). Although commercial anglers were typically less supportive of management changes than their recreational counterparts, the majority were still supportive of slot limits (54%) and mandated use of circle hooks (56%). Our study suggests that both recreational and commercial fishers are generally supportive of additional management strategies aimed at sustaining healthy striped bass populations and agree on a variety of strategies. However, both stakeholder groups were less supportive of harvest reductions, which is the most direct measure of reducing mortality available to fisheries managers. By revealing factors that influence stakeholders' support or willingness to comply with management strategies, studies such as ours can help managers identify potential stakeholder support for or conflicts that may

  16. Assessing Fishers' Support of Striped Bass Management Strategies

    PubMed Central

    Murphy, Robert D.; Scyphers, Steven B.; Grabowski, Jonathan H.

    2015-01-01

    Incorporating the perspectives and insights of stakeholders is an essential component of ecosystem-based fisheries management, such that policy strategies should account for the diverse interests of various groups of anglers to enhance their efficacy. Here we assessed fishing stakeholders’ perceptions on the management of Atlantic striped bass (Morone saxatilis) and receptiveness to potential future regulations using an online survey of recreational and commercial fishers in Massachusetts and Connecticut (USA). Our results indicate that most fishers harbored adequate to positive perceptions of current striped bass management policies when asked to grade their state’s management regime. Yet, subtle differences in perceptions existed between recreational and commercial fishers, as well as across individuals with differing levels of fishing experience, resource dependency, and tournament participation. Recreational fishers in both states were generally supportive or neutral towards potential management actions including slot limits (71%) and mandated circle hooks to reduce mortality of released fish (74%), but less supportive of reduced recreational bag limits (51%). Although commercial anglers were typically less supportive of management changes than their recreational counterparts, the majority were still supportive of slot limits (54%) and mandated use of circle hooks (56%). Our study suggests that both recreational and commercial fishers are generally supportive of additional management strategies aimed at sustaining healthy striped bass populations and agree on a variety of strategies. However, both stakeholder groups were less supportive of harvest reductions, which is the most direct measure of reducing mortality available to fisheries managers. By revealing factors that influence stakeholders’ support or willingness to comply with management strategies, studies such as ours can help managers identify potential stakeholder support for or conflicts that

  17. Current management of coarctation of the aorta

    PubMed Central

    Suradi, Hussam; Hijazi, Ziyad M.

    2015-01-01

    Coarctation of the aorta (C) is the sixth most common lesion in congenital heart disease and represents a spectrum of aortic narrowing that varies from a discrete entity to tubular hypoplasia. This condition was once thought to be a relatively simple lesion that would be “cured” upon repair of the narrowing, however, despite relief of the anatomical obstruction the subsequent risk of early morbidity and death persists. This review outlines the optimal management strategy of this disease from neonatal to adult life and provides insights to approach this straightforward but challenging condition. PMID:26779519

  18. Soil contamination in China: current status and mitigation strategies.

    PubMed

    Zhao, Fang-Jie; Ma, Yibing; Zhu, Yong-Guan; Tang, Zhong; McGrath, Steve P

    2015-01-20

    China faces great challenges in protecting its soil from contamination caused by rapid industrialization and urbanization over the last three decades. Recent nationwide surveys show that 16% of the soil samples, 19% for the agricultural soils, are contaminated based on China’s soil environmental quality limits, mainly with heavy metals and metalloids. Comparisons with other regions of the world show that the current status of soil contamination, based on the total contaminant concentrations, is not worse in China. However, the concentrations of some heavy metals in Chinese soils appear to be increasing at much greater rates. Exceedance of the contaminant limits in food crops is widespread in some areas, especially southern China, due to elevated inputs of contaminants, acidic nature of the soil and crop species or cultivars prone to heavy metal accumulation. Minimizing the transfer of contaminants from soil to the food chain is a top priority. A number of options are proposed, including identification of the sources of contaminants to agricultural systems, minimization of contaminant inputs, reduction of heavy metal phytoavailability in soil with liming or other immobilizing materials, selection and breeding of low accumulating crop cultivars, adoption of appropriate water and fertilizer management, bioremediation, and change of land use to grow nonfood crops. Implementation of these strategies requires not only technological advances, but also social-economic evaluation and effective enforcement of environmental protection law. PMID:25514502

  19. Current strategies for the prevention of breast cancer

    PubMed Central

    Advani, Pooja; Moreno-Aspitia, Alvaro

    2014-01-01

    Due to the high incidence of breast cancer in the United States, optimal strategies for its prevention are imperative. This entails identification of women who are at an increased risk for breast cancer and an integrative approach that includes effective screening methods as well as nutritional, pharmacologic, and surgical management. Several breast cancer risk-assessment tools, such as the Gail and Claus models, can help clinicians determine the quantitative risk of breast cancer. The role of selective estrogen receptor modulators, such as tamoxifen and raloxifene, for the prevention of breast cancer has been well established. Several other agents, such as aromatase inhibitors, are currently being investigated. The potential adverse effects of these chemopreventive agents, which include an impact on the quality of life, must be discussed with the patient before deciding on this approach. Additionally, breast cancer risk factors have been identified over the years; some of them are modifiable, but others are not. Although there is no conclusive evidence to suggest the protective role of specific dietary components, alcohol consumption and obesity are associated with an increased breast cancer risk; thus lifestyle changes can lead to a lower risk of developing breast cancer. Surgical approaches, including bilateral risk-reduction mastectomy and salpingo-oophorectomy, are usually limited to women with a hereditary predisposition to development of breast cancer. The objective of this review is to summarize the various approaches directed at reducing the incidence of breast cancer. PMID:24833917

  20. Current Clinical Management of Pulmonary Arterial Hypertension

    PubMed Central

    Sung, Yon K; Perez, Vinicio de Jesus; Liu, Juliana; Spiekerkoetter, Edda

    2014-01-01

    Over the last 2 decades there has been a tremendous evolution in the evaluation and care of patients with pulmonary arterial hypertension (PAH). The introduction of targeted PAH therapy consisting of prostacyclin and its analogues, endothelin antagonists, phosphodiestase-5 inhibitors, and now a soluble guanylate cyclase activator have increased therapeutic options and potentially reduced morbidity and mortality, yet none of the current therapies have been curative. Current clinical management of PAH has become more complex given the focus on early diagnosis, an increased number of available therapeutics within each mechanistic class, as well as the emergence of clinically challenging scenarios such as perioperative care. Efforts to standardize the clinical care of PAH patients have led to the formation of multidisciplinary PAH tertiary care programs that strive to offer medical care based on peer-reviewed evidence-based and expert consensus guidelines. Furthermore, these tertiary PAH centers often support clinical and basic science research programs to gain novel insights into the pathogenesis of PAH with the goal to improve the clinical management of this devastating disease. In this manuscript, we discuss the clinical approach and management of PAH from the perspective of a single US-based academic institution. We provide an overview of currently available clinical guidelines, and offer some insight into how we approach current controversies in clinical management of certain patient subsets. We conclude with an overview of our program structure as well as a perspective on research and the role of a tertiary PAH center in contributing new knowledge to the field. PMID:24951763

  1. Environmental management strategy: four forces analysis.

    PubMed

    Doyle, Martin W; Von Windheim, Jesko

    2015-01-01

    We develop an analytical approach for more systematically analyzing environmental management problems in order to develop strategic plans. This approach can be deployed by agencies, non-profit organizations, corporations, or other organizations and institutions tasked with improving environmental quality. The analysis relies on assessing the underlying natural processes followed by articulation of the relevant societal forces causing environmental change: (1) science and technology, (2) governance, (3) markets and the economy, and (4) public behavior. The four forces analysis is then used to strategize which types of actions might be most effective at influencing environmental quality. Such strategy has been under-used and under-valued in environmental management outside of the corporate sector, and we suggest that this four forces analysis is a useful analytic to begin developing such strategy. PMID:25331643

  2. Environmental Management Strategy: Four Forces Analysis

    NASA Astrophysics Data System (ADS)

    Doyle, Martin W.; Von Windheim, Jesko

    2015-01-01

    We develop an analytical approach for more systematically analyzing environmental management problems in order to develop strategic plans. This approach can be deployed by agencies, non-profit organizations, corporations, or other organizations and institutions tasked with improving environmental quality. The analysis relies on assessing the underlying natural processes followed by articulation of the relevant societal forces causing environmental change: (1) science and technology, (2) governance, (3) markets and the economy, and (4) public behavior. The four forces analysis is then used to strategize which types of actions might be most effective at influencing environmental quality. Such strategy has been under-used and under-valued in environmental management outside of the corporate sector, and we suggest that this four forces analysis is a useful analytic to begin developing such strategy.

  3. Heat management strategies for MSW landfills.

    PubMed

    Yeşiller, Nazli; Hanson, James L; Kopp, Kevin B; Yee, Emma H

    2016-10-01

    Heat is a primary byproduct of landfilling of municipal solid waste. Long-term elevated temperatures have been reported for MSW landfills under different operational conditions and climatic regions around the world. A conceptual framework is presented for management of the heat generated in MSW landfills. Three main strategies are outlined: extraction, regulation, and supplementation. Heat extraction allows for beneficial use of the excess landfill heat as an alternative energy source. Two approaches are provided for the extraction strategy: extracting all of the excess heat above baseline equilibrium conditions in a landfill and extracting only a part of the excess heat above equilibrium conditions to obtain target optimum waste temperatures for maximum gas generation. Heat regulation allows for controlling the waste temperatures to achieve uniform distribution at target levels at a landfill facility. Two approaches are provided for the regulation strategy: redistributing the excess heat across a landfill to obtain uniform target optimum waste temperatures for maximum gas generation and redistributing the excess heat across a landfill to obtain specific target temperatures. Heat supplementation allows for controlling heat generation using external thermal energy sources to achieve target waste temperatures. Two approaches are provided for the supplementation strategy: adding heat to the waste mass using an external energy source to increase waste temperatures and cooling the waste mass using an external energy source to decrease waste temperatures. For all strategies, available landfill heat energy is determined based on the difference between the waste temperatures and the target temperatures. Example analyses using data from landfill facilities with relatively low and high heat generation indicated thermal energy in the range of -48.4 to 72.4MJ/m(3) available for heat management. Further modeling and experimental analyses are needed to verify the effectiveness

  4. Management strategies for promoting successful breastfeeding.

    PubMed

    Bear, K; Tigges, B B

    1993-06-01

    Clinicians can promote a successful breastfeeding experience by providing support, anticipatory guidance and practical information. This article presents the components of early follow-up and guidelines for assessment. Management strategies for common problems are discussed, such as nipple soreness, cracked nipples, plugged ducts and mastitis, insufficient infant weight gain, perceived inadequacy of milk supply, breast-milk jaundice, sexual adjustment and failure at breastfeeding. Breastfeeding guidelines for employed mothers and adoptive mothers are indicated. PMID:8341432

  5. Evolution in clinical knowledge management strategy at Intermountain Healthcare.

    PubMed

    Hulse, Nathan C; Galland, Joel; Borsato, Emerson P

    2012-01-01

    In this manuscript, we present an overview of the clinical knowledge management strategy at Intermountain Healthcare in support of our electronic medical record systems. Intermountain first initiated efforts in developing a centralized enterprise knowledge repository in 2001. Applications developed, areas of emphasis served, and key areas of focus are presented. We also detail historical and current areas of emphasis, in response to business needs. PMID:23304309

  6. HRD Strategies for Expatriate Development: Review of Current Strategies and Potentials of Expatriate Mentoring

    ERIC Educational Resources Information Center

    Kim, Eunok Alice

    2007-01-01

    Expatriates are critical human resources and means of global organizations. Through review of literature, this paper examines HRD strategies that have been utilized to develop expatriates for international assignments, identifies gaps in current HRD strategies, and investigates unique potentials of expatriate mentoring contributing expatriate…

  7. Including environmental concerns in management strategies for depleted uranium hexafluoride

    SciTech Connect

    Goldberg, M.; Avci, H.I.; Bradley, C.E.

    1995-12-31

    One of the major programs within the Office of Nuclear Energy, Science, and Technology of the US Department of Energy (DOE) is the depleted uranium hexafluoride (DUF{sub 6}) management program. The program is intended to find a long-term management strategy for the DUF{sub 6} that is currently stored in approximately 46,400 cylinders at Paducah, KY; Portsmouth, OH; and Oak Ridge, TN, USA. The program has four major components: technology assessment, engineering analysis, cost analysis, and the environmental impact statement (EIS). From the beginning of the program, the DOE has incorporated the environmental considerations into the process of strategy selection. Currently, the DOE has no preferred alternative. The results of the environmental impacts assessment from the EIS, as well as the results from the other components of the program, will be factored into the strategy selection process. In addition to the DOE`s current management plan, other alternatives continued storage, reuse, or disposal of depleted uranium, will be considered in the EIS. The EIS is expected to be completed and issued in its final form in the fall of 1997.

  8. Current issues in postoperative pain management.

    PubMed

    Rawal, Narinder

    2016-03-01

    Postoperative pain has been poorly managed for decades. Recent surveys from USA and Europe do not show any major improvement. Persistent postoperative pain is common after most surgical procedures, and after thoracotomy and mastectomy, about 50% of patients may experience it. Opioids remain the mainstay of postoperative pain treatment in spite of strong evidence of their drawbacks. Multimodal analgesic techniques are widely used but new evidence is disappointing. Regional anaesthetic techniques are the most effective methods to treat postoperative pain. Current evidence suggests that epidural analgesia can no longer be considered the 'gold standard'. Perineural techniques are good alternatives for major orthopaedic surgery but remain underused. Infiltrative techniques with or without catheters are useful for almost all types of surgery. Simple surgeon-delivered local anaesthetic techniques such as wound infiltration, preperitoneal/intraperitoneal administration, transversus abdominis plane block and local infiltration analgesia can play a significant role in improvement of postoperative care, and the last of these has changed orthopaedic practice in many institutions. Current postoperative pain management guidelines are generally 'one size fits all'. It is well known that pain characteristics such as type, location, intensity and duration vary considerably after different surgical procedures. Procedure-specific postoperative pain management recommendations are evidence based, and also take into consideration the role of anaesthetic and surgical techniques, clinical routines and risk-benefit aspects. The role of acute pain services to improve pain management and outcome is well accepted but implementation seems challenging. The need for upgrading the role of surgical ward nurses and collaboration with surgeons to implement enhanced recovery after surgery protocols with regular audits to improve postoperative outcome cannot be overstated. PMID:26509324

  9. Fever management: Evidence vs current practice

    PubMed Central

    El-Radhi, A Sahib Mehdi

    2012-01-01

    Fever is a very common complaint in children and is the single most common non-trauma-related reason for a visit to the emergency department. Parents are concerned about fever and it’s potential complications. The biological value of fever (i.e., whether it is beneficial or harmful) is disputed and it is being vigorously treated with the belief of preventing complications such as brain injury and febrile seizures. The practice of alternating antipyretics has become widespread at home and on paediatric wards without supporting scientific evidence. There is still a significant contrast between the current concept and practice, and the scientific evidence. Why is that the case in such a common complaint like fever The article will discuss the significant contrast between the current concepts and practice of fever management on one hand, and the scientific evidence against such concepts and practice. PMID:25254165

  10. Forest management strategies for reducing carbon emissions, the French case

    NASA Astrophysics Data System (ADS)

    Valade, Aude; Luyssaert, Sebastiaan; Bellassen, Valentin; Vallet, Patrick; Martin, Manuel

    2015-04-01

    International agreements now recognize the role of forest in the mitigation of climate change through the levers of in-situ sequestration, storage in products and energy and product substitution. These three strategies of carbon management are often antagonistic and it is still not clear which strategy would have the most significant impact on atmospheric carbon concentrations. With a focus on France, this study compares several scenarios of forest management in terms of their effect on the overall carbon budget from trees to wood-products. We elaborated four scenarios of forest management that target different wood production objectives. One scenario is 'Business as usual' and reproduces the current forest management and wood production levels. Two scenarios target an increase in bioenergy wood production, with either long-term or short-term goals. One scenario aims at increasing the production of timber for construction. For this, an empirical regression model was developed building on the rich French inventory database. The model can project the current forest resource at a time horizon of 20 years for characteristic variables diameter, standing volume, above-ground biomass, stand age. A simplified life-cycle analysis provides a full carbon budget for each scenario from forest management to wood use and allows the identification of the scenario that most reduces carbon emissions.

  11. Optimal management of familial hypercholesterolemia: treatment and management strategies

    PubMed Central

    Nemati, Mohammad Hassan; Astaneh, Behrooz

    2010-01-01

    Familial hypercholesterolemia is an autosomally dominant disorder caused by various mutations in low-density lipoprotein receptor genes. This will lead to elevated levels of total and low-density lipoprotein cholesterol, which may in turn lead to premature coronary atherosclerosis and cardiac-related death. The symptoms are more severe in the homozygous type of the disease. Different options for the treatment of affected patients are now available. Diet therapy, pharmacologic therapy, lipid apheresis, and liver transplantation are among the various treatments. We clinically review the treatment and management strategies for the disease in order to shed light on the optimal management of familial hypercholesterolemia. PMID:21191428

  12. Suicide Gene Therapy for Cancer – Current Strategies

    PubMed Central

    Zarogoulidis, Paul; Darwiche, Kaid; Sakkas, Antonios; Yarmus, Lonny; Huang, Haidong; Li, Qiang; Freitag, Lutz; Zarogoulidis, Konstantinos; Malecki, Marek

    2013-01-01

    Current cancer treatments may create profound iatrogenic outcomes. The adverse effects of these treatments still remain, as the serious problems that practicing physicians have to cope with in clinical practice. Although, non-specific cytotoxic agents constitute an effective treatment modality against cancer cells, they also tend to kill normal, quickly dividing cells. On the other hand, therapies targeting the genome of the tumors are both under investigation, and some others are already streamlined to clinical practice. Several approaches have been investigated in order to find a treatment targeting the cancer cells, while not affecting the normal cells. Suicide gene therapy is a therapeutic strategy, in which cell suicide inducing transgenes are introduced into cancer cells. The two major suicide gene therapeutic strategies currently pursued are: cytosine deaminase/5-fluorocytosine and the herpes simplex virus/ganciclovir. The novel strategies include silencing gene expression, expression of intracellular antibodies blocking cells’ vital pathways, and transgenic expression of caspases and DNases. We analyze various elements of cancer cells’ suicide inducing strategies including: targets, vectors, and mechanisms. These strategies have been extensively investigated in various types of cancers, while exploring multiple delivery routes including viruses, non-viral vectors, liposomes, nanoparticles, and stem cells. We discuss various stages of streamlining of the suicide gene therapy into clinical oncology as applied to different types of cancer. Moreover, suicide gene therapy is in the center of attention as a strategy preventing cancer from developing in patients participating in the clinical trials of regenerative medicine. In oncology, these clinical trials are aimed at regenerating, with the aid of stem cells, of the patients’ organs damaged by pathologic and/or iatrogenic factors. However, the stem cells carry the risk of neoplasmic transformation. We

  13. Current concepts in the management of radial head fractures

    PubMed Central

    Kodde, Izaäk F; Kaas, Laurens; Flipsen, Mark; van den Bekerom, Michel PJ; Eygendaal, Denise

    2015-01-01

    Fracture of the radial head is a common injury. Over the last decades, the radial head is increasingly recognized as an important stabilizer of the elbow. In order to maintain stability of the injured elbow, goals of treatment of radial head fractures have become more and more towards restoring function and stability of the elbow. As treatment strategies have changed over the years, with an increasing amount of literature on this subject, the purpose of this article was to provide an overview of current concepts of the management of radial head fractures. PMID:26716091

  14. Blood Management Strategies in Total Knee Arthroplasty

    PubMed Central

    Dan, Michael; Martinez Martos, Sara; Beller, Elaine

    2016-01-01

    A perioperative blood management program is one of a number of important elements for successful patient care in total knee arthroplasty (TKA) and surgeons should be proactive in its application. The aims of blood conservation are to reduce the risk of blood transfusion whilst at the same time maximizing hemoglobin (Hb) in the postoperative period, leading to a positive effect on outcome and cost. An individualized strategy based on patient specific risk factors, anticipated blood loss and comorbidities are useful in achieving this aim. Multiple blood conservation strategies are available in the preoperative, intraoperative and postoperative periods and can be employed in various combinations. Recent literature has highlighted the importance of preoperative Hb optimization, minimizing blood loss and evidence-based transfusion guidelines. Given TKA is an elective procedure, a zero allogenic blood transfusion rate should be the aim and an achievable goal. PMID:27595070

  15. Blood Management Strategies in Total Knee Arthroplasty.

    PubMed

    Liu, David; Dan, Michael; Martinez Martos, Sara; Beller, Elaine

    2016-09-01

    A perioperative blood management program is one of a number of important elements for successful patient care in total knee arthroplasty (TKA) and surgeons should be proactive in its application. The aims of blood conservation are to reduce the risk of blood transfusion whilst at the same time maximizing hemoglobin (Hb) in the postoperative period, leading to a positive effect on outcome and cost. An individualized strategy based on patient specific risk factors, anticipated blood loss and comorbidities are useful in achieving this aim. Multiple blood conservation strategies are available in the preoperative, intraoperative and postoperative periods and can be employed in various combinations. Recent literature has highlighted the importance of preoperative Hb optimization, minimizing blood loss and evidence-based transfusion guidelines. Given TKA is an elective procedure, a zero allogenic blood transfusion rate should be the aim and an achievable goal. PMID:27595070

  16. A Water Demand Management Strategy For The Namibian Tourism Sector

    NASA Astrophysics Data System (ADS)

    Schachtschneider, K.; Winter, K.

    The arid conditions of Namibia are forcing its decision-makers to resort to new wa- ter resource management approaches, including Water Demand Management (WDM). When Namibia achieved its independence from South Africa 1990, a new opportunity arose to rewrite certain restrictive laws and policies in order to bring about redress, development and transformation. The new Water Policy is one example in which the mindset is changed from a supply to a demand oriented water management ap- proach. Legal support for WDM within the new Water Act is a critical component that will support the implementation of WDM in all economic sectors, such as agri- culture, mining and tourism. It is argued that an appropriate WDM strategy should be designed specifically for each sector, once the typical water use patterns in a sec- tor are understood and key water resource managers at all levels are identified. The Namibian tourism sector is geographically dispersed and control over its operations is compounded by the fact that it is frequently located in extremely remote areas that are arid and ecologically sensitive. In general, WDM is rarely practised, because it is not yet supported by law and there are currently no institutional arrangements to con- trol water use in this geographically dispersed industrial sector through which WDM could be enforced either through metering and/or payments. Managers of tourist en- terprises undertake most of the water management themselves, and have been identi- fied as being crucial to the implementation of WDM strategies. A study of six tourist facilities determined the willingness and motivation of these managers to undertake various WDM initiatives. The study identified three factors which appear to influence the actions of managers, namely external controls, economics and company ethics. It is recommended that a tourism sector WDM strategy should focus on these three factors in order to transform the WDM aims and objectives on the policy level into

  17. Current Trends in Supraventricular Tachycardia Management

    PubMed Central

    Sohinki, Daniel; Obel, Owen A.

    2014-01-01

    Background Supraventricular tachycardia (SVT) is a general term describing a group of arrhythmias whose mechanism involves or is above the atrioventricular node. The mechanisms of most forms of SVT have been elucidated, and pharmacologic and invasive therapies have evolved simultaneously. Methods We provide a brief overview of the mechanisms, classifications, and electrocardiographic characteristics of different SVTs and describe current trends in noninvasive and invasive therapies. Results The term SVT encompasses a heterogeneous group of arrhythmias with different electrophysiologic characteristics. Knowledge of the mechanism of each SVT is important in determining management at the bedside and in the electrophysiology laboratory. Conclusion In the acute setting, vagal maneuvers and pharmacologic therapy can be effective in arrhythmia termination. Catheter-based radiofrequency ablation has revolutionized therapy for many SVTs, and newer techniques have significantly improved ablation efficacy and reduced periprocedural complications and procedure times. Cryoablation is currently being investigated as an alternative form of energy delivery, although the long-term effectiveness of this procedure currently limits its use for many SVTs. PMID:25598724

  18. Invasive mycoses: strategies for effective management.

    PubMed

    Kontoyiannis, Dimitrios P

    2012-01-01

    Effective management of invasive fungal infections (IFIs) depends on early individualized therapy that optimizes efficacy and safety. Considering the negative consequences of IFI, for some high-risk patients the potential benefits of prophylactic therapy may outweigh the risks. When using a prophylactic, empiric, or preemptive therapeutic approach, clinicians must take into account the local epidemiology, spectrum of activity, pharmacokinetic and pharmacodynamic parameters, and safety profile of different antifungal agents, together with unique host-related factors that may affect antifungal efficacy or safety. Therapeutic drug monitoring is increasingly recognized as important or necessary when employing lipophilic triazoles (itraconazole, voriconazole, posaconazole) or flucytosine. Because early diagnostics remain limited for uncommon, yet emerging opportunistic molds (e.g., Mucorales), and treatment delay is associated with increased mortality, early effective management often depends on a high index of suspicion, taking into account predisposing factors, host cues favoring mucormycosis, and local epidemiology. Antifungal options for mucormycosis are limited, and optimal management depends on a multimodal approach that includes early diagnosis/clinical suspicion, correction of underlying predisposing factors, radical debridement of affected tissues, and extended antifungal therapy. This article discusses strategies for the effective management of invasive mycoses, with a particular focus on antifungal hepatotoxicity. PMID:22196206

  19. Part 2 -- current program integrating strategies and lubrication technology

    SciTech Connect

    Johnson, B.

    1996-12-01

    This paper is the second of two that describe the Predictive Maintenance Program for rotating machinery at the Palo Verde Nuclear Generating Station. The Predictive Maintenance program has been enhanced through organizational changes and improved interdisciplinary usage of technology. This paper will discuss current program strategies that have improved the interaction between the Vibration and Lube Oil programs. The {open_quotes}Lube Oil{close_quotes} view of the combined program along with case studies will then be presented.

  20. Antenatally diagnosed hydronephrosis: current postnatal management.

    PubMed

    Davenport, Michael T; Merguerian, Paul A; Koyle, Martin

    2013-03-01

    The issue of antenatal hydronephrosis has become a routine component for the care of a pregnant woman despite limited evidence of a clinical benefit. The genitourinary tract represents the most commonly detected organ system with identified abnormalities, with antenatal hydronephrosis (ANH), being the most notable and common finding. ANH represents a spectrum, with most cases being a trivial and inconsequential finding on maternal fetal ultrasound. However, there is a correlation with increased grades of ANH being associated with increased severity of urinary tract pathology. Most patients can be managed expectantly with appropriate evaluation commenced postnatally based on severity of ANH and proper parental counseling and education. The purpose of this review was to assess current literature and guidelines pertaining to ANH and incorporate our practical interpretations of their significance. PMID:23325322

  1. Current medical management of duodenal ulcer disease.

    PubMed Central

    Badley, B. W.

    1977-01-01

    Each of three agents used in the treatment of duodenal ulcer--magnesium--aluminum antacids in high doses, cimetidine and carbenoxolone sodium--appears to enhance the rate at which ulcers heal, although their ability to control symptoms has been less clearly demonstrated. Since a large proportion of ulcers heal either without treatment or when the patient is given a placebo, a rational management plan should emphasize the removal of known irritants and the provision of symptomatic relief while spontaneous healing is allowed to occur. Lack of response to such a regimen warrants more specific investigation and therapy. On the basis of current evidence, cimetidine appears to be the preferred therapeutic agent. PMID:603851

  2. Optimal management of genital herpes: current perspectives

    PubMed Central

    Sauerbrei, Andreas

    2016-01-01

    As one of the most common sexually transmitted diseases, genital herpes is a global medical problem with significant physical and psychological morbidity. Genital herpes is caused by herpes simplex virus type 1 or type 2 and can manifest as primary and/or recurrent infection. This manuscript provides an overview about the fundamental knowledge on the virus, its epidemiology, and infection. Furthermore, the current possibilities of antiviral therapeutic interventions and laboratory diagnosis of genital herpes as well as the present situation and perspectives for the treatment by novel antivirals and prevention of disease by vaccination are presented. Since the medical management of patients with genital herpes simplex virus infection is often unsatisfactory, this review aims at all physicians and health professionals who are involved in the care of patients with genital herpes. The information provided would help to improve the counseling of affected patients and to optimize the diagnosis, treatment, and prevention of this particular disease. PMID:27358569

  3. Optimal management of genital herpes: current perspectives.

    PubMed

    Sauerbrei, Andreas

    2016-01-01

    As one of the most common sexually transmitted diseases, genital herpes is a global medical problem with significant physical and psychological morbidity. Genital herpes is caused by herpes simplex virus type 1 or type 2 and can manifest as primary and/or recurrent infection. This manuscript provides an overview about the fundamental knowledge on the virus, its epidemiology, and infection. Furthermore, the current possibilities of antiviral therapeutic interventions and laboratory diagnosis of genital herpes as well as the present situation and perspectives for the treatment by novel antivirals and prevention of disease by vaccination are presented. Since the medical management of patients with genital herpes simplex virus infection is often unsatisfactory, this review aims at all physicians and health professionals who are involved in the care of patients with genital herpes. The information provided would help to improve the counseling of affected patients and to optimize the diagnosis, treatment, and prevention of this particular disease. PMID:27358569

  4. Neutralized current acid waste consolidation management plan

    SciTech Connect

    Powell, W.J.; Brown, R.G.; Galbraith, J.; Jensen, C.; Place, D.E.; Reddick, G.W.; Zuroff, W.; Brothers, A.J.

    1996-01-01

    The scope of this evaluation is to recommend a management plan for the high-heat tank waste, including neutralized current acid waste (NCAW) in AY and AZ Tank Farms, and tank C-106 waste. The movement of solids, liquids and salt cake in the designated tank farms is included. Decision analysis techniques were used to determine a recommended alternative. The recommended course of action was replacement of a 75-hp mixer pump in tank AY-102 and in-tank concentration of tank AZ-102 supernate. The alternative includes transfer fo tank C-106 sludge to tank AY-102, then transfer to tank AY-102 and tank C-106 sludge to tank AZ-101 using the new 75-hp mixer pump installed in tank AY-102. Tank AZ-101 becomes a storage tank for high-level waste (HLW) sludge, with the capacity to mix and transfer sludge as desired.

  5. Present and New Treatment Strategies in the Management of Glaucoma

    PubMed Central

    Kolko, M

    2015-01-01

    Glaucoma is a neurodegenerative disease characterized by retinal ganglion cell (RGC) death and axonal loss. It remains a major cause of blindness worldwide. All current modalities of treatment are focused on lowering intraocular pressure (IOP), and it is evident that increased IOP is an important risk factor for progression of the disease. However, it is clear that a significant number of glaucoma patients show disease progression despite of pressure lowering treatments. Much attention has been given to the development of neuroprotective treatment strategies, but the identification of such has been hampered by lack of understanding of the etiology of glaucoma. Hence, in spite of many attempts no neuroprotective drug has yet been clinically approved. Even though neuroprotection is without doubt an important treatment strategy, many glaucoma subjects are diagnosed after substantial loss of RGCs. In this matter, recent approaches aim to rescue RGCs and regenerate axons in order to restore visual function in glaucoma. The present review seeks to provide an overview of the present and new treatment strategies in the management of glaucoma. The treatment strategies are divided into current available glaucoma medications, new pressure lowering targets, prospective neuroprotective interventions, and finally possible neuroregenrative strategies. PMID:26069521

  6. Patient Experience Shows Little Relationship with Hospital Quality Management Strategies

    PubMed Central

    Groene, Oliver; Arah, Onyebuchi A.; Klazinga, Niek S.; Wagner, Cordula; Bartels, Paul D.; Kristensen, Solvejg; Saillour, Florence; Thompson, Andrew; Thompson, Caroline A.; Pfaff, Holger; DerSarkissian, Maral; Sunol, Rosa

    2015-01-01

    Objectives Patient-reported experience measures are increasingly being used to routinely monitor the quality of care. With the increasing attention on such measures, hospital managers seek ways to systematically improve patient experience across hospital departments, in particular where outcomes are used for public reporting or reimbursement. However, it is currently unclear whether hospitals with more mature quality management systems or stronger focus on patient involvement and patient-centered care strategies perform better on patient-reported experience. We assessed the effect of such strategies on a range of patient-reported experience measures. Materials and Methods We employed a cross-sectional, multi-level study design randomly recruiting hospitals from the Czech Republic, France, Germany, Poland, Portugal, Spain, and Turkey between May 2011 and January 2012. Each hospital contributed patient level data for four conditions/pathways: acute myocardial infarction, stroke, hip fracture and deliveries. The outcome variables in this study were a set of patient-reported experience measures including a generic 6-item measure of patient experience (NORPEQ), a 3-item measure of patient-perceived discharge preparation (Health Care Transition Measure) and two single item measures of perceived involvement in care and hospital recommendation. Predictor variables included three hospital management strategies: maturity of the hospital quality management system, patient involvement in quality management functions and patient-centered care strategies. We used directed acyclic graphs to detail and guide the modeling of the complex relationships between predictor variables and outcome variables, and fitted multivariable linear mixed models with random intercept by hospital, and adjusted for fixed effects at the country level, hospital level and patient level. Results Overall, 74 hospitals and 276 hospital departments contributed data on 6,536 patients to this study (acute

  7. Current Trends in Management of Atlantoaxial Dislocation.

    PubMed

    Yin, Qing-shui; Wang, Jian-hua

    2015-08-01

    Atlantoaxial dislocation (AAD), often caused by trauma, tumors or congenital malformations, is a challenging disorder of the craniocervical junction. Because of its deep location and intricate anatomic structure, the craniocervical junction is always a difficult region for spine surgery. With recent developments in medical science, great progress has been made in the diagnosis and treatment of AAD such that more instructive clinical classifications and efficacious treatment strategies, various novel operation techniques including innovative posterior or transoral anterior reduction, and novel fixation instruments are now widely used in clinical practice for managing AAD. However, surgeons continue to face more special characteristics and difficulty in carrying out upper cervical surgery than they encounter in other regions of the spine. Consequently, this high risk surgery should only be performed by extremely skilled and experienced surgeons and only when stringent indications have been met. Therefore, the aim of this course is to assist surgeons who are dealing with AAD by providing comprehensive information about AAD, including related anatomy, classification, clinical manifestations and diagnosis, imaging examinations and surgical techniques, thus decreasing the occurrence of complications and improving the level of diagnosis and treatment. PMID:26311092

  8. Concussion: current concepts in diagnosis and management.

    PubMed

    Borich, Michael R; Cheung, Katharine L; Jones, Paul; Khramova, Vera; Gavrailoff, Lauren; Boyd, Lara A; Virji-Babul, Naznin

    2013-09-01

    Current understanding of the term "concussion" is fraught with misconceptions regarding the extent and nature of brain injury. Despite increasing attention in popular media and within the context of sports, considerable gaps exist in our knowledge of the diagnosis, underlying brain pathology, recovery of function, and optimal interventions for concussion. In this special interest article, we discuss the definition and risk factors associated with concussion, summarize and highlight some of the most widely used assessment tools, and critique the evidence for current principles of concussion management. Our evaluation has identified opportunities for novel neuroimaging techniques to improve the understanding of the pathophysiology of concussion and to evaluate the changes in the recovering brain in response to rehabilitation. In summary, a clear definition of the underlying brain pathology, the potential long-term consequences, and the risk factors of injury and recovery will help guide future research aiming to minimize the impact of injury and develop innovative and successful therapeutic approaches aimed at ameliorating the functional impairments associated with concussion. PMID:23872682

  9. Multiple system atrophy: current and future approaches to management

    PubMed Central

    Flabeau, Olivier; Meissner, Wassilios G.; Tison, François

    2010-01-01

    Multiple system atrophy (MSA) is a rare neurodegenerative disorder without any effective treatment in slowing or stopping disease progression. It is characterized by poor levodopa responsive Parkinsonism, cerebellar ataxia, pyramidal signs and autonomic failure in any combination. Current therapeutic strategies are primarily based on dopamine replacement and improvement of autonomic failure. However, symptomatic management remains disappointing and no curative treatment is yet available. Recent experimental evidence has confirmed the key role of alpha-synuclein aggregation in the pathogenesis of MSA. Referring to this hypothesis, transgenic and toxic animal models have been developed to assess candidate drugs for MSA. The standardization of diagnosis criteria and assessment procedures will allow large multicentre clinical trials to be conducted. In this article we review the available symptomatic treatment, recent results of studies investigating potential neuroprotective drugs, and future approaches for the management in MSA. PMID:21179616

  10. Testicular torsion and the acute scrotum: current emergency management.

    PubMed

    Ta, Anthony; D'Arcy, Frank T; Hoag, Nathan; D'Arcy, John P; Lawrentschuk, Nathan

    2016-06-01

    The acute scrotum is a challenging condition for the treating emergency physician requiring consideration of a number of possible diagnoses including testicular torsion. Prompt recognition of torsion and exclusion of other causes may lead to organ salvage, avoiding the devastating functional and psychological issues of testicular loss and minimizing unnecessary exploratory surgeries. This review aims to familiarize the reader with the latest management strategies for the acute scrotum, discusses key points in diagnosis and management and evaluates the strengths and drawbacks of history and clinical examination from an emergency perspective. It outlines the types and mechanisms of testicular torsion, and examines the current and possible future roles of labwork and radiological imaging in diagnosis. Emergency departments should be wary of younger males presenting with the acute scrotum. PMID:26267075

  11. Management strategies in hospitals: scenario planning

    PubMed Central

    Ghanem, Mohamed; Schnoor, Jörg; Heyde, Christoph-Eckhard; Kuwatsch, Sandra; Bohn, Marco; Josten, Christoph

    2015-01-01

    Background: Instead of waiting for challenges to confront hospital management, doctors and managers should act in advance to optimize and sustain value-based health. This work highlights the importance of scenario planning in hospitals, proposes an elaborated definition of the stakeholders of a hospital and defines the influence factors to which hospitals are exposed to. Methodology: Based on literature analysis as well as on personal interviews with stakeholders we propose an elaborated definition of stakeholders and designed a questionnaire that integrated the following influence factors, which have relevant impact on hospital management: political/legal, economic, social, technological and environmental forces. These influence factors are examined to develop the so-called critical uncertainties. Thorough identification of uncertainties was based on a “Stakeholder Feedback”. Results: Two key uncertainties were identified and considered in this study: the development of workload for the medical staff the profit oriented performance of the medical staff. According to the developed scenarios, complementary education of the medical staff as well as of non-medical top executives and managers of hospitals was the recommended core strategy. Complementary scenario-specific strategic options should be considered whenever needed to optimize dealing with a specific future development of the health care environment. Conclusion: Strategic planning in hospitals is essential to ensure sustainable success. It considers multiple situations and integrates internal and external insights and perspectives in addition to identifying weak signals and “blind spots”. This flows into a sound planning for multiple strategic options. It is a state of the art tool that allows dealing with the increasing challenges facing hospital management. PMID:26504735

  12. Emergency strategies and trends in the management of liver trauma.

    PubMed

    Jiang, Hongchi; Wang, Jizhou

    2012-09-01

    The liver is the most frequently injured organ during abdominal trauma. The management of hepatic trauma has undergone a paradigm shift over the past several decades, with mandatory operation giving way to nonoperative treatment. Better understanding of the mechanisms and grade of liver injury aids in the initial assessment and establishment of a management strategy. Hemodynamically unstable patients should undergo focused abdominal sonography for trauma, whereas stable patients may undergo computed tomography, the standard examination protocol. The grade of liver injury alone does not accurately predict the need for operation, and nonoperative management is rapidly becoming popular for high-grade injuries. Hemodynamic instability with positive focused abdominal sonography for trauma and peritonitis is an indicator of the need for emergent operative intervention. The damage control concept is appropriate for the treatment of major liver injuries and is associated with significant survival advantages compared with traditional prolonged surgical techniques. Although surgical intervention for hepatic trauma is not as common now as it was in the past, current trauma surgeons should be familiar with the emergency surgical skills necessary to manage complex hepatic injuries, such as packing, Pringle maneuver, selective vessel ligation, resectional debridement, and parenchymal sutures. The present review presents emergency strategies and trends in the management of liver trauma. PMID:22673827

  13. Why Leading Consumer Product Companies Develop Proactive Chemical Management Strategies

    PubMed Central

    Scruggs, Caroline E.; Van Buren, Harry J.

    2014-01-01

    Scholars have studied the various pressures that companies face related to socially responsible behavior when stakeholders know the particular social issues under consideration. Many have examined social responsibility in the context of environmental responsibility and the general approaches companies take regarding environmental management. The issue of currently unregulated, but potentially hazardous, chemicals in consumer products is not well understood by the general public, but a number of proactive consumer product companies have voluntarily adopted strategies to minimize use of such chemicals. These companies are exceeding regulatory requirements by restricting from their products chemicals that could harm human or environmental health, despite the fact that these actions are costly. They do not usually advertise the details of their strategies to end consumers. This article uses interviews with senior environmental directors of 20 multinational consumer product companies to investigate why these companies engage in voluntary chemicals management. The authors conclude that the most significant reasons are to achieve a competitive advantage and stay ahead of regulations, manage relationships and maintain legitimacy with stakeholders, and put managerial values into practice. Many of the characteristics related to the case of chemicals management are extendable to other areas of stakeholder management in which risks to stakeholders are either unknown or poorly understood. PMID:27471326

  14. Health plans' strategies for managing outpatient specialty pharmaceuticals.

    PubMed

    Mullins, C Daniel; Lavallee, Danielle Chauncey; Pradel, Françoise G; DeVries, Andrea R; Caputo, Nadine

    2006-01-01

    Balancing increased spending for specialty pharmaceuticals while providing affordable and equitable coverage for consumers is a key issue for public and private payers. Health plans rely on an array of strategies, including both medical management and those used for more traditional pharmaceuticals. To explore specific management strategies for outpatient specialty pharmaceuticals, a survey was administered to thirty-eight Blue Cross and Blue Shield plans, focused on identifying core strategies. Prior authorization was the most commonly used strategy, implemented by 83.3 percent of respondents. Other frequently implemented management strategies included claims review (82.8 percent), formulary management (76.7 percent), and utilization review (70 percent). PMID:16966730

  15. Relationship-Driven Classroom Management: Strategies That Promote Student Motivation.

    ERIC Educational Resources Information Center

    Vitto, John M.

    This book combines information about resiliency, classroom management, and discipline into a user-friendly discussion suitable for all teachers. The material covers both preventive strategies and reactive strategies. The chapters of part 1, "Reinventive Strategies," are: (1) "Relationship-Driven Classroom Management and Resilience"; (2)…

  16. Current and Potential Therapeutic Strategies for Hemodynamic Cardiorenal Syndrome

    PubMed Central

    Obi, Yoshitsugu; Kim, Taehee; Kovesdy, Csaba P.; Amin, Alpesh N.; Kalantar-Zadeh, Kamyar

    2016-01-01

    Background Cardiorenal syndrome (CRS) encompasses conditions in which cardiac and renal disorders co-exist and are pathophysiologically related. The newest classification of CRS into seven etiologically and clinically distinct types for direct patient management purposes includes hemodynamic, uremic, vascular, neurohumoral, anemia- and/or iron metabolism-related, mineral metabolism-related and protein-energy wasting-related CRS. This classification also emphasizes the pathophysiologic pathways. The leading CRS category remains hemodynamic CRS, which is the most commonly encountered type in patient care settings and in which acute or chronic heart failure leads to renal impairment. Summary This review focuses on selected therapeutic strategies for the clinical management of hemodynamic CRS. This is often characterized by an exceptionally high ratio of serum urea to creatinine concentrations. Loop diuretics, positive inotropic agents including dopamine and dobutamine, vasopressin antagonists including vasopressin receptor antagonists such as tolvaptan, nesiritide and angiotensin-neprilysin inhibitors are among the pharmacologic agents used. Additional therapies include ultrafiltration (UF) via hemofiltration or dialysis. The beneficial versus unfavorable effects of these therapies on cardiac decongestion versus renal blood flow may act in opposite directions. Some of the most interesting options for the outpatient setting that deserve revisiting include portable continuous dobutamine infusion, peritoneal dialysis and outpatient UF via hemodialysis or hemofiltration. Key Messages The new clinically oriented CRS classification system is helpful in identifying therapeutic targets and offers a systematic approach to an optimal management algorithm with better understanding of etiologies. Most interventions including UF have not shown a favorable impact on outcomes. Outpatient portable dobutamine infusion is underutilized and not well studied. Revisiting traditional and

  17. Current Therapeutic Strategies and Novel Approaches in Osteosarcoma

    PubMed Central

    Ando, Kosei; Heymann, Marie-Françoise; Stresing, Verena; Mori, Kanji; Rédini, Françoise; Heymann, Dominique

    2013-01-01

    Osteosarcoma is the most frequent malignant primary bone tumor and a main cause of cancer-related death in children and adolescents. Although long-term survival in localized osteosarcoma has improved to about 60% during the 1960s and 1970s, long-term survival in both localized and metastatic osteosarcoma has stagnated in the past several decades. Thus, current conventional therapy consists of multi-agent chemotherapy, surgery and radiation, which is not fully adequate for osteosarcoma treatment. Innovative drugs and approaches are needed to further improve outcome in osteosarcoma patients. This review describes the current management of osteosarcoma as well as potential new therapies. PMID:24216993

  18. Current management of pediatric soft tissue sarcomas.

    PubMed

    Sangkhathat, Surasak

    2015-11-01

    Pediatric soft tissue sarcomas are a group of malignant neoplasms arising within embryonic mesenchymal tissues during the process of differentiation into muscle, fascia and fat. The tumors have a biphasic peak for age of incidence. Rhabdomyosarcoma (RMS) is diagnosed more frequently in younger children, whereas adult-type non-RMS soft tissue sarcoma is predominately observed in adolescents. The latter group comprises a variety of rare tumors for which diagnosis can be difficult and typically requires special studies, including immunohistochemistry and molecular genetic analysis. Current management for the majority of pediatric sarcomas is based on the data from large multi-institutional trials, which has led to great improvements in outcomes over recent decades. Although surgery remains the mainstay of treatment, the curative aim cannot be achieved without adjuvant treatment. Pre-treatment staging and risk classification are of prime importance in selecting an effective treatment protocol. Tumor resectability, the response to induction chemotherapy, and radiation generally determine the risk-group, and these factors are functions of tumor site, size and biology. Surgery provides the best choice of local control of small resectable tumors in a favorable site. Radiation therapy is added when surgery leaves residual disease or there is evidence of regional spread. Chemotherapy aims to reduce the risk of relapse and improve overall survival. In addition, upfront chemotherapy reduces the aggressiveness of the required surgery and helps preserve organ function in a number of cases. Long-term survival in low-risk sarcomas is feasible, and the intensity of treatment can be reduced. In high-risk sarcoma, current research is allowing more effective disease control. PMID:26566481

  19. Current management of pediatric soft tissue sarcomas

    PubMed Central

    Sangkhathat, Surasak

    2015-01-01

    Pediatric soft tissue sarcomas are a group of malignant neoplasms arising within embryonic mesenchymal tissues during the process of differentiation into muscle, fascia and fat. The tumors have a biphasic peak for age of incidence. Rhabdomyosarcoma (RMS) is diagnosed more frequently in younger children, whereas adult-type non-RMS soft tissue sarcoma is predominately observed in adolescents. The latter group comprises a variety of rare tumors for which diagnosis can be difficult and typically requires special studies, including immunohistochemistry and molecular genetic analysis. Current management for the majority of pediatric sarcomas is based on the data from large multi-institutional trials, which has led to great improvements in outcomes over recent decades. Although surgery remains the mainstay of treatment, the curative aim cannot be achieved without adjuvant treatment. Pre-treatment staging and risk classification are of prime importance in selecting an effective treatment protocol. Tumor resectability, the response to induction chemotherapy, and radiation generally determine the risk-group, and these factors are functions of tumor site, size and biology. Surgery provides the best choice of local control of small resectable tumors in a favorable site. Radiation therapy is added when surgery leaves residual disease or there is evidence of regional spread. Chemotherapy aims to reduce the risk of relapse and improve overall survival. In addition, upfront chemotherapy reduces the aggressiveness of the required surgery and helps preserve organ function in a number of cases. Long-term survival in low-risk sarcomas is feasible, and the intensity of treatment can be reduced. In high-risk sarcoma, current research is allowing more effective disease control. PMID:26566481

  20. Nanomedicinal strategies to treat multidrug-resistant tumors: current progress

    PubMed Central

    Dong, Xiaowei; Mumper, Russell J

    2010-01-01

    Multidrug resistance (MDR) is a major impediment to the success of cancer chemotherapy. P-glycoprotein is an important and the best-known membrane transporter involved in MDR. Several strategies have been used to address MDR, especially P-glycoprotein-mediated drug resistance in tumors. However, clinical success has been limited, largely due to issues regarding lack of efficacy and/or safety. Nanoparticles have shown the ability to target tumors based on their unique physical and biological properties. To date, nanoparticles have been investigated primarily to address P-glycoprotein and the observed improved anticancer efficacy suggests that nanomedicinal strategies provide a new opportunity to overcome MDR. This article focuses on nanotechnology-based formulations and current nanomedicine approaches to address MDR in tumors and discusses the proposed mechanisms of action. PMID:20528455

  1. National launch strategy vehicle data management system

    NASA Technical Reports Server (NTRS)

    Cordes, David

    1990-01-01

    The national launch strategy vehicle data management system (NLS/VDMS) was developed as part of the 1990 NASA Summer Faculty Fellowship Program. The system was developed under the guidance of the Engineering Systems Branch of the Information Systems Office, and is intended for use within the Program Development Branch PD34. The NLS/VDMS is an on-line database system that permits the tracking of various launch vehicle configurations within the program development office. The system is designed to permit the definition of new launch vehicles, as well as the ability to display and edit existing launch vehicles. Vehicles can be grouped in logical architectures within the system. Reports generated from this package include vehicle data sheets, architecture data sheets, and vehicle flight rate reports. The topics covered include: (1) system overview; (2) initial system development; (3) supercard hypermedia authoring system; (4) the ORACLE database; and (5) system evaluation.

  2. Performance management vital in implementing new strategies

    SciTech Connect

    Kruzner, D.; Trollinger, R.

    1996-11-11

    Wedged between the growing cost of environmental compliance and consumer protests over prices, the downstream oil and gas and petrochemical business segments are having to accelerate the changes that have engulfed their industry. Despite recent price increases, thinning margins have driven energy companies to rethink their role in life and to revaluate and reshape operations and assets in pursuit of new strategies. As companies concentrate on core competencies, shift to demand-pull production, and try to leverage their clout in selected regions for market dominance, performance of key operations has become paramount. In theory, performance management is a simple, straightforward proposition. It means deploying a comprehensive, strategy-linked framework for measuring performance across the entire enterprise and then using the results of these measurements to serve two critical managerial functions. First, performance measurement is the means for making informed, knowledge-based decisions about important business issues such as minimizing operational costs, manufacturing the right mix of products, identifying the most profitable distribution channels, and optimizing the utilization of assets. Second -- and in the long run more importantly -- measuring performance is a means for identifying and addressing areas where a company needs to make the kinds of organizational and process improvements that can develop, sustain, and amplify competitive advantage over the long haul. Experiences at a variety of companies, both within and outside the oil and gas and chemical business segments, demonstrate that progress towards comprehensive performance management is possible, with quantifiable benefits and results. Competitive advantage will be enjoyed by those companies that advance further and faster down this path.

  3. Preparing Future Leaders: Project Management Strategies for Service Learning

    ERIC Educational Resources Information Center

    Munger, Roger; Gutowski, Amanda

    2008-01-01

    This article makes a case for teaching project management strategies in service-learning courses. The authors describe three specific documents students can create to help them manage a service-learning project and then present strategies that can help students manage their project teams. Such skills, the authors argue, provide the tools students…

  4. Remedial strategies for municipal solid waste management in China.

    PubMed

    Wang, H; Nie, Y

    2001-02-01

    The purpose of this investigation is to evaluate the current status and to identify the problems of municipal solid waste (MSW) management in China to determine appropriate remedial strategies. This is the second of two papers proposed on this topic. Major problems or difficulties identified in MSW management in China include MSW land, air, and water pollution, commingled collection, poor administration, shortage of funds, lack of facilities, and problems of training and public awareness. In order to solve these problems and to improve MSW management in China, remedial strategies in three areas are recommended: institutional reform, technology development, and legislation and administrative improvement. The primary principle involved in institutional reform is unifying legislative responsibilities into one body and developing a market mechanism for handling MSW. Composting, landfills, and incineration should be equally developed in accordance with China's needs. The feasibility of developing technology to handle MSW in China is discussed. Also recommended is the establishment of sound regulatory systems, including a service fee system, a source separation system, and a training program. China is presently undergoing economic and institutional reform at the national and local levels. Results of this study will provide useful information on MSW management in China. PMID:11256501

  5. Regional economic effects of current and proposed management alternatives for Sand Lake National Wildlife Refuge

    USGS Publications Warehouse

    Koontz, Lynne; Lambert, Heather

    2005-01-01

    This report first provides a description of the local community and economy near the Refuge. An analysis of current and proposed management strategies that could affect the local economy is then presented. The Refuge management activities of economic concern in this analysis are Refuge personnel staffing and Refuge spending within the local community, and spending in the local community by Refuge visitors.

  6. Regional economic effects of current and proposed management alternatives for Arrowwood National Wildlife Refuge

    USGS Publications Warehouse

    Koontz, Lynne; Lambert, Heather

    2005-01-01

    This report first provides a description of the local community and economy near the Refuge. An analysis of current and proposed management strategies that could affect the local economy is then presented. The Refuge management activities of economic concern in this analysis are Refuge personnel staffing and Refuge spending within the local community, and spending in the local community by Refuge visitors.

  7. Improving Recall Using Database Management Systems: A Learning Strategy.

    ERIC Educational Resources Information Center

    Jonassen, David H.

    1986-01-01

    Describes the use of microcomputer database management systems to facilitate the instructional uses of learning strategies relating to information processing skills, especially recall. Two learning strategies, cross-classification matrixing and node acquisition and integration, are highlighted. (Author/LRW)

  8. Current therapeutic strategies for premature ejaculation and future perspectives

    PubMed Central

    Xin, Zhong-Cheng; Zhu, Yi-Chen; Yuan, Yi-Ming; Cui, Wan-Shou; Jin, Zhe; Li, Wei-Ren; Liu, Tao

    2011-01-01

    Premature ejaculation (PE) is a common sexual disorder in men that is mediated by disturbances in the peripheral and central nervous systems. Although all pharmaceutical treatments for PE are currently used ‘off-label', some novel oral agents and some newer methods of drug administration now provide important relief to PE patients. However, the aetiology of this condition has still not been unified, primarily because of the lack of a standard animal model for basic research and the absence of a widely accepted definition and assessment tool for evidence-based clinical studies in patients with PE. In this review, we focus on the current therapeutic strategies and future treatment perspectives for PE. PMID:21532601

  9. Therapeutic strategies for Leber's hereditary optic neuropathy: A current update.

    PubMed

    Gueven, Nuri; Faldu, Dharmesh

    2013-11-01

    Leber's hereditary optic neuropathy (LHON) is a rare mitochondrial retinopathy, caused by mutations in subunits of complex I of the respiratory chain, which leads to elevated levels of oxidative stress and an insufficient energy supply. This molecular pathology is thought to be responsible for the dysfunction and eventual apoptotic loss of retinal ganglion cells in the eye, which ultimately results in blindness. Many strategies, ranging from neuroprotectants, antioxidants, anti-apoptotic- and anti-inflammatory compounds have been tested with mixed results. Currently, the most promising compounds are short-chain quinones that have been shown to protect the vision of LHON patients during the early stages of the disease. This commentary gives a brief overview on the current status of tested therapeutics and also addresses future developments such as the use of gene therapy that hopefully will provide safe and efficient therapy options for all LHON patients. PMID:25343117

  10. A review of current treatment strategies for gestational diabetes mellitus

    PubMed Central

    Kelley, Kristi W; Carroll, Dana G; Meyer, Allison

    2015-01-01

    Approximately 90% of diabetes cases in pregnant women are considered gestational diabetes mellitus (GDM). It is well known that uncontrolled glucose results in poor pregnancy outcomes in both the mother and fetus. Worldwide there are many guidelines with recommendations for appropriate management strategies for GDM once lifestyle modifications have been instituted and failed to achieve control. The efficacy and particularly the safety of other treatment modalities for GDM has been the source of much debate in recent years. Studies that have demonstrated the safety and efficacy of both glyburide and metformin in the management of patients with GDM will be reviewed. There is a lack of evidence with other oral and injectable non-insulin agents to control blood glucose in GDM. The role of insulin will be discussed, with emphasis on insulin analogs. Ideal patient characteristics for each treatment modality will be reviewed. In addition, recommendations for postpartum screening of patients will be described as well as recommendations for use of agents to manage subsequent type 2 diabetes in patients who are breastfeeding. PMID:26213555

  11. Erection rehabilitation following prostatectomy - current strategies and future directions.

    PubMed

    Sopko, Nikolai A; Burnett, Arthur L

    2016-04-01

    Despite continued advances in urological surgery, erectile dysfunction (ED) remains a serious adverse effect of radical prostatectomy. In this setting, ED is predominantly caused by injury to the neurovascular bundles, which lie alongside the prostate and are responsible for initiating and maintaining the erectile response. Most men will experience some degree of ED after radical prostatectomy, although erectile function outcomes have already remarkably improved since the development of nerve-sparing surgical techniques. To further improve outcomes, erection rehabilitation strategies are being investigated, which emphasize early treatment regimens with the aim of preventing adverse remodelling after surgery and preserving erectile function. Strategies include pharmacological therapy, mechanical therapy and psychosocial support. In addition, novel therapeutic approaches involving new targets for small-molecule treatments and regenerative medicine therapies are being developed to aid in restoring erectile function. Although ED treatments can be effective following radical prostatectomy, no specific erection rehabilitation regimen has currently been shown to be superior to other investigated rehabilitation regimens. Nevertheless, the different strategies rightfully remain an area of intensive research, as preservation of erectile function is a critical part of providing comprehensive care for men with prostate cancer to ensure their overall well-being, in contrast to just treating a patient's tumour. PMID:26976244

  12. Liquid Acquisition Strategies for Exploration Missions: Current Status 2010

    NASA Technical Reports Server (NTRS)

    Chato, David J.

    2010-01-01

    NASA is currently developing the propulsion system concepts for human exploration missions to the lunar surface. The propulsion concepts being investigated are considering the use of cryogenic propellants for the low gravity portion of the mission, that is, the lunar transit, lunar orbit insertion, lunar descent and the rendezvous in lunar orbit with a service module after ascent from the lunar surface. These propulsion concepts will require the vapor free delivery of the cryogenic propellants stored in the propulsion tanks to the exploration vehicles main propulsion system (MPS) engines and reaction control system (RCS) engines. Propellant management devices (PMD s) such as screen channel capillary liquid acquisition devices (LAD s), vanes and sponges currently are used for earth storable propellants in the Space Shuttle Orbiter OMS and RCS applications and spacecraft propulsion applications but only very limited propellant management capability exists for cryogenic propellants. NASA has begun a technology program to develop LAD cryogenic fluid management (CFM) technology through a government in-house ground test program of accurately measuring the bubble point delta-pressure for typical screen samples using LO2, LN2, LH2 and LCH4 as test fluids at various fluid temperatures and pressures. This presentation will document the CFM project s progress to date in concept designs, as well ground testing results.

  13. A holistic strategy for adaptive land management

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Adaptive management is widely applied to natural resources management. Adaptive management can be generally defined as an iterative decision-making process that incorporates formulation of management objectives, actions designed to address these objectives, monitoring of results, and repeated adapta...

  14. The current management of cholangiocarcinoma: A comparison of current guidelines.

    PubMed

    Cai, Yulong; Cheng, Nansheng; Ye, Hui; Li, Fuyu; Song, Peipei; Tang, Wei

    2016-05-23

    Cholangiocarcinoma (CC) accounts for about 3% of all gastrointestinal tumors and is the second most common primary liver tumor. Quality guidelines on CC are needed to guide hepatobiliary surgeons. Here, current guidelines on CC were reviewed to provide useful information and suggestions to help institutes and organizations all around the world to draft better guidelines on CC. Literature databases were electronically searched to identify guidelines or consensus statements regarding CC published from 2002-2016. Nine guidelines were included in this review. Comparison of the current guidelines revealed several inconsistencies. Signs of conflicting views indicated a lack of high level evidence. More studies need to be conducted in areas of contention to help update the guidelines. Organizations and medical societies need to be encouraged to use standard evaluation measures, to restrict tumors to CC or iCC, pCC, or dCC specifically, to give recommendations in accordance with the equipment that is available for diagnosis and treatment in different counties, and to use an appropriate and consistent structure when establishing and drafting guidelines for CC. PMID:27026485

  15. SUSTAINABLE MSW MANAGEMENT STRATEGIES IN THE UNITED STATES

    EPA Science Inventory

    Under increasing pressure to minimize potential environmental burdens and costs for municipal solid waste (MSW) management, state and local governments often must modify programs and adopt more efficient integrated MSW management strategies that reflect dynamic shifts in MSW mana...

  16. Systemic therapy strategies for head-neck carcinomas: Current status

    PubMed Central

    Hoffmann, Thomas K.

    2012-01-01

    Head and neck cancers, most of which are squamous cell tumours, have an unsatisfactory prognosis despite intensive local treatment. This can be attributed, among other factors, to tumour recurrences inside or outside the treated area, and metastases at more distal locations. These tumours therefore require not only the standard surgical and radiation treatments, but also effective systemic modalities. The main option here is antineoplastic chemotherapy, which is firmly established in the palliative treatment of recurrent or metastatic stages of disease, and is used with curative intent in the form of combined simultaneous or adjuvant chemoradiotherapy in patients with inoperable or advanced tumour stages. Neoadjuvant treatment strategies for tumour reduction before surgery have yet to gain acceptance. Induction chemotherapy protocols before radiotherapy have to date been used in patients at high risk of distant metastases or as an aid for decision-making (“chemoselection”) in those with extensive laryngeal cancers, prior to definitive chemoradiotherapy or laryngectomy. Triple-combination induction therapy (taxanes, cisplatin, 5-fluorouracil) shows high remission rates with significant toxicity and, in combination with (chemo-)radiotherapy, is currently being compared with simultaneous chemoradiotherapy; the current gold standard with regards to efficacy and long-term toxicity. A further systemic treatment strategy, called “targeted therapy”, has been developed to help increase specificity and reduce toxicity. An example of targeted therapy, EGFR-specific antibodies, can be used in palliative settings and, in combination with radiotherapy, to treat advanced head and neck cancers. A series of other novel biologicals such as signal cascade inhibitors, genetic agents, or immunotherapies, are currently being evaluated in large-scale clinical studies, and could prove useful in patients with advanced, recurring or metastatic head and neck cancers. When developing

  17. Current controversies in the management of malignant pleural effusions.

    PubMed

    Azzopardi, Maree; Porcel, José M; Koegelenberg, Coenraad F N; Lee, Y C Gary; Fysh, Edward T H

    2014-12-01

    Malignant pleural effusion (MPE) can complicate most malignancies and is a common clinical problem presenting to respiratory and cancer care physicians. Despite its frequent occurrence, current knowledge of MPE remains limited and controversy surrounds almost every aspect in its diagnosis and management. A lack of robust data has led to significant practice variations worldwide, inefficiencies in healthcare provision, and threats to patient safety. Recent studies have highlighted evolving concepts in MPE care that challenge traditional beliefs. Advancing laboratory techniques have improved the diagnostic yield from pleural fluid cytology, minimizing the need for invasive tissue biopsies, even in many cases of mesothelioma. Imaging-guided biopsy is comparable to thoracoscopy in suitable patients, if cytological examination was noncontributory. Cumulating evidence for the benefits of indwelling pleural catheters (IPCs) has led some centers to adopt this approach as first-line definitive management for MPE over conventional talc pleurodesis. The optimal technique of talc pleurodesis is still debated despite its use for many decades. Strategies combining pleurodesis and IPC are being studied. MPE consists of a heterogenous group of diseases and careful phenotyping of malignant effusion patients can provide important clinical information that will advance the field and allow better stratification of patients and planning of therapy accordingly. This review addresses the controversies in MPE diagnosis and management and exposes the deficits in knowledge of MPE that should be the focus of future research. PMID:25463163

  18. Evidence-based Management Strategies for Treatment of Chronic Wounds

    PubMed Central

    Werdin, Frank; Tennenhaus, Mayer; Schaller, Hans-Eberhardt; Rennekampff, Hans-Oliver

    2009-01-01

    The care and management of patients with chronic wounds and their far-reaching effects challenge both the patient and the practitioner. Further complicating this situation is the paucity of evidence-based treatment strategies for chronic wound care. After searching both MEDLINE and Cochrane databases, we reviewed currently available articles concerning chronic wound care. Utilizing this information, we have outlined a review of current, evidence-based concepts as they pertain to the treatment of chronic wounds, focusing on fundamental treatment principles for the management of venous, arterial, diabetic, and pressure ulcers. Individualized treatment options as well as general wound management principles applicable to all varieties of chronic wounds are described. Classification and treatment guidelines as well as the adoption of the TIME acronym facilitate an organized conceptional approach to wound care. In so doing, individual aspects of generalized wound care such as debridement, infection, and moisture control as well as attention to the qualities of the wound edge are comprehensively evaluated, communicated, and addressed. Effective adjuvant agents for the therapy of chronic wounds including nutritional and social support measures are listed, as is a brief review of strategies helpful for preventing recurrence. An appreciation of evidence-based treatment pathways and an understanding of the pathophysiology of chronic wounds are important elements in the management of patients with chronic wounds. To achieve effective and long-lasting results, a multidisciplinary approach to patient care, focused on the education and coordination of patient, family as well as medical and support staff can prove invaluable. PMID:19578487

  19. Combined strategies in the management of obesity.

    PubMed

    Dixon, John B; Dixon, Maureen E

    2006-01-01

    Obesity is a chronic relapsing disease requiring a similar long term approach to management as that of other chronic conditions. Management needs to be multifaceted aiming to achieve sustainable behavioural changes to physical activity and diet to alter the patient and family microenvironment to one favouring better weight control. A range of therapies including specific diets, calorie counting, meal replacements, very low calorie diets, pharmacotherapy, intragastric balloons and surgery can provide very useful additional benefit. Use of these should be guided by the extent of weight loss required to reduce BMI to an acceptable level with regard to the patient's ethnicity, risk and comorbid conditions. Patients need to set goals that are optimistic, but realistic, and understand the benefits of sustained modest weight loss and the likelihood of weight regain requiring repeat episodes of weight loss. Practitioners need to be informed about the efficacy of current therapies and their combinations to enhance choice of suitable methods for achieving the optimal weight loss required by the patient. They will also need to anticipate trigger points for renewed periods of weight loss in the event of weight regain, as relapse is likely but not a reason for abandoning the battle. PMID:16928663

  20. Priapism: Current Updates in Clinical Management

    PubMed Central

    Song, Phil Hyun

    2013-01-01

    Priapism is a persistent penile erection that continues for hours beyond, or is unrelated to, sexual stimulation. Priapism requires a prompt evaluation and usually requires an emergency management. There are two types of priapism: 1) ischemic (veno-occlusive or low-flow), which is found in 95% of cases, and 2) nonischemic (arterial or high-flow). Stuttering (intermittent or recurrent) priapism is a recurrent form of ischemic priapism. To initiate appropriate management, the physician must decide whether the priapism is ischemic or nonischemic. In the management of an ischemic priapism, resolution should be achieved as promptly as possible. Initial treatment is therapeutic aspiration with or without irrigation of the corpora. If this fails, intracavernous injection of sympathomimetic agents is the next step. Surgical shunts should be performed in cases involving failure of nonsurgical treatment. The first management of a nonischemic priapism should be observation. Selective arterial embolization is recommended for the management of nonischemic priapism in cases that request treatment. The goal of management for stuttering priapism is prevention of future episodes. This article provides a review of recent clinical developments in the medical and surgical management of priapism and an investigation of scientific research activity in this rapidly developing field of study. PMID:24363861

  1. Current Status of On-Site Wastewater Management

    ERIC Educational Resources Information Center

    Senn, Charles L.

    1978-01-01

    Wastewater management is becoming an important environmental issue nationally. This article reports the history and current status of wastewater management. Regulatory programs are discussed with specific state examples. Needs assessment is also included. (MA)

  2. Steam generator degradation: Current mitigation strategies for controlling corrosion

    SciTech Connect

    Millett, P.

    1997-02-01

    Steam Generator degradation has caused substantial losses of power generation, resulted in large repair and maintenance costs, and contributed to significant personnel radiation exposures in Pressurized Water Reactors (PWRs) operating throughout the world. EPRI has just published the revised Steam Generator Reference Book, which reviews all of the major forms of SG degradation. This paper discusses the types of SG degradation that have been experienced with emphasis on the mitigation strategies that have been developed and implemented in the field. SG degradation is presented from a world wide perspective as all countries operating PWRs have been effected to one degree or another. The paper is written from a US. perspective where the utility industry is currently undergoing tremendous change as a result of deregulation of the electricity marketplace. Competitive pressures are causing utilities to strive to reduce Operations and Maintenance (O&M) and capital costs. SG corrosion is a major contributor to the O&M costs of PWR plants, and therefore US utilities are evaluating and implementing the most cost effective solutions to their corrosion problems. Mitigation strategies developed over the past few years reflect a trend towards plant specific solutions to SG corrosion problems. Since SG degradation is in most cases an economic problem and not a safety problem, utilities can focus their mitigation strategies on their unique financial situation. Accordingly, the focus of R&D has shifted from the development of more expensive, prescriptive solutions (e.g. reduced impurity limits) to corrosion problems to providing the utilities with a number of cost effective mitigation options (e.g. molar ratio control, boric acid treatment).

  3. Current methods and research strategies for modeling atmospheric mercury

    SciTech Connect

    Bullock, O.R.

    1999-01-01

    The atmospheric pathway of the global mercury cycle is known to be the primary source of mercury contamination to most threatened aquatic ecosystems. While much effort has been made to quantify the total mass flux of mercury to the atmosphere from various natural and anthropogenic sources, discrimination of the chemical and physical forms of these emissions is just beginning in response to early modeling exercises showing this discrimination to be critical for accurate modeling estimates of the sources responsible for observed mercury deposition. In this paper, current atmospheric mercury modeling techniques and the information obtained from them are described. A strategy for future field research and numerical model development is proposed which is designed to confidently identify the sources of atmospheric mercury responsible for observed contamination of aquatic ecosystems.

  4. [Current cell therapy strategies for repairing the central nervous system].

    PubMed

    Féron, F

    2007-09-01

    One of the chief contemporary goals of neurologists and neuroscientists is to find a way to overcome the debilitating effects of brain diseases, especially neurodegenerative diseases. Since very few molecules have been found to be efficient in curing the patients and even halting the progression of the symptoms, cell therapy is now seen as an attractive alternative. Two therapeutic strategies are currently under investigation: i) the "substitution" strategy, based on grafts of cells capable of differentiating in the appropriate cells and restoring lost functions and ii) the "neuroprotective" or "conservative" strategy aiming to increase the resistance of spared cells to the toxicity of their environment and to reinforce the body's own mechanisms of healing. Twenty years ago, foetal neuroblasts were the first cells to be transplanted in the brains of patients with Parkinson's or Huntington disease. A phase II clinical trial is presently conducted in France for the latter disorder. However, the numerous ethical and technical issues raised by the use of embryonic and foetal cells have directed the focus of clinicians and researchers towards substitute cell types. In this review, we summarise the main findings of the most recent basic studies and clinical trials based on: i) the grafting of surrogate adult cells such as bone marrow mesenchymal stem cells and olfactory ensheathing cells; ii) the potential therapeutic applications of neuropoiesis - the persistent neurogenesis in the brain - as a source for tissue engraftment and as self-repair by a person's own indigenous population of pluripotent cells and iii) immune-based therapy (autologous activated macrophages and T cell vaccination) as well as administration of immunomodulatory molecules. Unexpectedly, it has been found that undifferentiated adult stem cells can display immune-like functions when they home in on an inflamed brain area while immune cells and immunosuppressors can improve functional and

  5. Strategy Maps in University Management: A Comparative Study

    ERIC Educational Resources Information Center

    Han, Shuangmiao; Zhong, Zhou

    2015-01-01

    In this study, the conceptual use of the strategy map approach and the strategy map which it produces have been adapted from the business sector and introduced as tools for achieving more effective strategic planning and management in higher education institutions (HEIs). This study discusses the development of strategy maps as transformational…

  6. New Management Strategies in Heart Failure.

    PubMed

    Owens, Anjali Tiku; Brozena, Susan C; Jessup, Mariell

    2016-02-01

    Despite >100 clinical trials, only 2 new drugs had been approved by the US Food and Drug Administration for the treatment of chronic heart failure in more than a decade: the aldosterone antagonist eplerenone in 2003 and a fixed dose combination of hydralazine-isosorbide dinitrate in 2005. In contrast, 2015 has witnessed the Food and Drug Administration approval of 2 new drugs, both for the treatment of chronic heart failure with reduced ejection fraction: ivabradine and another combination drug, sacubitril/valsartan or LCZ696. Seemingly overnight, a range of therapeutic possibilities, evoking new physiological mechanisms, promise great hope for a disease that often carries a prognosis worse than many forms of cancer. Importantly, the newly available therapies represent a culmination of basic and translational research that actually spans many decades. This review will summarize newer drugs currently being used in the treatment of heart failure, as well as newer strategies increasingly explored for their utility during the stages of the heart failure syndrome. PMID:26846642

  7. The current approach of atrial fibrillation management

    PubMed Central

    Amin, Anish; Houmsse, Aseel; Ishola, Abiodun; Tyler, Jaret; Houmsse, Mahmoud

    2016-01-01

    Atrial fibrillation (AF) is the most commonly encountered arrhythmia in clinical practice. Aging populations coupled with improved outcomes for many chronic medical conditions has led to increases in AF diagnoses. AF is also known to be associated with an increased risk of adverse events such as transient ischemic attack, ischemic stroke, systemic embolism, and death. This association is enhanced in select populations with preexisting comorbid conditions such as chronic heart failure. The aim of this review is to highlight the advances in the field of cardiology in the management of AF in both acute and long-term settings. We will also review the evolution of anticoagulation management over the past few years and landmark trials in the development of novel oral anticoagulants (NOACs), reversal agents for new NOACs, nonpharmacological options to anticoagulation therapy, and the role of implantable loop recorder in AF management. PMID:26955600

  8. Determining management strategies for the Sarikum Nature Protection Area.

    PubMed

    Öztürk, Sevgi

    2015-03-01

    In recent years, many environmental problems have become important factors in promoting the economic need to develop tourist activity: climate change such as energy wars, increasing hunger and aridity, population increases in urban areas, excessive and unthinking use of natural resources, difficult international relations, economic competition, and increasing environmental stress. Trends in global tourism have changed with changes in culture and our attitude to nature. Changes in both the profile and consumption patterns of tourists have called for the need to balance the use of natural and cultural assets with the need to adequately protect them. In this study, the Sarikum Nature Protection Area (SNPA) was selected as a case study because of its significance as a Turkish wetland area and the variety of different ecosystems coexisting within it. The study focussed on management strategies, but also provides a broader strategy for an area that currently has no management plan. Strengths and weaknesses, opportunities and threats (SWOT) analyses of the area were gathered and analyzed using R'WOT analysis (ranking + SWOT), a multi-criteria assessment method, in order to determine strategies, obtain the participation of interest groups, and assess their opinions and attitudes. The analysis showed the following: the rich biological diversity and the existence of endemic species were the reserve's most significant strength; the presence of natural areas in surrounding regions was the most significant opportunity; the shortage of infrastructure and lack of legal regulation of ecotourism was the most significant weakness; and the lack of a management plan was the most immediate threat. PMID:25678353

  9. Dual Therapy Treatment Strategies for the Management of Patients Infected with HIV: A Systematic Review of Current Evidence in ARV-Naive or ARV-Experienced, Virologically Suppressed Patients

    PubMed Central

    Baril, Jean-Guy; Angel, Jonathan B.; Gill, M. John; Gathe, Joseph; Cahn, Pedro; van Wyk, Jean; Walmsley, Sharon

    2016-01-01

    Objective We reviewed the current literature regarding antiretroviral (ARV)-sparing therapy strategies to determine whether these novel regimens can be considered appropriate alternatives to standard regimens for the initial treatment of ARV-naive patients or as switch therapy for those patients with virologically suppressed HIV infection. Methods A search for studies related to HIV dual therapy published from January 2000 through April 2014 was performed using Biosis, Derwent Drug File, Embase, International Pharmaceutical Abstracts, Medline, Pascal, SciSearch, and TOXNET databases; seven major trial registries, and the abstracts of major conferences. Using predetermined criteria for inclusion, an expert review committee critically reviewed and qualitatively evaluated all identified trials for efficacy and safety results and potential limitations. Results Sixteen studies of dual therapy regimens were critiqued for the ARV-naive population. Studies of a protease inhibitor/ritonavir in combination with the integrase inhibitor raltegravir or the nucleoside reverse transcriptase inhibitor lamivudine provided the most definitive evidence supporting a role for dual therapy. In particular, lopinavir/ritonavir or darunavir/ritonavir combined with raltegravir and lopinavir/ritonavir combined with lamivudine demonstrated noninferiority to standard of care triple therapy after 48 weeks of treatment. Thirteen trials were critiqued in ARV-experienced, virologically suppressed patients. The virologic efficacy outcomes were mixed. Although overall data regarding toxicity are limited, when compared with standard triple therapy, certain dual therapy regimens may offer advantages in renal function, bone mineral density, and limb fat changes; however, some dual combinations may elevate lipid or bilirubin levels. Conclusions The potential benefits of dual therapy regimens include reduced toxicity, improved tolerability and adherence, and reduced cost. Although the data reviewed here

  10. Library and Learning Resources Management: Current Trends.

    ERIC Educational Resources Information Center

    Armsby, Allen; And Others

    1987-01-01

    The seven papers that make up this report focus on the impact of new information technology on curriculum and resource management at the college level in England and Wales. A brief preface, an introduction, and a foreword provide background information on the report and introduce the following papers: (1) "Curriculum Developments in Further…

  11. Current Initiatives and Issues in Collection Management.

    ERIC Educational Resources Information Center

    Bennett, Scott

    1984-01-01

    Reports on initiatives being taken by the Association of Research Libraries, University of Pittsburgh, Research Libraries Group, and Center for Research Libraries in response to development of collection management in academic librarianship, and comments on issues emerging from these initiatives--use documentation, cooperation, and paperless…

  12. Current remote sensing in natural resource management

    NASA Astrophysics Data System (ADS)

    Greer, Jerry D.

    2003-08-01

    Natural resource management agencies continue to be one of the heavy users of remote sensing data. From the earliest days of aerial photography, managers have depended upon broad area coverage in various levels of resolution for information needed to conserve and preserve the Earth's resource base. The USDA Forest Service is one agency that has been an active user of remote sensing data since the days when foresters began using aerial photographs to analyze timber crops. To this day, the use of data acquired by aerial reconnaissance is an important part of the tools used to gather information. Last year, in April of 2002, the Forest Service, Remote Sensing Applications Cener with headquarters in Salt Lake City, Utah, sponsored The Ninth Biennial Remote Sensing Applications Conference in San Diego, California. Presentations at that conference demonstrate that airborne reconnaissance techniques continue to be of importance to managers of our natural resources. This paper is an overview of papers presented at the conference with emphasis upon applications that either use or have the potential to use airborne reconnaissance in data collection. Primary areas of interest include data collection for natural resource management and for law enforcement purposes on public lands an other remote, inaccessible back country areas.

  13. Current surgical strategies for total arthroplasty in valgus knee

    PubMed Central

    Nikolopoulos, Dimitrios; Michos, Ioannis; Safos, George; Safos, Petros

    2015-01-01

    The majority of orthopaedic surgeons even currently agree that primary total arthroplasty in valgus knees with a deformity of more than ten degrees may prove challenging. The unique sets of bone and soft tissue abnormalities that must be addressed at the time of the operation make accurate axis restoration, component orientation and joint stability attainment a difficult task. Understanding the specific pathologic anatomic changes associated with the valgus knee is a prerequisite so as to select the proper surgical method, to optimize component position and restore soft-tissue balance. The purpose of this article is to review the valgus knee anatomical variations, to assess the best pre-operative planning and to evaluate how to choose the grade of constraint of the implant. It will also be underlying the up-to-date main approaches and surgical techniques be proposed in the English literature both for bone cuts and soft tissue management of valgus knees. PMID:26191494

  14. [Electronic health strategies in The Americas: current situation and perspectives].

    PubMed

    D Agostino, Marcelo

    2015-01-01

    The main objective of the Strategy and Plan of Action on eHealth (2012-2017) is to contribute to sustainable development of health systems of member states. Its adoption aims to improve quality and access to health services through the use of information and communication technologies (ICT), the implementation of digital literacy programs and access to quality information to advance towards more informed, equitable, competitive and democratic societies. PAHO/WHO considers that in society, free and equal access to health information should be a fundamental right of individuals. Access to information, knowledge sharing and use of information and communication technology in the health sector continues to grow and is driving significant changes in the way people interact with health services and among themselves in social networks and through the use of mobile devices (mHealth). This hyper-connected society, or information society, brings new challenges and opportunities related to the use of massive data (Big Data) that forces us to rethink our relationship with reality and the traditional ways of managing health information. PMID:26338398

  15. Anaplastic glioma: current treatment and management.

    PubMed

    Le Rhun, Emilie; Taillibert, Sophie; Chamberlain, Marc C

    2015-06-01

    Anaplastic glioma (AG) is divided into three morphology-based groups (anaplastic astrocytoma, anaplastic oligodendroglioma, anaplastic oligoastrocytoma) as well as three molecular groups (glioma-CpG island methylation phenotype [G-CIMP] negative, G-CIMP positive non-1p19q codeleted tumors and G-CIMP positive codeleted tumors). The RTOG 9402 and EORTC 26951 trials established radiotherapy plus (procarbazine, lomustine, vincristine) chemotherapy as the standard of care in 1p/19q codeleted AG. Uni- or non-codeleted AG are currently best treated with radiotherapy only or alkylator-based chemotherapy only as determined by the NOA-04 trial. Maturation of NOA-04 and results of the currently accruing studies, CODEL (for codeleted AG) and CATNON (for uni or non-codeleted AG), will likely refine current up-front treatment recommendations for AG. PMID:25936680

  16. Current management of autosomal dominant polycystic kidney disease.

    PubMed

    Akoh, Jacob A

    2015-09-01

    Autosomal dominant polycystic kidney disease (ADPKD), the most frequent cause of genetic renal disease affecting approximately 4 to 7 million individuals worldwide and accounting for 7%-15% of patients on renal replacement therapy, is a systemic disorder mainly involving the kidney but cysts can also occur in other organs such as the liver, pancreas, arachnoid membrane and seminal vesicles. Though computed tomography and magnetic resonance imaging (MRI) were similar in evaluating 81% of cystic lesions of the kidney, MRI may depict septa, wall thickening or enhancement leading to upgrade in cyst classification that can affect management. A screening strategy for intracranial aneurysms would provide 1.0 additional year of life without neurological disability to a 20-year-old patient with ADPKD and reduce the financial impact on society of the disease. Current treatment strategies include reducing: cyclic adenosine monophosphate levels, cell proliferation and fluid secretion. Several randomised clinical trials (RCT) including mammalian target of rapamycin inhibitors, somatostatin analogues and a vasopressin V2 receptor antagonist have been performed to study the effect of diverse drugs on growth of renal and hepatic cysts, and on deterioration of renal function. Prophylactic native nephrectomy is indicated in patients with a history of cyst infection or recurrent haemorrhage or to those in whom space must be made to implant the graft. The absence of large RCT on various aspects of the disease and its treatment leaves considerable uncertainty and ambiguity in many aspects of ADPKD patient care as it relates to end stage renal disease (ESRD). The outlook of patients with ADPKD is improving and is in fact much better than that for patients in ESRD due to other causes. This review highlights the need for well-structured RCTs as a first step towards trying newer interventions so as to develop updated clinical management guidelines. PMID:26380198

  17. Current management of autosomal dominant polycystic kidney disease

    PubMed Central

    Akoh, Jacob A

    2015-01-01

    Autosomal dominant polycystic kidney disease (ADPKD), the most frequent cause of genetic renal disease affecting approximately 4 to 7 million individuals worldwide and accounting for 7%-15% of patients on renal replacement therapy, is a systemic disorder mainly involving the kidney but cysts can also occur in other organs such as the liver, pancreas, arachnoid membrane and seminal vesicles. Though computed tomography and magnetic resonance imaging (MRI) were similar in evaluating 81% of cystic lesions of the kidney, MRI may depict septa, wall thickening or enhancement leading to upgrade in cyst classification that can affect management. A screening strategy for intracranial aneurysms would provide 1.0 additional year of life without neurological disability to a 20-year-old patient with ADPKD and reduce the financial impact on society of the disease. Current treatment strategies include reducing: cyclic adenosine monophosphate levels, cell proliferation and fluid secretion. Several randomised clinical trials (RCT) including mammalian target of rapamycin inhibitors, somatostatin analogues and a vasopressin V2 receptor antagonist have been performed to study the effect of diverse drugs on growth of renal and hepatic cysts, and on deterioration of renal function. Prophylactic native nephrectomy is indicated in patients with a history of cyst infection or recurrent haemorrhage or to those in whom space must be made to implant the graft. The absence of large RCT on various aspects of the disease and its treatment leaves considerable uncertainty and ambiguity in many aspects of ADPKD patient care as it relates to end stage renal disease (ESRD). The outlook of patients with ADPKD is improving and is in fact much better than that for patients in ESRD due to other causes. This review highlights the need for well-structured RCTs as a first step towards trying newer interventions so as to develop updated clinical management guidelines. PMID:26380198

  18. Current management of sickle cell anemia.

    PubMed

    McGann, Patrick T; Nero, Alecia C; Ware, Russell E

    2013-08-01

    Proper management of sickle cell anemia (SCA) begins with establishing the correct diagnosis early in life, ideally during the newborn period. The identification of affected infants by neonatal screening programs allows early initiation of prophylactic penicillin and pneumococcal immunizations, which help prevent overwhelming sepsis. Ongoing education of families promotes the early recognition of disease-released complications, which allows prompt and appropriate medical evaluation and therapeutic intervention. Periodic evaluation by trained specialists helps provide comprehensive care, including transcranial Doppler examinations to identify children at risk for primary stroke, plus assessments for other parenchymal organ damage as patients become teens and adults. Treatment approaches that previously highlighted acute vaso-occlusive events are now evolving to the concept of preventive therapy. Liberalized use of blood transfusions and early consideration of hydroxyurea treatment represent a new treatment paradigm for SCA management. PMID:23709685

  19. Current Management of Sickle Cell Anemia

    PubMed Central

    McGann, Patrick T.; Nero, Alecia C.; Ware, Russell E.

    2013-01-01

    Proper management of sickle cell anemia (SCA) begins with establishing the correct diagnosis early in life, ideally during the newborn period. The identification of affected infants by neonatal screening programs allows early initiation of prophylactic penicillin and pneumococcal immunizations, which help prevent overwhelming sepsis. Ongoing education of families promotes the early recognition of disease-released complications, which allows prompt and appropriate medical evaluation and therapeutic intervention. Periodic evaluation by trained specialists helps provide comprehensive care, including transcranial Doppler examinations to identify children at risk for primary stroke, plus assessments for other parenchymal organ damage as patients become teens and adults. Treatment approaches that previously highlighted acute vaso-occlusive events are now evolving to the concept of preventive therapy. Liberalized use of blood transfusions and early consideration of hydroxyurea treatment represent a new treatment paradigm for SCA management. PMID:23709685

  20. Current Strategies for the Treatment of Aneurysmal Bone Cysts.

    PubMed

    Tsagozis, Panagiotis; Brosjö, Otte

    2015-12-28

    Aneurysmal bone cysts are benign bone tumors that usually present in childhood and early adulthood. They usually manifest as expansile osteolytic lesions with a varying potential to be locally aggressive. Since their first description in 1942, a variety of treatment methods has been proposed. Traditionally, these tumors were treated with open surgery. Either intralesional surgical procedures or en bloc excisions have been described. Furthermore, a variety of chemical or physical adjuvants has been utilized in order to reduce the risk for local recurrence after excision. Currently, there is a shift to more minimally invasive procedures in order to avoid the complications of open surgical excision. Good results have been reported during percutaneous surgery, or the use of embolization. Recently, sclerotherapy has emerged as a promising treatment, showing effective consolidation of the lesions and functional results that appear to be superior to the ones of open surgery. Lastly, non-invasive treatment, such as pharmaceutical intervention with denosumab or bisphosphonates has been reported to be effective in the management of the disease. Radiotherapy has also been shown to confer good local control, either alone or in conjunction to other treatment modalities, but is associated with serious adverse effects. Here, we review the current literature on the methods of treatment of aneurysmal bone cysts. The indication for each type of treatment along reported outcome of the intervention, as well as potential complications are systematically presented. Our review aims to increase awareness of the different treatment modalities and facilitate decision-making regarding each individual patient. PMID:26793296

  1. Current Strategies for the Treatment of Aneurysmal Bone Cysts

    PubMed Central

    Brosjö, Otte

    2015-01-01

    Aneurysmal bone cysts are benign bone tumors that usually present in childhood and early adulthood. They usually manifest as expansile osteolytic lesions with a varying potential to be locally aggressive. Since their first description in 1942, a variety of treatment methods has been proposed. Traditionally, these tumors were treated with open surgery. Either intralesional surgical procedures or en bloc excisions have been described. Furthermore, a variety of chemical or physical adjuvants has been utilized in order to reduce the risk for local recurrence after excision. Currently, there is a shift to more minimally invasive procedures in order to avoid the complications of open surgical excision. Good results have been reported during percutaneous surgery, or the use of embolization. Recently, sclerotherapy has emerged as a promising treatment, showing effective consolidation of the lesions and functional results that appear to be superior to the ones of open surgery. Lastly, non-invasive treatment, such as pharmaceutical intervention with denosumab or bisphosphonates has been reported to be effective in the management of the disease. Radiotherapy has also been shown to confer good local control, either alone or in conjunction to other treatment modalities, but is associated with serious adverse effects. Here, we review the current literature on the methods of treatment of aneurysmal bone cysts. The indication for each type of treatment along reported outcome of the intervention, as well as potential complications are systematically presented. Our review aims to increase awareness of the different treatment modalities and facilitate decision-making regarding each individual patient. PMID:26793296

  2. Management of polycythaemia vera: a critical review of current data.

    PubMed

    McMullin, Mary F; Wilkins, Bridget S; Harrison, Claire N

    2016-02-01

    Polycythaemia vera (PV) is a chronic blood cancer; its clinical features are dominated by myeloproliferation (erythrocytosis, often leucocytosis and/or thrombocytosis) and a tendency for thrombosis and transformation to myelofibrosis or acute myeloid leukaemia. In the past 10 years the pathophysiology of this condition has been defined as JAK/STAT pathway activation, almost always due to mutations in JAK2 exons 12 or 14 (JAK2 V617F). In the same time period our understanding of the optimal management of PV has expanded, most recently culminating in the approval of JAK inhibitors for the treatment of PV patients who are resistant or intolerant to therapy with hydroxycarbamide. It has also been demonstrated that life expectancy for many patients with PV is not normal, nor is their quality of life. We critically explore these findings and discuss their impact. In addition, we highlight persisting gaps in our current management strategy; for example, what is the optimal first line cytoreductive therapy and, indeed, which patients need cytoreductive drugs. PMID:26492433

  3. The 'Toolbox' of strategies for managing Haemonchus contortus in goats: What's in and what's out.

    PubMed

    Kearney, P E; Murray, P J; Hoy, J M; Hohenhaus, M; Kotze, A

    2016-04-15

    A dynamic and innovative approach to managing the blood-consuming nematode Haemonchus contortus in goats is critical to crack dependence on veterinary anthelmintics. H. contortus management strategies have been the subject of intense research for decades, and must be selected to create a tailored, individualized program for goat farms. Through the selection and combination of strategies from the Toolbox, an effective management program for H. contortus can be designed according to the unique conditions of each particular farm. This Toolbox investigates strategies including vaccines, bioactive forages, pasture/grazing management, behavioural management, natural immunity, FAMACHA, Refugia and strategic drenching, mineral/vitamin supplementation, copper Oxide Wire Particles (COWPs), breeding and selection/selecting resistant and resilient individuals, biological control and anthelmintic drugs. Barbervax(®), the ground-breaking Haemonchus vaccine developed and currently commercially available on a pilot scale for sheep, is prime for trialling in goats and would be an invaluable inclusion to this Toolbox. The specialised behaviours of goats, specifically their preferences to browse a variety of plants and accompanying physiological adaptations to the consumption of secondary compounds contained in browse, have long been unappreciated and thus overlooked as a valuable, sustainable strategy for Haemonchus management. These strategies are discussed in this review as to their value for inclusion into the 'Toolbox' currently, and the future implications of ongoing research for goat producers. Combining and manipulating strategies such as browsing behaviour, pasture management, bioactive forages and identifying and treating individual animals for haemonchosis, in addition to continuous evaluation of strategy effectiveness, is conducted using a model farm scenario. Selecting strategies from the Toolbox, with regard to their current availability, feasibility, economical cost

  4. Current management of carcinoma of the breast.

    PubMed Central

    Eberlein, T J

    1994-01-01

    OBJECTIVE: An in-depth retrospective review of the multidisciplinary approach to the management of carcinoma of the breast was done. The author reviewed previous trials and treatment from the past to the present. The indications and contraindications of surgical procedures, radiation therapy, systemic chemotherapy, and hormonal therapy are discussed. SUMMARY BACKGROUND DATA: Carcinoma of the breast is one of the most common malignancies treated by the practicing general or oncologic surgeon. The disease is best treated using a multidisciplinary approach, combining the efforts of surgery, radiation therapy, and systemic treatments. Understanding the indications and contraindications for each of these modalities will provide the practicing surgeon the most up-to-date algorithms for the management of his/her patient. CONCLUSIONS: The author provides a comprehensive analysis of the multidisciplinary approach to the management of carcinoma of the breast. It emphasizes the results of previous trials and discusses future controversies and areas for study. Images Figure 1. Figure 3. Figure 4. PMID:8053734

  5. Medical Management of Uveitis – Current Trends

    PubMed Central

    Babu, Kalpana; Mahendradas, Padmamalini

    2013-01-01

    Uveitis is a challenging disease to treat. Corticosteroids have been used in the treatment of uveitis for many years. Immunosuppressives are gaining momentum in recent years in the treatment of uveitis. In this article we present an overview of current treatment of uveitis and the major breakthroughs and advances in drugs and ocular drug delivery systems in the treatment of uveitis. PMID:23803479

  6. Managing work and family: Do control strategies help?

    PubMed

    Versey, H Shellae

    2015-11-01

    How can we effectively manage competing obligations from work and family without becoming overwhelmed? This question inspires the current study by examining control strategies that may facilitate better work-life balance, with a specific focus on the role of lowered aspirations and positive reappraisals, attitudes that underlie adaptive coping behaviors. Data from the Midlife in the United States Survey (MIDUS II) were used to explore the relationship between negative spillover, control strategies, and well-being among full-time working men and women (N = 2,091). In this nationally representative sample, findings indicate that while positive reappraisals function as a protective buffer, lowering aspirations exacerbate the relationship between work-family spillover and well-being, with moderating effects stronger among women. This study extends prior research tying work-life conflict to health and mental health, and suggests further investigation is needed to consider types of resources that may be effective coping strategies in balancing work and family. PMID:26322486

  7. Current preventive strategies and management of Epstein-Barr virus-related post-transplant lymphoproliferative disease in solid organ transplantation in Europe. Results of the ESGICH Questionnaire-based Cross-sectional Survey.

    PubMed

    San-Juan, R; Manuel, O; Hirsch, H H; Fernández-Ruiz, M; López-Medrano, F; Comoli, P; Caillard, S; Grossi, P; Aguado, J M

    2015-06-01

    There is limited clinical evidence on the utility of the monitoring of Epstein-Barr virus (EBV) DNAemia in the pre-emptive management of post-transplant lymphoproliferative disease (PTLD) in solid organ transplant (SOT) recipients. We investigated current preventive measures against EBV-related PTLD through a web-based questionnaire sent to 669 SOT programmes in 35 European countries. This study was performed on behalf of the ESGICH study group from the European Society of Clinical Microbiology and Infectious Diseases. A total of 71 SOT programmes from 15 European countries participated in the study. EBV serostatus of the recipient is routinely obtained in 69/71 centres (97%) and 64 (90%) have access to EBV DNAemia assays. EBV monitoring is routinely used in 85.9% of the programmes and 77.4% reported performing pre-emptive treatment for patients with significant EBV DNAemia levels. Pre-emptive treatment for EBV DNAemia included reduction of immunosuppression in 50.9%, switch to mammalian target of rapamycin inhibitors in 30.9%, and use of rituximab in 14.5% of programmes. Imaging by whole-body 18-fluoro-deoxyglucose positron emission tomography (FDG-PET) is used in 60.9% of centres to rule out PTLD and complemented computer tomography is used in 50%. In 10.9% of centres, FDG-PET is included in the first-line diagnostic workup in patients with high-risk EBV DNAemia. Despite the lack of definitive evidence, EBV load measurements are frequently used in Europe to guide diagnostic workup and pre-emptive reduction of immunosuppression. We need prospective and controlled studies to define the impact of EBV monitoring in reducing the risk of PTLD in SOT recipients. PMID:25686696

  8. Open Source for Knowledge and Learning Management: Strategies beyond Tools

    ERIC Educational Resources Information Center

    Lytras, Miltiadis, Ed.; Naeve, Ambjorn, Ed.

    2007-01-01

    In the last years, knowledge and learning management have made a significant impact on the IT research community. "Open Source for Knowledge and Learning Management: Strategies Beyond Tools" presents learning and knowledge management from a point of view where the basic tools and applications are provided by open source technologies. This book…

  9. Evidence-Based Classroom Behaviour Management Strategies

    ERIC Educational Resources Information Center

    Parsonson, Barry S.

    2012-01-01

    This paper reviews a range of evidence-based strategies for application by teachers to reduce disruptive and challenging behaviours in their classrooms. These include a number of antecedent strategies intended to help minimise the emergence of problematic behaviours and a range of those which provide positive consequences for appropriate student…

  10. Molecular mechanisms in aging and current strategies to counteract sarcopenia.

    PubMed

    Sakuma, Kunihiro; Yamaguchi, Akihiko

    2010-07-01

    Sarcopenia, the progressive loss of muscle mass with age, is characterized by a deterioration of muscle quantity and quality leading to a gradual slowing of movement and a decline in strength and power. Sarcopenia is a highly significant public health problem. Since these age-related changes in skeletal muscle are largely attributed to various molecular mediators affecting fiber size, mitochondrial homeostatis, and apoptosis, the mechanisms responsible for these deleterious changes present numerous therapeutic targets for drug discovery. We and other researchers demonstrated that a disruption of Akt-mTOR and RhoA-SRF signaling but not Atrogin-1 or MuRF1 contributes to sarcopenia. In addition, sarcopenia seems to include a marked loss of fibers attributable to apoptosis. This review deals with molecular mechanisms of muscle atrophy and provides an update on current strategies (resistance training, myostatin inhibition, treatment with amino acids or testosterone, calorie restriction, etc) for counteracting this loss. Resistance training in combination with amino acid-containing nutrition would be the best candidate to attenuate, prevent, or ultimately reverse age-related muscle wasting and weakness. PMID:20158492

  11. Liver transplantation for malignancy: Current treatment strategies and future perspectives

    PubMed Central

    Hackl, Christina; Schlitt, Hans J; Kirchner, Gabriele I; Knoppke, Birgit; Loss, Martin

    2014-01-01

    In 1967, Starzl et al performed the first successful liver transplantation for a patient diagnosed with hepatoblastoma. In the following, liver transplantation was considered ideal for complete tumor resection and potential cure from primary hepatic malignancies. Several reports of liver transplantation for primary and metastatic liver cancer however showed disappointing results and the strategy was soon dismissed. In 1996, Mazzaferro et al introduced the Milan criteria, offering liver transplantation to patients diagnosed with limited hepatocellular carcinoma. Since then, liver transplantation for malignant disease is an ongoing subject of preclinical and clinical research. In this context, several aspects must be considered: (1) Given the shortage of deceased-donor organs, long-term overall and disease free survival should be comparable with results obtained in patients transplanted for non-malignant disease; (2) In this regard, living-donor liver transplantation may in selected patients help to solve the ethical dilemma of optimal individual patient treatment vs organ allocation justice; and (3) Ongoing research focusing on perioperative therapy and anti-proliferative immunosuppressive regimens may further reduce tumor recurrence in patients transplanted for malignant disease and thus improve overall survival. The present review gives an overview of current indications and future perspectives of liver transplantation for malignant disease. PMID:24833863

  12. Current intervention strategies for the microbial safety of sprouts.

    PubMed

    Sikin, Adi Md; Zoellner, Claire; Rizvi, Syed S H

    2013-12-01

    Sprouts have gained popularity worldwide due to their nutritional values and health benefits. The fact that their consumption has been associated with numerous outbreaks of foodborne illness threatens the $250 million market that this industry has established in the United States. Therefore, sprout manufacturers have utilized the U.S. Food and Drug Administration recommended application of 20,000 ppm of calcium hypochlorite solution to seeds before germination as a preventative method. Concentrations of up to 200 ppm of chlorine wash are also commonly used on sprouts. However, chlorine-based treatment achieves on average only 1- to 3-log reductions in bacteria and is associated with negative health and environmental issues. The search for alternative strategies has been widespread, involving chemical, biological, physical, and hurdle processes that can achieve up to 7-log reductions in bacteria in some cases. The compilation here of the current scientific data related to these techniques is used to compare their efficacy for ensuring the microbial safety of sprouts and their practicality for commercial producers. Of specific importance for alternative seed and sprout treatments is maintaining the industry-accepted germination rate of 95% and the sensorial attributes of the final product. This review provides an evaluation of suggested decontamination technologies for seeds and sprouts before, during, and after germination and concludes that thermal inactivation of seeds and irradiation of sprouts are the most practical stand-alone microbial safety interventions for sprout production. PMID:24290689

  13. Current Research Therapeutic Strategies for Alzheimer's Disease Treatment

    PubMed Central

    Folch, Jaume; Petrov, Dmitry; Ettcheto, Miren; Abad, Sonia; Sánchez-López, Elena; García, M. Luisa; Olloquequi, Jordi; Beas-Zarate, Carlos; Auladell, Carme; Camins, Antoni

    2016-01-01

    Alzheimer's disease (AD) currently presents one of the biggest healthcare issues in the developed countries. There is no effective treatment capable of slowing down disease progression. In recent years the main focus of research on novel pharmacotherapies was based on the amyloidogenic hypothesis of AD, which posits that the beta amyloid (Aβ) peptide is chiefly responsible for cognitive impairment and neuronal death. The goal of such treatments is (a) to reduce Aβ production through the inhibition of β and γ secretase enzymes and (b) to promote dissolution of existing cerebral Aβ plaques. However, this approach has proven to be only modestly effective. Recent studies suggest an alternative strategy centred on the inhibition of the downstream Aβ signalling, particularly at the synapse. Aβ oligomers may cause aberrant N-methyl-D-aspartate receptor (NMDAR) activation postsynaptically by forming complexes with the cell-surface prion protein (PrPC). PrPC is enriched at the neuronal postsynaptic density, where it interacts with Fyn tyrosine kinase. Fyn activation occurs when Aβ is bound to PrPC-Fyn complex. Fyn causes tyrosine phosphorylation of the NR2B subunit of metabotropic glutamate receptor 5 (mGluR5). Fyn kinase blockers masitinib and saracatinib have proven to be efficacious in treating AD symptoms in experimental mouse models of the disease. PMID:26881137

  14. Soil Contamination and Remediation Strategies. Current research and future challenge

    NASA Astrophysics Data System (ADS)

    Petruzzelli, G.

    2012-04-01

    eliminating the source of pollution, but also on blocking the pathways from contaminants to receptors or reducing the exposure to contaminants,. Future challenge integration of sustainability into remediation decision-making. Soil is not a waste! There is a growing interest in the clean up approaches that maintain soil quality after remediation treatments. This issue is of great importance in the U.S.A. where the EPA from 2009 is promoting innovative clean-up strategies (Green Remediation). Green remediation is defined as the practice of considering all environmental effects of remedy and incorporating options to maximize environmental benefit of cleanup actions . These remediation strategies restore contaminated sites to productive use with a great attention to the global environmental quality, including the preservation of soil functionality according to the following principles: use minimally invasive technologies; use passive energy technologies such as bioremediation and phytoremediation as primary remedies or finishing steps where possible and effective; minimize soil and habitat disturbance; minimize bioavailability of contaminants trough adequate contaminant source and plume control If we move from the current definition of remedial targets based on total concentrations, technologies with low impact on the environment can be utilized reducing the wrong choice to disposal soil in landfill destroying quickly a not renewable essential resource.

  15. Maternal mortality in India: current status and strategies for reduction.

    PubMed

    Prakash, A; Swain, S; Seth, A

    1991-12-01

    The causes (medical, reproductive factors, health care delivery system, and socioeconomic factors) of maternal mortality in India and strategies for reducing maternal mortality are presented. Maternal mortality rates (MMR) are very high in Asia and Africa compared with Northern Europe's 4/100,000 live births. An Indian hospital study found the MMR to be 4.21/1000 live births. 50-98% of maternal deaths are caused by direct obstetric causes (hemorrhage, infection, and hypertensive disorders, ruptured uterus, hepatitis, and anemia). 50% of maternal deaths due to sepsis are related to illegal induced abortion. MMR in India has not declined significantly in the past 15 years. Age, primi and grande multiparity, unplanned pregnancy, and related illegal abortion are the reproductive causes. In 1985 WHO reported that 63-80% of maternal deaths due to direct obstetric causes and 88-98% of all maternal deaths could probably have been prevented with proper handling. In India, coordination between levels in the delivery system and fragmentation of care account for the poor quality of maternal health care. Mass illiteracy is another cause. Effective strategies for reducing the MMR are 1) to place a high priority on maternal and child health (MCH) services and integrate vertical programs (e.g., family planning) related to MCH; 2) to give attention to care during labor and delivery, which is the most critical period for complications; 3) to provide community-based delivery huts which can provide a clean and safe delivery place close to home, and maternity waiting rooms in hospitals for high risk mothers; 4) to improve the quality of MCH care at the rural community level (proper history taking, palpation, blood pressure and fetal heart screening, risk factor screening, and referral); 5) to improve quality of care at the primary health care level (emergency care and proper referral); 6) to include in the postpartum program MCH and family planning services; 7) to examine the

  16. A holistic strategy for adaptive land management

    USGS Publications Warehouse

    Herrick, Jeffrey E.; Duniway, Michael C.; Pyke, David A.; Bestelmeyer, Brandon T.; Wills, Skye A.; Brown, Joel R.; Karl, Jason W.; Havstad, Kris M.

    2012-01-01

    Adaptive management is widely applied to natural resources management (Holling 1973; Walters and Holling 1990). Adaptive management can be generally defined as an iterative decision-making process that incorporates formulation of management objectives, actions designed to address these objectives, monitoring of results, and repeated adaptation of management until desired results are achieved (Brown and MacLeod 1996; Savory and Butterfield 1999). However, adaptive management is often criticized because very few projects ever complete more than one cycle, resulting in little adaptation and little knowledge gain (Lee 1999; Walters 2007). One significant criticism is that adaptive management is often used as a justification for undertaking actions with uncertain outcomes or as a surrogate for the development of specific, measurable indicators and monitoring programs (Lee 1999; Ruhl 2007).

  17. "Defence-in-Depth" Strategy in Transport Risk Management

    NASA Astrophysics Data System (ADS)

    Szymanek, Andrzej

    Safety management is a kind of system management, that is management by purposes. Taking "defence-in-depth" strategy, DDS - there can be defined four main aims and four method groups of risk management in transport: 1. minimizing transport accidents risk; 2. minimizing number of undesirable transport events (incidents, conflicts, collisions, accidents). Above purposes relate stages of safety management in transport. At each level of management should be elaborated methods, procedures and technologies of minimizing transport accidents risk. According to DDS any management system of transport safety should have a structure of multilevel chain protections which supervise main transport processes. About those problems in the paper.

  18. Use of single large or several small policies as strategies to manage people-park interactions.

    PubMed

    Mackenzie, Catrina A; Baird, Timothy D; Hartter, Joel

    2014-12-01

    Biodiversity conservation has been criticized for undermining or ignoring social well-being. Currently efforts to mutually promote social justice, rural development, and biodiversity conservation, which have been contentious and yielded mixed results, continue to spread despite a general dearth of effective management strategies. We contend that social and economic concerns should be integral to conservation planning and propose that the scale of these phenomena is also critical. To evaluate the merit of this proposal, we adopted and expanded a conservation management strategy framework developed by Joel Heinen and examined how population density, economic disparity, and ethnic heterogeneity vary spatially surrounding 2 contrasting protected areas in East Africa: Kibale National Park in Uganda and Tarangire National Park in Tanzania. Analyses of demographic, wealth, and ethnicity data from regional censuses and household surveys conducted in 2009 and 2010 indicated that choice of scale (landscape or community) changed the management strategies recommended by the model. Therefore, "several small" people-park management strategies varying around a given protected area may be more appropriate than a "single large" people-park strategy applied across an entire protected area. Correspondingly, scale adjusted Heinen recommendations offered new strategies for effective conservation management within these human landscapes not incorporated in current in situ management plans. PMID:25039927

  19. Conservation values and management strategies of coastal windbreaks

    NASA Astrophysics Data System (ADS)

    Lee, M. J.; Song, G. Z. M.

    2015-12-01

    Taiwan is surrounded by oceans, so that the citizens' daily lives and the industrial activities in coast areas are exposed to and affected by strong winds and dust storms caused by the winter monsoon. Tree windbreaks present the functions of windproof, dust inhibition, damp-proof, and climate moderation. However, in recent years, the construction of roads, establishment industrial districts, development of recreation areas, building of wind turbines, and the cultivation of local citizens have greatly changed the width and integrity of tree windbreak belts, and in turn affected their functionality. Our study focus on tree windbreaks right next to the estuary of the Zhoushui River in Taiwan. Through environmental investigations, questionnaire surveys for local citizens, and vegetation sureys, the current functions of windbreaks and impacts of human disturbances on windbreaks will be evaluated. The conservation values and management strategies of tree windbreaks will be proposed after all.

  20. Alzheimer's disease: current knowledge, management and research

    PubMed Central

    Gauthier, S; Panisset, M; Nalbantoglu, J; Poirier, J

    1997-01-01

    Alzheimer's disease is a common neurological condition, appearing as early as age 40 but increasing dramatically in incidence over age 85. Different genetic factors are at play, modified by events over a lifetime. Clinical diagnosis is possible through careful history taking with a reliable informant and a minimum number of laboratory tests. A relatively predictable natural history can be observed, with progression through stages of cognitive loss, functional impairment and behavioural disinhibition or apathy. New medications such as donepezil offer hope for improving or stabilizing symptoms. Such treatment can be administered by primary care physicians with experience in the diagnosis and management of Alzheimer's disease. Disease stabilization, or even prevention, may be possible in the future. PMID:9347775

  1. Current haemodynamic management of septic shock.

    PubMed

    Vincent, Jean-Louis; Orbegozo Cortés, Diego; Acheampong, Angela

    2016-04-01

    Early and adequate resuscitation of patients with acute circulatory failure is important to restore the balance between oxygen needs and delivery. Haemodynamic management can globally be separated into three categories according to the VIP mnemonic - Ventilate, Infuse, Pump - which should be considered simultaneously in the patient with shock. Sufficient oxygen should be given early, and endotracheal intubation and mechanical ventilation performed without hesitation if there is any indication that oxygenation is inadequate. Fluids should be administered using the SOSD mnemonic - Salvage, Optimization, Stabilization, De-escalation. After initial liberal administration, ongoing requirements should be guided by repeated fluid challenges using a combination of balanced crystalloid solutions and colloid. Noradrenaline is the vasopressor of choice and should be started early. Dobutamine may be needed to improve myocardial contractility and cardiac output. Haemodynamic support should be personalized according to individual patient characteristics and global and regional parameters of haemodynamic and oxygenation status. PMID:27079763

  2. [Current management of renal artery stenosis].

    PubMed

    Lenz, T

    2013-12-01

    Severe renal artery stenosis may cause renovascular hypertension; in case of bilateral narrowing or in a stenotic solitary kidney, renal insufficiency (ischemic kidney disease) or rarely pulmonary flush edema may occur. Renal artery stenosis may be treated by revascularization, using either percutaneous (balloon angioplasty, stenting) or less common open surgical procedures, both with excellent primary patency rates. However, randomized trials of renal artery angioplasty or stenting have failed to demonstrate a longer-term benefit with regard to blood pressure control and renal function over medical management alone (except for fibromuscular disease). Furthermore, endovascular procedures are associated with substantial risks. It has not yet been demonstrated that renal revascularization leads to a prolongation of event-free survival. Careful patient selection is essential to maximize the potential benefit. PMID:24217529

  3. Current diagnosis and management of hypertensive emergency.

    PubMed

    Haas, Andrew R; Marik, Paul E

    2006-01-01

    The appropriate and timely evaluation and treatment of patients with severely elevated blood pressure is essential to avoid serious adverse outcomes. Most importantly, the distinction between a hypertensive emergency (crisis) and urgency needs to be made. A sudden elevation in systolic (SBP) and/or diastolic blood pressure (DBP) that is associated with acute end organ damage (cardiovascular, cerebrovascular, or renal) is defined as a hypertensive crisis or emergency. In contrast, acute elevation in SBP and/or DBP not associated with evidence of end organ damage is defined as hypertensive urgency. In patients with a hypertensive emergency, blood pressure control should be attained as expeditiously as possible with parenteral medications to prevent ongoing and potentially permanent end organ damage. In contrast, with hypertensive urgency, blood pressure control can be achieved with the use of oral medications within 24-48 hours. This paper reviews the management of hypertensive emergencies. PMID:17150051

  4. Thymoma: current medical and surgical management.

    PubMed

    Kesler, Kenneth A; Wright, Cameron D; Loehrer, Patrick J

    2004-03-01

    Thymoma is a rare neoplasm usually with an indolent growth pattern; however, local invasion and/or dissemination may occur. Surgery has been the standard of care for early stage disease with good to excellent cure rates anticipated. This neoplasm has been found to be relatively sensitive to cisplatinum-based chemotherapy as compared with most other epithelial tumors. Aggressive multimodality therapy therefore can result in long-term disease-free survival for patients presenting with locally advanced or even disseminated disease. This chapter outlines the current medical and surgical treatment options for thymoma. PMID:15229793

  5. Current Management of Surgical Oncologic Emergencies

    PubMed Central

    Bosscher, Marianne R. F.; van Leeuwen, Barbara L.; Hoekstra, Harald J.

    2015-01-01

    Objectives For some oncologic emergencies, surgical interventions are necessary for dissolution or temporary relieve. In the absence of guidelines, the most optimal method for decision making would be in a multidisciplinary cancer conference (MCC). In an acute setting, the opportunity for multidisciplinary discussion is often not available. In this study, the management and short term outcome of patients after surgical oncologic emergency consultation was analyzed. Method A prospective registration and follow up of adult patients with surgical oncologic emergencies between 01-11-2013 and 30-04-2014. The follow up period was 30 days. Results In total, 207 patients with surgical oncologic emergencies were included. Postoperative wound infections, malignant obstruction, and clinical deterioration due to progressive disease were the most frequent conditions for surgical oncologic emergency consultation. During the follow up period, 40% of patients underwent surgery. The median number of involved medical specialties was two. Only 30% of all patients were discussed in a MCC within 30 days after emergency consultation, and only 41% of the patients who underwent surgery were discussed in a MCC. For 79% of these patients, the surgical procedure was performed before the MCC. Mortality within 30 days was 13%. Conclusion In most cases, surgery occurred without discussing the patient in a MCC, regardless of the fact that multiple medical specialties were involved in the treatment process. There is a need for prognostic aids and acute oncology pathways with structural multidisciplinary management. These will provide in faster institution of the most appropriate personalized cancer care, and prevent unnecessary investigations or invasive therapy. PMID:25933135

  6. Unique strategies for technical information management at Johnson Space Center

    NASA Technical Reports Server (NTRS)

    Krishen, Vijay

    1994-01-01

    In addition to the current NASA manned programs, the maturation of Space Station and the introduction of the Space Exploration programs are anticipated to add substantially to the number and variety of data and documentation at NASA Johnson Space Center (JSC). This growth in the next decade has been estimated at five to ten fold compared to the current numbers. There will be an increased requirement for the tracking and currency of space program data and documents with National pressures to realize economic benefits from the research and technological developments of space programs. From a global perspective the demand for NASA's technical data and documentation is anticipated to increase at local, national, and international levels. The primary users will be government, industry, and academia. In our present national strategy, NASA's research and technology will assume a great role in the revitalization of the economy and gaining international competitiveness. Thus, greater demand will be placed on NASA's data and documentation resources. In this paper the strategies and procedures developed by DDMS, Inc., to accommodate the present and future information utilization needs are presented. The DDMS, Inc., strategies and procedures rely on understanding user requirements, library management issues, and technological applications for acquiring, searching, storing, and retrieving specific information accurately and quickly. The proposed approach responds to changing customer requirements and product deliveries. The unique features of the proposed strategy include: (1) To establish customer driven data and documentation management through an innovative and unique methods to identify needs and requirements. (2) To implement a structured process which responds to user needs, aimed at minimizing costs and maximizing services, resulting in increased productivity. (3) To provide a process of standardization of services and procedures. This standardization is the central

  7. Current imaging strategies for the evaluation of uterine cervical cancer

    PubMed Central

    Bourgioti, Charis; Chatoupis, Konstantinos; Moulopoulos, Lia Angela

    2016-01-01

    Uterine cervical cancer still remains an important socioeconomic issue because it largely affects women of reproductive age. Prognosis is highly depended on extent of the disease at diagnosis and, therefore, accurate staging is crucial for optimal management. Cervical cancer is clinically staged, according to International Federation of Gynecology and Obstetrics guidelines, but, currently, there is increased use of cross sectional imaging modalities [computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography-CT (PET-CT)] for the study of important prognostic factors like tumor size, parametrial invasion, endocervical extension, pelvic side wall or adjacent/distal organs involvement and lymph node status. Imaging indications also include cervical cancer follow-up, evaluation of tumor response to treatment and selection of suitable candidates for less radical surgeries like radical trachelectomy for fertility preservation. The preferred imaging method for local cervical cancer evaluation is MRI; CT is equally effective for evaluation of extrauterine spread of the disease. PET-CT shows high diagnostic performance for the detection of tumor relapse and metastatic lymph nodes. The aim of this review is to familiarize radiologists with the MRI appearance of cervical carcinoma and to discuss the indications of cross sectional imaging during the course of the disease in patients with cervical carcinoma. PMID:27158421

  8. Current percutaneous treatment strategies for saphenous vein graft disease.

    PubMed

    Marmagkiolis, Kostantinos; Grines, Cindy; Bilodeau, Luc

    2013-09-01

    Coronary artery bypass graft surgery remains one of the most widely performed surgical procedures in North America and aortocoronary saphenous vein grafts (SVG) are the most frequently used surgical conduits. SVG disease (SVGD) remains the leading cause of symptomatic coronary artery disease postcoronary artery bypass graft. When optimal medical therapy is ineffective, repeat surgery is associated with higher mortality combined with less favorable clinical and angiographic results, thus percutaneous revascularization on SVG is currently the standard of care for the revascularization of SVGD. Balloon angioplasty, bare metal stents, polytetrafluoroethylene-covered stents, and drug-eluting stents have been extensively investigated for SVG interventions. Multiple recent randomized trials and meta-analyses have confirmed the pathophysiologic and clinical differences between SVGD and coronary artery disease. Decisions such as patient selection, premedication, stent, and protection device characteristics should be carefully considered to achieve optimal procedural and clinical results. Acute coronary syndromes due to SVG involvement, chronic total occlusions, retrograde approaches, and SVG perforation management are newer fields requesting additional research. PMID:22777812

  9. Current management of ductal carcinoma in situ.

    PubMed

    Barth, A; Brenner, R J; Giuliano, A E

    1995-10-01

    Ductal carcinoma in situ represents a biologically and histologically heterogeneous group of lesions characterized by the proliferation of neoplastic epithelial cells confined to the ducts of the breast. Before screening mammography, ductal carcinoma in situ was considered uncommon; patients were usually diagnosed by a breast mass or bloody nipple discharge, and their treatment was mastectomy. Today it represents 20% to 30% of mammographically detected breast cancers and 10% to 15% of all diagnosed breast cancers in the United States. The invariable progression of this cancer to invasive breast cancer requiring mastectomy has been challenged, but because most patients have been treated with mastectomy, knowledge about ductal carcinoma in situ is limited and primarily based on retrospective data. Further insight will emerge from randomized prospective studies that are near completion. Currently available data indicate that breast-conserving treatments are valid alternatives to mastectomy for most patients with this disease. PMID:7483593

  10. Current management of urethral stricture disease

    PubMed Central

    Smith, Thomas G.

    2016-01-01

    Introduction: Broadly defined, urethral strictures are narrowing of the urethral lumen that is surrounded by corpus spongiosum, i.e., urethral meatus through the bulbar urethra. Urethral stenosis is narrowing of the posterior urethra, i.e., membranous urethra through bladder neck/prostate junction, which is not enveloped by corpus spongiosum. The disease has significant quality of life ramifications because many times younger patients are affected by this compared to many other urological diseases. Methods: A review of the scientific literature concerning urethral stricture, stenosis, treatment, and outcomes was performed using Medline and PubMed (U.S. National Library of Medicine and the National Institutes of Health). Abstracts from scientific meetings were included in this review. Results: There is level 3 evidence regarding the etiology and epidemiology of urethral strictures, stenoses, and pelvic fracture urethral injuries. Outcomes data from literature regarding intervention for urethral stricture are largely limited to level 3 evidence and expert opinion. There is a single level 1 study comparing urethral dilation and direct vision internal urethrotomy. Urethroplasty outcomes data are limited to level 3 case series. Conclusions: Progress is being made toward consistent terminology, and nomenclature which will, in turn, help to standardize treatment within the field of urology. Treatment for urethral stricture and stenosis remains inconsistent between reconstructive and nonreconstructive urologists due to varying treatment algorithms and approaches to disease management. Tissue engineering appears to be future for reconstructive urethral surgery with reports demonstrating feasibility in the use of different tissue substitutes and grafts. PMID:26941491

  11. 10 Budget-Savvy Content Management Strategies

    ERIC Educational Resources Information Center

    Hillis, David J.

    2004-01-01

    Facing an overall budget reduction of 10 percent, most colleges or universities would postpone investing in a Web content management system. However, for California State University Monterey Bay (CSUMB), a large budget cut made Web content management even more important. CSUMB found an innovative way to purchase and implement a new Content…

  12. Federal facility compliance: Strategies, policies and management

    SciTech Connect

    1999-07-01

    Federal Facility Compliance reviews developments in environmental legislative/regulatory analysis, climate change, and environmental management practices at the US Postal Service. It also covers the management of ozone-depleting chemicals at US Army Reserve facilities, Title 5, and wastewater system assessments at military installations.

  13. Current and emerging treatment strategies for Duchenne muscular dystrophy.

    PubMed

    Mah, Jean K

    2016-01-01

    Duchenne muscular dystrophy (DMD) is the most common form of muscular dystrophy in childhood. It is caused by mutations of the DMD gene, leading to progressive muscle weakness, loss of independent ambulation by early teens, and premature death due to cardiorespiratory complications. The diagnosis can usually be made after careful review of the history and examination of affected boys presenting with developmental delay, proximal weakness, and elevated serum creatine kinase, plus confirmation by muscle biopsy or genetic testing. Precise characterization of the DMD mutation is important for genetic counseling and individualized treatment. Current standard of care includes the use of corticosteroids to prolong ambulation and to delay the onset of secondary complications. Early use of cardioprotective agents, noninvasive positive pressure ventilation, and other supportive strategies has improved the life expectancy and health-related quality of life for many young adults with DMD. New emerging treatment includes viral-mediated microdystrophin gene replacement, exon skipping to restore the reading frame, and nonsense suppression therapy to allow translation and production of a modified dystrophin protein. Other potential therapeutic targets involve upregulation of compensatory proteins, reduction of the inflammatory cascade, and enhancement of muscle regeneration. So far, data from DMD clinical trials have shown limited success in delaying disease progression; unforeseen obstacles included immune response against the generated mini-dystrophin, inconsistent evidence of dystrophin production in muscle biopsies, and failure to demonstrate a significant improvement in the primary outcome measure, as defined by the 6-minute walk test in some studies. The long-term safety and efficacy of emerging treatments will depend on the selection of appropriate clinical end points and sensitive biomarkers to detect meaningful changes in disease progression. Correction of the underlying

  14. Current and emerging treatment strategies for Duchenne muscular dystrophy

    PubMed Central

    Mah, Jean K

    2016-01-01

    Duchenne muscular dystrophy (DMD) is the most common form of muscular dystrophy in childhood. It is caused by mutations of the DMD gene, leading to progressive muscle weakness, loss of independent ambulation by early teens, and premature death due to cardiorespiratory complications. The diagnosis can usually be made after careful review of the history and examination of affected boys presenting with developmental delay, proximal weakness, and elevated serum creatine kinase, plus confirmation by muscle biopsy or genetic testing. Precise characterization of the DMD mutation is important for genetic counseling and individualized treatment. Current standard of care includes the use of corticosteroids to prolong ambulation and to delay the onset of secondary complications. Early use of cardioprotective agents, noninvasive positive pressure ventilation, and other supportive strategies has improved the life expectancy and health-related quality of life for many young adults with DMD. New emerging treatment includes viral-mediated microdystrophin gene replacement, exon skipping to restore the reading frame, and nonsense suppression therapy to allow translation and production of a modified dystrophin protein. Other potential therapeutic targets involve upregulation of compensatory proteins, reduction of the inflammatory cascade, and enhancement of muscle regeneration. So far, data from DMD clinical trials have shown limited success in delaying disease progression; unforeseen obstacles included immune response against the generated mini-dystrophin, inconsistent evidence of dystrophin production in muscle biopsies, and failure to demonstrate a significant improvement in the primary outcome measure, as defined by the 6-minute walk test in some studies. The long-term safety and efficacy of emerging treatments will depend on the selection of appropriate clinical end points and sensitive biomarkers to detect meaningful changes in disease progression. Correction of the underlying

  15. STRATEGIES FOR DEVELOPING BIOHERBICIDES FOR SUSTAINABLE WEED MANAGEMENT

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Biological weed control is an important component in sustainable crop production systems. Environmental and social pressures that shift the dependency on chemical herbicides towards integrated weed management strategies have provided opportunities for use of bioherbicides. A pragmatic approach in ...

  16. Spatial strategies for managing visitor impacts in National Parks

    USGS Publications Warehouse

    Leung, Y.-F.; Marion, J.L.

    1999-01-01

    Resource and social impacts caused by recreationists and tourists have become a management concern in national parks and equivalent protected areas. The need to contain visitor impacts within acceptable limits has prompted park and protected area managers to implement a wide variety of strategies and actions, many of which are spatial in nature. This paper classifies and illustrates the basic spatial strategies for managing visitor impacts in parks and protected areas. A typology of four spatial strategies was proposed based on the recreation and park management literature. Spatial segregation is a common strategy for shielding sensitive resources from visitor impacts or for separating potentially conflicting types of use. Two forms of spatial segregation are zoning and closure. A spatial containment strategy is intended to minimize the aggregate extent of visitor impacts by confining use to limited designated or established Iocations. In contrast, a spatial dispersal strategy seeks to spread visitor use, reducing the frequency of use to levels that avoid or minimize permanent resource impacts or visitor crowding and conflict. Finally, a spatial configuration strategy minimizes impacting visitor behavior though the judicious spatial arrangement of facilities. These four spatial strategics can be implemented separately or in combination at varying spatial scales within a single park. A survey of national park managers provides an empirical example of the diversity of implemented spatial strategies in managing visitor impacts. Spatial segregation is frequently applied in the form of camping restrictions or closures to protect sensitive natural or cultural resources and to separate incompatible visitor activities. Spatial containment is the most widely applied strategy for minimizing the areal extent of resource impacts. Spatial dispersal is commonly applied to reduce visitor crowding or conflicts in popular destination areas but is less frequently applied or

  17. The current management of septic shock.

    PubMed

    Russel, J A

    2008-10-01

    This is a review of the management of septic shock that suggests an approach to treatment (ABCDEF: Airway, Breathing, Circulation, Drugs, Evaluate the source of sepsis, Fix the source of sepsis) for clinicians. The incidence of septic shock is increasing and mortality ranges from 30% to 70%. The commonest sources of infection are lung (25%), abdomen (25%), and other sources. Septic shock occurs because of highly complex interactions between the infecting microorganism(s) and the responses of the human host. The innate immune response is rapidly followed by the more specific adaptive immune response. Septic shock is characterized by alterations in the coagulant/anticoagulant balance such that there is a more pro-coagulant phenotype. Lung protective ventilation (which means the use of relatively low tidal volumes of 4 -6 mL/kg ideal body weight) is recommended for treatment of patients who have septic shock. Rivers early goal-directed therapy is recommended because it showed a significant increase in survival. Surviving Sepsis guidelines recommend resuscitation of septic shock with either crystalloid or colloid. Patients who have septic shock should be treated with intravenous broad-spectrum antibiotics as rapidly as possible and certainly within one hour. Activated protein C (APC) is a vitamin K dependent serine protease that is an anticoagulant and is also cytoprotective and anti-inflammatory. APC (24 mg/kg/hour infusion for 96 hours) decreased mortality (APC 25% vs placebo 31%, relative risk 0.81P=0.005) and improved organ dysfunction in patients at high risk of death (e.g. APACHE II >25 [APC 31% vs placebo 44%]). APC is not recommended to treat surgical patients who have one organ system dysfunction. In 2006, the European regulatory authority indicated that there must be another randomized placebo-controlled trial of APC to further establish efficacy as assessed by mortality reduction. Vasopressin is a key stress hormone in response to hypotension. The VASST

  18. Management of asthma in adults: current therapy and future directions

    PubMed Central

    Green, R; Brightling, C; Pavord, I; Wardlaw, A

    2003-01-01

    Asthma is increasing in prevalence worldwide and results in significant use of healthcare resources. Although most patients with asthma can be adequately treated with inhaled corticosteroids, an important number of patients require additional therapy and an increasing number of options are available. A further minority of patients develop severe persistent asthma which remains difficult to manage despite current pharmacological therapies. This review discusses the various treatment options currently available for each stage of asthma severity, highlights some of the limitations of current management, and outlines directions which may improve the management of asthma in the future. PMID:12782771

  19. Current concepts in the management of gonorrhoea.

    PubMed

    Tapsall, John

    2002-02-01

    The incidence of gonorrhoea is again rising in developed countries and a high disease rate has been maintained in less developed regions for a number of years. The need not only for treatment of the individual but also for control of gonorrhoea at a community level has increased significantly following recognition of its role in the amplification of human immunodeficiency virus (HIV) transmission. A sustainable decrease in the incidence of gonorrhoea and other sexually transmitted diseases (STDs) requires an integrated approach combining improved prevention, better diagnosis and optimal treatment. Effective antibiotic treatment is an essential element of this approach. However, antibiotic treatment of gonorrhoea has been severely hampered by the development of antibiotic resistance in Neisseria gonorrhoeae, to the extent that many therapies are no longer effective. Those treatments that retain acceptable efficacy are often unaffordable where they are most needed. Penicillins and tetracyclines should no longer be used in gonococcal disease, there are limitations on the effectiveness of newer macrolides and spectinomycin and in many parts of the world quinolones have been withdrawn from schedules for the treatment of gonorrhoea. Of all the current agents used to treat all forms of gonococcal disease, only the third generation cephalosporins (most notably ceftriaxone) have retained their efficacy; however, decreased susceptibility to these antibiotics has also appeared. Continuing reliance on antibiotic treatment for controlling gonorrhoea in the absence of other necessary approaches will see a further deterioration in the situation. In these circumstances the possibility that gonorrhoea will be untreatable becomes more real. PMID:11829728

  20. Current Pharmacological Management of Gastroesophageal Reflux Disease

    PubMed Central

    Wang, Yao-Kuang; Hsu, Wen-Hung; Wang, Sophie S. W.; Lu, Chien-Yu; Kuo, Fu-Chen; Su, Yu-Chung; Yang, Sheau-Fang; Chen, Chiao-Yun; Wu, Deng-Chyang

    2013-01-01

    Gastroesophageal reflux disease (GERD), a common disorder with troublesome symptoms caused by reflux of gastric contents into the esophagus, has adverse impact on quality of life. A variety of medications have been used in GERD treatment, and acid suppression therapy is the mainstay of treatment for GERD. Although proton pump inhibitor is the most potent acid suppressant and provides good efficacy in esophagitis healing and symptom relief, about one-third of patients with GERD still have persistent symptoms with poor response to standard dose PPI. Antacids, alginate, histamine type-2 receptor antagonists, and prokinetic agents are usually used as add-on therapy to PPI in clinical practice. Development of novel therapeutic agents has focused on the underlying mechanisms of GERD, such as transient lower esophageal sphincter relaxation, motility disorder, mucosal protection, and esophageal hypersensitivity. Newer formulations of PPI with faster and longer duration of action and potassium-competitive acid blocker, a newer acid suppressant, have also been investigated in clinical trials. In this review, we summarize the current and developing therapeutic agents for GERD treatment. PMID:23878534

  1. Analysis of Human Resources Management Strategy in China Electronic Commerce Enterprises

    NASA Astrophysics Data System (ADS)

    Shao, Fang

    The paper discussed electronic-commerce's influence on enterprise human resources management, proposed and proved the human resources management strategy which electronic commerce enterprise should adopt from recruitment strategy to training strategy, keeping talent strategy and other ways.

  2. Knowledge Management and the Competitive Strategy of the Firm

    ERIC Educational Resources Information Center

    Halawi, Leila A.; McCarthy, Richard V.; Aronson, Jay E.

    2006-01-01

    Purpose: Knowledge management (KM) has emerged as a strategy to improve organizational competitiveness. Our purpose is to identify the relationship between KM and the firm's competitive advantage. Design/methodology/approach: We review the existing literature on KM and strategy formulation. We utilize the resource-based view approach as a lens for…

  3. CHOOSING OPTIMUM MANAGEMENT STRATEGIES FOR POLLUTION CONTROL

    EPA Science Inventory

    This seminar publication is addressed to managers and supervisors who have some responsibility for their plant's pollution control measures. The information and guidance provided to these decision personnel are drawn from case histories of working plants and include laws, regulat...

  4. Strategies for Crisis Management in the Schools.

    ERIC Educational Resources Information Center

    Thompson, Rosemary A.

    1990-01-01

    As violence and suicide increase in our society, educators are helping students, staff members, and families cope with the sudden loss of a peer or child. Pragmatic intervention strategies can help survivors deal with their reactions to sudden death and posttraumatic stress disorders. Counseling techniques are also outlined. (MLH)

  5. Current concepts of oxygen management in retinopathy of prematurity.

    PubMed

    Owen, Leah A; Hartnett, M Elizabeth

    2014-01-01

    Retinopathy of prematurity (ROP) is a potentially blinding disorder in premature infants. The underlying pathophysiology is incompletely understood, limiting the prevention and treatment of this devastating condition. Current therapies are directed toward management of aberrant neovascularization thought to result from retinal ischemia in the developing preterm retina. The molecular mediators important for development of retinal ischemia and subsequent neovascular pathology are not fully understood. However, oxygen has been shown to be a key mediator of disease and the oxygen environment for preterm infants has been extensively studied. Despite this, the optimal oxygen environment for preterm infants remains unclear and recent works seeking to clarify this relationship demonstrate somewhat disparate findings. These data further substantiate that ROP is a complex disease with multifactorial etiology including genetic and environmental factors. Therefore, while environmental factors such as oxygen are important to our understanding of the disease process and care of preterm infants, identification of the molecular mediators downstream of oxygen which are necessary for development of ROP pathology will be critical to improve prevention, diagnosis and treatment strategies. PMID:24982738

  6. Current update in the management of diabetic nephropathy.

    PubMed

    Van Buren, Peter Noel; Toto, Robert

    2013-01-01

    Diabetic nephropathy is the leading cause of end-stage renal disease in the United States. The progression of kidney disease in patients with diabetes can take many years, and interventions such as glycemic control, blood pressure control, and inhibition of the renin-angiotensin-aldosterone system have been shown to slow this progression. Despite the implementation of these strategies, the number of patients with diabetes that ultimately develop end-stage renal disease remains high. Recent investigation has focused on the optimization of renin-angiotensin-aldosterone system blockade in patients with diabetic nephropathy using combinations of drugs that target this pathway. Additional investigation has focused on the potential of novel therapies that either target various pathways upregulated by hyperglycemia or other targets believed to promote progression of diabetic nephropathy such as the endothelin system, inflammation and vitamin D receptors. This review article addresses some of the well-established principles regarding the progression and accepted management of diabetic nephropathy and includes current updates on the most recent clinical research trials exploring novel therapeutics in this field. PMID:23167665

  7. Managing organizational change: strategies for the female health care supervisor.

    PubMed

    Davies, G

    1990-07-01

    In responding to resistance to change in the current health care organization, the new female supervisor can learn to support her staff in encountering and accepting these changes. The strategies and skills discussed above are characteristic of a supervisory style that may naturally occur for women, but also can be incorporated into the leadership style of men in health care management today. Health care leaders of tomorrow must work from an androgynous framework in which the behavior patterns and responses of each gender are learned and used appropriately by both men and women. Sargent suggests that the best managers are androgynous and that this is the inevitable wave of the future. Whether man or woman, a supervisor should learn, accept, and use methods that are characteristic of both sexes to be successful in managing people. Women and men must learn from each other's strengths and share these diverse skills. Given that women now outnumber men in health care management positions and organizations are changing to a more nurturing environment, the androgynous supervisor will be the successful leader of the future. Finally, women in health care supervisory positions have the potential to bring change where it is badly needed. Women in these roles often have a system wide view of health care policy issues that recognizes less federal commitment to social programs. Many women in health care positions believe that the issues of children, women, the elderly, the poor, and the homeless need focused attention. The growing number of women in health care supervisory and leadership roles is an important factor in changing national health policy for the benefit of these groups.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:10105044

  8. Strategies for managing impressions of racial identity in the workplace.

    PubMed

    Roberts, Laura Morgan; Cha, Sandra E; Kim, Sung Soo

    2014-10-01

    This article deepens understanding of the workplace experiences of racial minorities by investigating racial identity-based impression management (RIM) by Asian American journalists. Racial centrality, directly or indirectly, predicted the use of 4 RIM strategies (avoidance, enhancement, affiliation, and racial humor). Professional centrality also predicted strategy use, which was related to life satisfaction and perceived career success. By shedding light on proactive strategies that individuals use to influence colleagues' impressions of their racial identity, we contribute to research on diversity in organizations, impression management, and racial identity. PMID:25090148

  9. Classroom Management Strategies and Behavioral Interventions to Support Academic Achievement

    ERIC Educational Resources Information Center

    Gilpatrick, Robin Sue Holzworth

    2010-01-01

    This mixed method project study identified the need for effective classroom management strategies to dissuade student noncompliant behavior and to ensure academic success for all students. Enhancing classroom management practices is vital to improved student achievement and teacher self-efficacy. Within a constructivist framework, it is critical…

  10. A Strategy for Optimizing Item-Pool Management

    ERIC Educational Resources Information Center

    Ariel, Adelaide; van der Linden, Wim J.; Veldkamp, Bernard P.

    2006-01-01

    Item-pool management requires a balancing act between the input of new items into the pool and the output of tests assembled from it. A strategy for optimizing item-pool management is presented that is based on the idea of a periodic update of an optimal blueprint for the item pool to tune item production to test assembly. A simulation study with…

  11. Delegation: Win-Win Strategies for Managing Early Childhood Settings.

    ERIC Educational Resources Information Center

    Hayden, Jacqueline

    1999-01-01

    This issue of the Australian Early Childhood Association Research in Practice Series provides staff management strategies for directors and others involved with the management of early childhood settings and suggests ways to effectively delegate authority and tasks in order to reduce administrative pressures and workload. The booklet presents…

  12. Ecological principles underpinning invasive plant management tools and strategies

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The broad focus of ecologically-based invasive plant management is to identify and repair the ecological processes facilitating plant invasion. To be useful, however, EBIPM requires that our application of management tools and strategies be based on ecological principles that determine the rate and ...

  13. A Policy Change Strategy for Head Lice Management

    ERIC Educational Resources Information Center

    Andresen, Kathleen; McCarthy, Ann Marie

    2009-01-01

    The purpose of this project was to formulate an effective change strategy for head lice management in a group of five separate school districts within one county. Despite a desire to use evidence to support their practice, school nurses often encounter educational system barriers that prevent independent management of health conditions. The use of…

  14. Current Issues for Higher Education Information Resources Management.

    ERIC Educational Resources Information Center

    CAUSE/EFFECT, 1995

    1995-01-01

    Current issues that are important for the future of information resources management in higher education are presented. They include: integrating planning for information resources within institution-wide strategic planning; reengineering fundamental services; change management; distributed computing support; networking; the changing communication…

  15. Multigeneration employees: strategies for effective management.

    PubMed

    Kupperschmidt, B R

    2000-09-01

    Today's health care workforce comprises Traditional, Baby Boomer, and Generation X employees. Effective managers must understand the times and generational characteristics of these employees and they must assure that employees understand and respect one another's differences. They must foster open discussion of how generational differences influence attitudes toward work and organizations. They must provide opportunities for multigeneration employees to contribute their best concurrent with meeting organizational goals. Employees must be offered a conditional security based upon value-added results and collaboration. Managers must use leadership practices that encourage the hearts of dispirited employees. PMID:11183655

  16. In vitro genotoxicity testing strategy for nanomaterials and the adaptation of current OECD guidelines

    PubMed Central

    Doak, S.H.; Manshian, B.; Jenkins, G.J.S.; Singh, N.

    2012-01-01

    There is a pressing requirement to define a hazard identification and risk management strategy for nanomaterials due to the rapid growth in the nanotechnology industry and their promise of life-style revolutions through the development of wide-ranging nano-containing consumer products. Consequently, a battery of well defined and appropriate in vitro assays to assess a number of genotoxicity endpoints is required to minimise extensive and costly in vivo testing. However, the validity of the established protocols in current OECD recognised genotoxicity assays for nanomaterials is currently being questioned. In this report, we therefore consider the in vitro OECD genotoxicity test battery including the Ames, micronucleus and HPRT forward mutation assays, and their potential role in the safety assessment of nanomaterial induced DNA damage in vitro. PMID:21971291

  17. Managing incidental pancreatic cystic neoplasms with integrated molecular pathology is a cost-effective strategy

    PubMed Central

    Das, Ananya; Brugge, William; Mishra, Girish; Smith, Dennis M.; Sachdev, Mankanwal; Ellsworth, Eric

    2015-01-01

    Background and study aims: Current guidelines recommend using endoscopic ultrasound (EUS), carcinoembryonic antigen (CEA) testing and cytology to manage incidental pancreatic cystic neoplasms (PCN); however, studies suggest a strategy including integrated molecular pathology (IMP) of cyst fluid may further aid in predicting risk of malignancy. Here, we evaluate several strategies for diagnosing and managing asymptomatic PCN using healthcare economic modeling. Patients and methods: A third-party-payer perspective Markov decision model examined four management strategies in a hypothetical cohort of 1000 asymptomatic patients incidentally found to have a 3 cm solitary pancreatic cystic lesion. Strategy I used cross-sectional imaging, recommended surgery only if symptoms or risk factors emerged. Strategy II considered patients for resection without initial EUS. Strategy III (EUS + CEA + Cytology) referred only those with mucinous cysts (CEA > 192 ng/mL) for resection. Strategy IV implemented IMP; a commercially available panel provided a “Benign,” “Mucinous,” or “Aggressive” classification based on the level of mutational change in cyst fluid. “Benign” and “Mucinous” patients were followed with surveillance; “Aggressive” patients were referred for resection. Quality-adjusted life-years (QALY), relative risk with 95 %CI, Number Needed to Treat (NNT), and incremental cost-effectiveness ratios were calculated. Results: Strategy IV provided the greatest increase in QALY at nearly identical cost to the cheapest approach, Strategy I. Relative risk of malignancy compared to the current standard of care and nearest competing strategy, Strategy III, was 0.18 (95 %CI 0.06 – 0.53) with an NNT of 56 (95 %CI 34 – 120). Conclusions: Use of IMP was the most cost-effective strategy, supporting its routine clinical use. PMID:26528505

  18. Emotion Management and Strategies for Social Interaction.

    ERIC Educational Resources Information Center

    Saarni, Carolyn

    Emotion scripts provide children with culturally meaningful emotional experiences and plans of action for managing feelings and the circumstances surrounding emotional experiences. In an effort to understand how developing children acquire these emotion scripts, two studies described here investigated how children deploy emotion scripts to manage…

  19. Case management: planning and coordinating strategies.

    PubMed

    Walden, T; Hammer, K; Kurland, C H

    1990-01-01

    In summary, planning a case management system involves moving through sequenced stages; namely, (1) a developmental stage; (2) a phase-in stage; and (3) an operational stage. During the developmental stage, before processes have been formalized, attention is given to the political realities, the formation of a representative planning group, formulating goals and objectives, obtaining administrative support, information gathering, assessment of needs, resource procurement, program structure and design, selection of a case management model, participatory decision making, determining organizational fit, and beginning networking. During the phase-in or early implementation state, the formal stage of system introduction, attention is given to the establishment of interorganizational relationships, contracting for services, job descriptions, work assignments, training, problem solving, and conflict resolution. During the operational or full implementation stage, a period when the system should become more stabilized, attention needs to be given to managing movement of the client through the system, the flow of information, program updating, quality assurance, recordkeeping, resource management, evaluating, and system refurbishing. In practice, these stages will interact and overlap. Closure, if the system is to remain viable and open to change, should never occur. PMID:10110505

  20. Classroom Management: Students' Perspectives, Goals and Strategies.

    ERIC Educational Resources Information Center

    Allen, James D.

    A study investigated classroom management from the students' perspective. Ninety-seven high school students (primarily ninth graders) were observed in one school for 15 weeks in five different classes. Data were collected from this observation, as well as from student and teacher interviews. The guidelines of the Constant-Comparative Method of…

  1. Reservoir management strategy for East Randolph Field, Randolph Township, Portage County, Ohio

    SciTech Connect

    Safley, L.E.; Salamy, S.P.; Young, M.A.; Fowler, M.L.; Wing, J.L.; Thomas, J.B.; Mills, J.; Wood, D.

    1998-07-01

    The primary objective of the Reservoir Management Field Demonstration Program is to demonstrate that multidisciplinary reservoir management teams using appropriate software and methodologies with efforts scaled to the size of the resource are a cost-effective method for: Increasing current profitability of field operations; Forestalling abandonment of the reservoir; and Improving long-term economic recovery for the company. The primary objective of the Reservoir Management Demonstration Project with Belden and Blake Corporation is to develop a comprehensive reservoir management strategy to improve the operational economics and optimize oil production from East Randolph field, Randolph Township, Portage County, Ohio. This strategy identifies the viable improved recovery process options and defines related operational and facility requirements. In addition, strategies are addressed for field operation problems, such as paraffin buildup, hydraulic fracture stimulation, pumping system optimization, and production treatment requirements, with the goal of reducing operating costs and improving oil recovery.

  2. Wastewater reclamation and recharge: A water management strategy for Albuquerque

    SciTech Connect

    Gorder, P.J.; Brunswick, R.J.; Bockemeier, S.W.

    1995-12-31

    Approximately 61,000 acre-feet of the pumped water is annually discharged to the Rio Grande as treated wastewater. Albuquerque`s Southside Water Reclamation Plant (SWRP) is the primary wastewater treatment facility for most of the Albuquerque area. Its current design capacity is 76 million gallons per day (mgd), which is expected to be adequate until about 2004. A master plan currently is being prepared (discussed here in Wastewater Master Planning and the Zero Discharge Concept section) to provide guidelines for future expansions of the plant and wastewater infrastructure. Construction documents presently are being prepared to add ammonia and nitrogen removal capability to the plant, as required by its new discharge permit. The paper discusses water management strategies, indirect potable reuse for Albuquerque, water quality considerations for indirect potable reuse, treatment for potable reuse, geohydrological aspects of a recharge program, layout and estimated costs for a conceptual reclamation and recharge system, and work to be accomplished under phase 2 of the reclamation and recharge program.

  3. Solubility and dissolution enhancement strategies: current understanding and recent trends.

    PubMed

    Jain, Shashank; Patel, Niketkumar; Lin, Senshang

    2015-06-01

    Identification of lead compounds with higher molecular weight and lower aqueous solubility has become increasingly prevalent with the advent of high throughput screening. Poor aqueous solubility of these lipophilic compounds can drastically affect the dissolution rate and subsequently the drug absorbed in the systemic circulation, imposing a significant burden of time and money during drug development process. Various pre-formulation and formulation strategies have been applied in the past that can improve the aqueous solubility of lipophilic compounds by manipulating either the crystal lattice properties or the activity coefficient of a solute in solution or both, if possible. However, despite various strategies available in the armor of formulation scientist, solubility issue still remains an overriding problem in the drug development process. It is perhaps due to the insufficient conceptual understanding of solubility and dissolution phenomenon that hinders the judgment in selecting suitable strategy for improving aqueous solubility and/or dissolution rate. This article, therefore, focuses on (i) revisiting the theoretical and mathematical concepts associated with solubility and dissolution, (ii) their application in making rationale decision for selecting suitable pre-formulation and formulation strategies and (iii) the relevant research performed in this field in past decade. PMID:25342479

  4. Understanding beef-cattle farming management strategies by identifying motivations behind farmers' priorities.

    PubMed

    Magne, M A; Cerf, M; Ingrand, S

    2012-06-01

    This study aimed to identify and better understand management strategies that help livestock farmers adapt to changes in their production contexts, a fundamental challenge. A total of nine beef-cattle farmers were interviewed three times over 1 year to discuss 13 dimensions of livestock farming (e.g. reproduction, feeding, sales, etc.). Characterisation of management strategies rested on three main factors: (i) ranking of the dimensions according to the degree to which farmers desired to control them, (ii) reasons for the ranking and (iii) management guidelines. Although farmers agreed upon the rank of certain dimensions, such as herd management, they differed on that of others, such as sales and administration/regulations. Four motivation categories were identified: risk, pleasure, efficiency and ability to control the dimension. Three management guidelines were identified, which indicated that farmers managed for future survival of their farms at different scales (animal/herd v. whole-farm), involving different resources (biological v. financial) and based on different animal categories (reproductive cows v. animals sold). These results improve understanding of individual livestock farmers and their current management strategies by integrating the motivations behind their strategies. For this reason, they constitute methodological elements that agricultural advisors can use to provide relevant information to farmers while accommodating differences in farm management. PMID:22558968

  5. Result Merging Strategies for a Current News Metasearcher.

    ERIC Educational Resources Information Center

    Rasolofo, Yves; Hawking, David; Savoy, Jacques

    2003-01-01

    Metasearching of online current news services is a potentially useful Web application of distributed information retrieval techniques. Reports experiences in building a metasearcher designed to provide up-to-date searching over a significant number of rapidly changing current news sites, focusing on how to merge results from the search engines at…

  6. Nonpharmacologic strategies in the management of insomnia.

    PubMed

    Yang, Chien-Ming; Spielman, Arthur J; Glovinsky, Paul

    2006-12-01

    Many psychiatric patients have significant sleep disturbance. Insomnia should be addressed directly even when comorbid with a psychiatric disorder. Nonpharmacologic treatments are effective and especially well suited for long-term management of sleep problems. Although the techniques themselves are fairly straightforward, they work best when applied with the kind of clinical insight and experience that psychiatrists regularly draw on in their practices. This article briefly reviews the evaluation of insomnia, with the aim of eliciting clinical material sufficiently comprehensive to inform the choice of treatment, and provides a practical overview of the basic nondrug approaches to insomnia, emphasizing what the clinician and the patient may expect from their application. PMID:17118274

  7. Xcel Energy implements an alarm management strategy

    SciTech Connect

    Bass, J.; Abreu, G.

    2007-11-15

    Not so long ago, Xcel Energy's Pawnee Station, a 505 MW coal-fired generating station in Brush, Colorado, USA was commonly generating 300 to 400 alarms per 8-hour shift. The article describes how the alarm system was revised and improved by tackling alarm dead-bands, and rationalising alarms for routine events. Operators are trained to understand the functions of alarm management components, their use and response, and obtain feedback. Today the power station reports about one alarm per hour. 3 photos.

  8. Prevention-centered caries management strategies during critical periods in early childhood.

    PubMed

    Milgrom, Peter; Chi, Donald L

    2011-10-01

    The current caries management model in the United States is based on restoring teeth rather than preventing disease. Scarce resources make this approach unsustainable, especially in clinical settings that serve vulnerable child populations. This paper presents specific prevention-centered caries management strategies that should form the basis of clinical interventions targeted at children during four critical periods in childhood: pre-age 1, ages 1-3, ages 4-5, and ages 6-7. PMID:22132585

  9. Complexity Science Applications to Dynamic Trajectory Management: Research Strategies

    NASA Technical Reports Server (NTRS)

    Sawhill, Bruce; Herriot, James; Holmes, Bruce J.; Alexandrov, Natalia

    2009-01-01

    The promise of the Next Generation Air Transportation System (NextGen) is strongly tied to the concept of trajectory-based operations in the national airspace system. Existing efforts to develop trajectory management concepts are largely focused on individual trajectories, optimized independently, then de-conflicted among each other, and individually re-optimized, as possible. The benefits in capacity, fuel, and time are valuable, though perhaps could be greater through alternative strategies. The concept of agent-based trajectories offers a strategy for automation of simultaneous multiple trajectory management. The anticipated result of the strategy would be dynamic management of multiple trajectories with interacting and interdependent outcomes that satisfy multiple, conflicting constraints. These constraints would include the business case for operators, the capacity case for the Air Navigation Service Provider (ANSP), and the environmental case for noise and emissions. The benefits in capacity, fuel, and time might be improved over those possible under individual trajectory management approaches. The proposed approach relies on computational agent-based modeling (ABM), combinatorial mathematics, as well as application of "traffic physics" concepts to the challenge, and modeling and simulation capabilities. The proposed strategy could support transforming air traffic control from managing individual aircraft behaviors to managing systemic behavior of air traffic in the NAS. A system built on the approach could provide the ability to know when regions of airspace approach being "full," that is, having non-viable local solution space for optimizing trajectories in advance.

  10. Current Strategies to Improve the Bioactivity of PEEK

    PubMed Central

    Ma, Rui; Tang, Tingting

    2014-01-01

    The synthetic thermoplastic polymer polyetheretherketone (PEEK) is becoming a popular component of clinical orthopedic and spinal applications, but its practical use suffers from several limitations. Although PEEK is biocompatible, chemically stable, radiolucent and has an elastic modulus similar to that of normal human bone, it is biologically inert, preventing good integration with adjacent bone tissues upon implantation. Recent efforts have focused on increasing the bioactivity of PEEK to improve the bone-implant interface. Two main strategies have been used to overcome the inert character of PEEK. One approach is surface modification to activate PEEK through surface treatment alone or in combination with a surface coating. Another strategy is to prepare bioactive PEEK composites by impregnating bioactive materials into PEEK substrate. Researchers believe that modified bioactive PEEK will have a wide range of orthopedic applications. PMID:24686515

  11. Current Diagnostic and Therapeutic Strategies in Microvascular Angina

    PubMed Central

    Mumma, Bryn; Flacke, Nathalie

    2014-01-01

    Microvascular angina is common among patients with signs and symptoms of acute coronary syndrome and is associated with an increased risk of cardiovascular and cerebrovascular events. Unfortunately, microvascular is often under-recognized in clinical settings. The diagnosis of microvascular angina relies on assessment of the functional status of the coronary microvasculature. Invasive strategies include acetylcholine provocation, intracoronary Doppler ultrasound, and intracoronary thermodilution; noninvasive strategies include cardiac positron emission tomography (PET), cardiac magnetic resonance, and Doppler echocardiography. Once the diagnosis of microvascular angina is established, treatment is focused on improving symptoms and reducing future risk of cardiovascular and cerebrovascular events. Pharmacologic options and lifestyle modifications for patients with microvascular angina are similar to those for patients with coronary artery disease. PMID:25685641

  12. MicroRNA Detection: Current Technology and Research Strategies

    NASA Astrophysics Data System (ADS)

    Hunt, Eric A.; Broyles, David; Head, Trajen; Deo, Sapna K.

    2015-07-01

    The relatively new field of microRNA (miR) has experienced rapid growth in methodology associated with its detection and bioanalysis as well as with its role in -omics research, clinical diagnostics, and new therapeutic strategies. The breadth of this area of research and the seemingly exponential increase in number of publications on the subject can present scientists new to the field with a daunting amount of information to evaluate. This review aims to provide a collective overview of miR detection methods by relating conventional, established techniques [such as quantitative reverse transcription polymerase chain reaction (RT-qPCR), microarray, and Northern blotting (NB)] and relatively recent advancements [such as next-generation sequencing (NGS), highly sensitive biosensors, and computational prediction of microRNA/targets] to common miR research strategies. This should guide interested readers toward a more focused study of miR research and the surrounding technology.

  13. Current strategies for probing substrate specificity of proteases.

    PubMed

    Poreba, M; Drag, M

    2010-01-01

    In this review we describe in detail the available technologies used for investigating the substrate specificity of proteases. Critical comparison of the available detection methods and their choice for certain type of screening is discussed. We present successful strategies along with appropriate examples for the design and synthesis of combinatorial libraries of substrates using both chemical and biological approaches. Proteomic tools for the identification of natural substrates of proteases are also discussed. PMID:20939826

  14. A framework for the assessment of severe accident management strategies

    SciTech Connect

    Kastenberg, W.E.; Apostolakis, G.; Dhir, V.K.

    1993-09-01

    Severe accident management can be defined as the use of existing and/or altemative resources, systems and actors to prevent or mitigate a core-melt accident. For each accident sequence and each combination of severe accident management strategies, there may be several options available to the operator, and each involves phenomenological and operational considerations regarding uncertainty. Operational uncertainties include operator, system and instrumentation behavior during an accident. A framework based on decision trees and influence diagrams has been developed which incorporates such criteria as feasibility, effectiveness, and adverse effects, for evaluating potential severe accident management strategies. The framework is also capable of propagating both data and model uncertainty. It is applied to several potential strategies including PWR cavity flooding, BWR drywell flooding, PWR depressurization and PWR feed and bleed.

  15. Management strategy of solitary pulmonary nodules

    PubMed Central

    Zhan, Ping; Xu, Chunhua; Hao, Keke; Hou, Zhibo; Song, Yong

    2013-01-01

    Solitary pulmonary nodules (SPNs) are increasingly detected with the widespread use of chest computed tomography (CT) scans. The management of patients with SPN should begin with estimating the probability of cancer from the patient’s clinical risk factors and CT characteristics. The decision-making process need to incorporate the probability of cancer, the potential benefits and harms of surgery, the accuracy of the available diagnostic tests and patient preferences. For patients with a very low probability of cancer, careful observation with serial CT is warranted. For patients in the intermediate range of probabilities, either CT-guided fine-needle aspiration biopsy (FNAB) or positron emission tomography (PET), is recommended. For those with a high probability of cancer, surgical diagnosis is warranted. PMID:24409361

  16. Management strategy of solitary pulmonary nodules.

    PubMed

    Zhan, Ping; Xie, Haiyan; Xu, Chunhua; Hao, Keke; Hou, Zhibo; Song, Yong

    2013-12-01

    Solitary pulmonary nodules (SPNs) are increasingly detected with the widespread use of chest computed tomography (CT) scans. The management of patients with SPN should begin with estimating the probability of cancer from the patient's clinical risk factors and CT characteristics. The decision-making process need to incorporate the probability of cancer, the potential benefits and harms of surgery, the accuracy of the available diagnostic tests and patient preferences. For patients with a very low probability of cancer, careful observation with serial CT is warranted. For patients in the intermediate range of probabilities, either CT-guided fine-needle aspiration biopsy (FNAB) or positron emission tomography (PET), is recommended. For those with a high probability of cancer, surgical diagnosis is warranted. PMID:24409361

  17. Technology and Current Reading/Literacy Assessment Strategies

    ERIC Educational Resources Information Center

    Balajthy, Ernest

    2007-01-01

    Computer-based technologies offer promise as a means to assess students and provide teachers with better understandings of their students' achievement. This article describes recent developments in computer-based and web-based reading and literacy assessment, focusing on assessment administration, information management, and report creation. In…

  18. Power Management Based Current Control Technique for Photovoltaic-Battery Assisted Wind-Hydro Hybrid System

    NASA Astrophysics Data System (ADS)

    Ram Prabhakar, J.; Ragavan, K.

    2013-07-01

    This article proposes new power management based current control strategy for integrated wind-solar-hydro system equipped with battery storage mechanism. In this control technique, an indirect estimation of load current is done, through energy balance model, DC-link voltage control and droop control. This system features simpler energy management strategy and necessitates few power electronic converters, thereby minimizing the cost of the system. The generation-demand (G-D) management diagram is formulated based on the stochastic weather conditions and demand, which would likely moderate the gap between both. The features of management strategy deploying energy balance model include (1) regulating DC-link voltage within specified tolerances, (2) isolated operation without relying on external electric power transmission network, (3) indirect current control of hydro turbine driven induction generator and (4) seamless transition between grid-connected and off-grid operation modes. Furthermore, structuring of the hybrid system with appropriate selection of control variables enables power sharing among each energy conversion systems and battery storage mechanism. By addressing these intricacies, it is viable to regulate the frequency and voltage of the remote network at load end. The performance of the proposed composite scheme is demonstrated through time-domain simulation in MATLAB/Simulink environment.

  19. Roles of managers in academic health centers: strategies for the managed care environment.

    PubMed

    Guo, Kristina L

    2002-03-01

    This article addresses survival strategies of academic health centers (AHCs) in responding to market pressures and government reforms. Using six case studies of AHCs, the study links strategic changes in structure and management to managerial role performance. Utilizing Mintzberg's classification of work roles, the roles of liaison, monitor, entrepreneur, and resource allocator were found to be used by top-level managers as they implement strategies to enhance the viability of their AHCs. Based on these new roles, the study recommends improving management practices through education and training as well as changing organizational culture to support management decision making and foster the continued growth of managers and their AHCs. PMID:11944815

  20. SECONDARY WASTE MANAGEMENT STRATEGY FOR EARLY LOW ACTIVITY WASTE TREATMENT

    SciTech Connect

    TW, CRAWFORD

    2008-07-17

    This study evaluates parameters relevant to River Protection Project secondary waste streams generated during Early Low Activity Waste operations and recommends a strategy for secondary waste management that considers groundwater impact, cost, and programmatic risk. The recommended strategy for managing River Protection Project secondary waste is focused on improvements in the Effiuent Treatment Facility. Baseline plans to build a Solidification Treatment Unit adjacent to Effluent Treatment Facility should be enhanced to improve solid waste performance and mitigate corrosion of tanks and piping supporting the Effiuent Treatment Facility evaporator. This approach provides a life-cycle benefit to solid waste performance and reduction of groundwater contaminants.

  1. Strategies to manage low-bone turnover.

    PubMed

    Spasovski, G

    2009-01-01

    A change in paradigm occurred lately whereby not hypocalcemia but hypercalcemia and positive calcium balance were considered negative factors. Namely, the use of calcium- based binders in combination with vitamin D analogues, has been shown to lead to an over-suppression of parathyroid hormone (PTH) and development of low-bone turnover adynamic bone disease (ABD). The changing prevalence of various types of bone diseases from a high to low-bone turnover goes in line with the presence of increased risk for vascular calcification (VC), morbidity and mortality in the dialysis population. The attenuation of the previous great expectations in calcium-based phosphate binders and vitamin D-analogues entailed a new treatment strategy to preserve bone and vascular health. Hence, a new evidence for treatment of ABD with various types of non calcium based binders and low calcium dialysate is presented. Sevelamer treatment has reduced calcium concentration and increased PTH levels, resulting in the improvement of markers of bone turnover, increased bone formation and improved trabecular architecture, providing a slower progression of VC. Data on lanthanum beneficial effect on ABD histology have been demonstrated in long-term clinical studies. Although there is a slow release of lanthanum from its bone deposits after discontinuation of the treatment and no association with aluminium- like bone toxicity, there is still an ongoing scientific debate about its long-term toxic potential. Finally, reducing the number of calcium based binders and low calcium dialysate (1.25 mmol/l) has been reported to have an impact on the evolution towards markers reflecting higher bone turnover. Then, adoption of the non calcium-based binders should be reserved to high risk patients with ABD and progression of vascular calcifications associated with increased morbidity and mortality. PMID:19668299

  2. Caries Management Strategies for Primary Molars

    PubMed Central

    Santamaria, R.M.; Innes, N.P.T.; Machiulskiene, V.; Evans, D.J.P.; Splieth, C.H.

    2014-01-01

    Minimal invasive approaches to managing caries, such as partial caries removal techniques, are showing increasing evidence of improved outcomes over the conventional complete caries removal. There is also increasing interest in techniques where no caries is removed. We present the 1-yr results of clinical efficacy for 3 caries management options for occlusoproximal cavitated lesions in primary molars: conventional restorations (CR; complete caries removal and compomer restoration), Hall technique (HT; no caries removal, sealing in with stainless steel crowns), and nonrestorative caries treatment (NRCT; no caries removal, opening up the cavity, teaching brushing and fluoride application). In sum, 169 children (3-8 yr old; mean, 5.56 ± 1.45 yr) were enrolled in this secondary care–based, 3-arm, parallel-group, randomized clinical trial. Treatments were carried out by specialist pediatric dentists or postgraduate trainees. One lesion per child received CR, HT, or NRCT. Outcome measures were clinical failure rates, grouped as minor failure (restoration loss/need for replacement, reversible pulpitis, caries progression, etc.) and major failure (irreversible pulpitis, abscess, etc.). There were 148 children (87.6%) with a minimum follow-up of 11 mo (mean, 12.23 ± 0.98 mo). Twenty teeth were recorded as having at least 1 minor failure: NRCT, n = 8 (5%); CR, n = 11 (7%); HT, n = 1 (1%) (p = .002, 95% CI = 0.001 to 0.003). Only the comparison between NRCT and CR showed no significant difference (p = .79, 95% CI = 0.78 to 0.80). Nine (6%) experienced at least 1 major failure: NRCT, n = 4 (2%); CR, n = 5 (3%); HT, n = 0 (0%) (p = .002, 95% CI = 0.001 to 0.003). Individual comparison of NRCT and CR showed no statistically significant difference in major failures (p = .75, 95% CI = 0.73 to 0.76). Success and failure rates were not significantly affected by pediatric dentists’ level of experience (p = .13, 95% CI = 0.12 to 0.14). The HT was significantly more successful

  3. Managing Liability. Employment Discrimination: A Risk Management Strategy.

    ERIC Educational Resources Information Center

    McMullan, Sandra H.

    This booklet discusses the risks that educational institutions face in regard to employment discrimination litigation and outlines a program to effectively manage such risks. Institutions need to address three main types of employment discrimination issues: sexual harassment, disability-based discrimination, and age discrimination. To deal with…

  4. Regional economic impacts of current and proposed management alternatives for Don Edwards National Wildlife Refuge

    USGS Publications Warehouse

    Richardson, Leslie; Huber, Chris; Koontz, Lynne

    2012-01-01

    The National Wildlife Refuge System Improvement Act of 1997 requires all units of the National Wildlife Refuge System to be managed under a Comprehensive Conservation Plan. The Comprehensive Conservation Plan must describe the desired future conditions of a Refuge and provide long-range guidance and management direction to achieve refuge purposes. The Don Edwards San Francisco Bay National Wildlife Refuge, located at the south end of California's San Francisco Bay and one of seven refuges in the San Francisco Bay National Wildlife Refuge Complex, is in the process of developing a range of management goals, objectives, and strategies for the Comprehensive Conservation Plan. The Comprehensive Conservation Plan must contain an analysis of expected effects associated with current and proposed Refuge management strategies. For Refuge Comprehensive Conservation Plan planning, a regional economic analysis provides a means of estimating how current management (No Action Alternative) and proposed management activities (alternatives) affect the local economy. This type of analysis provides two critical pieces of information: (1) it illustrates the Don Edwards San Francisco Bay National Wildlife Refuge's contribution to the local community, and (2) it can help in determining whether economic effects are or are not a real concern in choosing among management alternatives. This report first presents a description of the local community and economy near the Don Edwards San Francisco Bay National Wildlife Refuge. Next, the methods used to conduct a regional economic impact analysis are described. An analysis of the final Comprehensive Conservation Plan management strategies that could affect stakeholders, residents, and the local economy is then presented. The management activities of economic concern in this analysis are: * Spending in the local community by Refuge visitors; * Refuge personnel salary spending; and * Refuge purchases of goods and services within the local

  5. Strategies for searching and managing evidence-based practice resources.

    PubMed

    Robb, Meigan; Shellenbarger, Teresa

    2014-10-01

    Evidence-based nursing practice requires the use of effective search strategies to locate relevant resources to guide practice change. Continuing education and staff development professionals can assist nurses to conduct effective literature searches. This article provides suggestions for strategies to aid in identifying search terms. Strategies also are recommended for refining searches by using controlled vocabulary, truncation, Boolean operators, PICOT (Population/Patient Problem, Intervention, Comparison, Outcome, Time) searching, and search limits. Suggestions for methods of managing resources also are identified. Using these approaches will assist in more effective literature searches and may help evidence-based practice decisions. PMID:25221988

  6. Using scenario analysis to determine managed care strategy.

    PubMed

    Krentz, S E; Gish, R S

    2000-09-01

    In today's volatile healthcare environment, traditional planning tools are inadequate to guide financial managers of provider organizations in developing managed care strategies. These tools often disregard the uncertainty surrounding market forces such as employee benefit structure, the future of Medicare managed care, and the impact of consumer behavior. Scenario analysis overcomes this limitation by acknowledging the uncertain healthcare environment and articulating a set of plausible alternative futures, thus supplying financial executives with the perspective to craft strategies that can improve the market position of their organizations. By being alert for trigger points that might signal the rise of a specific scenario, financial managers can increase their preparedness for changes in market forces. PMID:11066387

  7. Improving nuclear plant management effectiveness: Aligning strategy, systems, and people

    SciTech Connect

    Price, K.F.

    1991-11-01

    The effectiveness of any organization requires alignment of the appropriate financial, physical, and human resources. The manager's role is to efficiently utilize the right combination of these resources to achieve organizational objectives. In-depth studies of the nuclear programs of three major investor-owned utilities using a culture assessment process called the communication, values, and rewards (CVR) assessment have shown significant misalignments in those organizations' strategies, systems and people management. The CVR assessment related employees' perceptions of what drives their company's culture with the stated company strategic direction and management philosophies. Specifically, CVR provides a comparison of employee-held work-related values with those desired by management. Data obtained by a CVR assessment can be used to understand organizational misalignment and make changes to bring systems into alignment with corporate strategy and culture.

  8. Autism Spectrum Disorder: Examining Current Diagnosis Strategies and Assessment Tools

    ERIC Educational Resources Information Center

    Wormald, Amy Marie

    2011-01-01

    Recent literature notes a significant increase in students being diagnosed with Autism Spectrum Disorder (ASD). Yet, no uniform testing protocol exists. It is vital for students and educators that a unified testing process be created and established. This study investigated which ASD testing instruments were currently used in Southern California…

  9. Exploring strategies used following a group-based fatigue management programme for people with multiple sclerosis (FACETS) via the Fatigue Management Strategies Questionnaire (FMSQ)

    PubMed Central

    Thomas, S; Kersten, P; Thomas, P W; Slingsby, V; Nock, A; Jones, R; Davies Smith, A; Galvin, K T; Baker, R; Hillier, C

    2015-01-01

    Objectives To explore cross-sectional patterns of use of fatigue management strategies in people with multiple sclerosis (MS) who had attended a group-based fatigue management programme, Fatigue: Applying Cognitive behavioural and Energy effectiveness Techniques to lifeStyle (‘FACETS’). In a multicentre randomised controlled trial (RCT) the FACETS programme was shown to reduce fatigue severity and improve self-efficacy and quality of life. Design A questionnaire substudy within a RCT involving the self-completed Fatigue Management Strategies Questionnaire (FMSQ). The FMSQ includes: (1) closed questions about the use and helpfulness of fatigue management strategies taught in FACETS and (2) open items about changes to lifestyle, attitudes or expectations, barriers or difficulties encountered and helpful strategies not covered in FACETS. Participants All had a clinical diagnosis of MS, significant fatigue, were ambulatory and had attended at least 4 of 6 scheduled FACETS sessions. Methods Participants (n=72) were posted the FMSQ with a prepaid return envelope 4 months after the end of the FACETS programme. Results 82% (59/72) of participants returned the FMSQ. The fatigue management strategies most frequently used since attending FACETS were prioritisation (80%), pacing (78%), saying no to others (78%), grading tasks (75%) and challenging unhelpful thoughts (71%). Adding in those participants who were already using the respective strategies prior to FACETS, the three most used strategies at 4 months were prioritisation (55/59), grading (54/59) and pacing (53/58). Free-text comments illustrated the complex interplay between attitudes/expectations, behaviours, emotions and the environment. Issues related to expectations featured strongly in participants’ comments. Expectations (from self and others) were both facilitators and barriers to effective fatigue management. Conclusions Individuals’ comments highlighted the complex, multifaceted nature of fatigue

  10. Diversity in current ecological thinking: implications for environmental management.

    PubMed

    Moore, Susan A; Wallington, Tabatha J; Hobbs, Richard J; Ehrlich, Paul R; Holling, C S; Levin, Simon; Lindenmayer, David; Pahl-Wostl, Claudia; Possingham, Hugh; Turner, Monica G; Westoby, Mark

    2009-01-01

    Current ecological thinking emphasizes that systems are complex, dynamic, and unpredictable across space and time. What is the diversity in interpretation of these ideas among today's ecologists, and what does this mean for environmental management? This study used a Policy Delphi survey of ecologists to explore their perspectives on a number of current topics in ecology. The results showed general concurrence with nonequilibrium views. There was agreement that disturbance is a widespread, normal feature of ecosystems with historically contingent responses. The importance of recognizing multiple levels of organization and the role of functional diversity in environmental change were also widely acknowledged. Views differed regarding the predictability of successional development, whether "patchiness" is a useful concept, and the benefits of shifting the focus from species to ecosystem processes. Because of their centrality to environmental management, these different views warrant special attention from both managers and ecologists. Such divergence is particularly problematic given widespread concerns regarding the poor linkages between science (here, ecology) and environmental policy and management, which have been attributed to scientific uncertainty and a lack of consensus among scientists, both jeopardizing the transfer of science into management. Several suggestions to help managers deal with these differences are provided, especially the need to interpret broader theory in the context of place-based assessments. The uncertainty created by these differences requires a proactive approach to environmental management, including clearly identifying environmental objectives, careful experimental design, and effective monitoring. PMID:18709471

  11. Diversity in Current Ecological Thinking: Implications for Environmental Management

    NASA Astrophysics Data System (ADS)

    Moore, Susan A.; Wallington, Tabatha J.; Hobbs, Richard J.; Ehrlich, Paul R.; Holling, C. S.; Levin, Simon; Lindenmayer, David; Pahl-Wostl, Claudia; Possingham, Hugh; Turner, Monica G.; Westoby, Mark

    2009-01-01

    Current ecological thinking emphasizes that systems are complex, dynamic, and unpredictable across space and time. What is the diversity in interpretation of these ideas among today’s ecologists, and what does this mean for environmental management? This study used a Policy Delphi survey of ecologists to explore their perspectives on a number of current topics in ecology. The results showed general concurrence with nonequilibrium views. There was agreement that disturbance is a widespread, normal feature of ecosystems with historically contingent responses. The importance of recognizing multiple levels of organization and the role of functional diversity in environmental change were also widely acknowledged. Views differed regarding the predictability of successional development, whether “patchiness” is a useful concept, and the benefits of shifting the focus from species to ecosystem processes. Because of their centrality to environmental management, these different views warrant special attention from both managers and ecologists. Such divergence is particularly problematic given widespread concerns regarding the poor linkages between science (here, ecology) and environmental policy and management, which have been attributed to scientific uncertainty and a lack of consensus among scientists, both jeopardizing the transfer of science into management. Several suggestions to help managers deal with these differences are provided, especially the need to interpret broader theory in the context of place-based assessments. The uncertainty created by these differences requires a proactive approach to environmental management, including clearly identifying environmental objectives, careful experimental design, and effective monitoring.

  12. Current and emerging strategies for treatment of childhood dystonia.

    PubMed

    Bertucco, Matteo; Sanger, Terence D

    2015-01-01

    Childhood dystonia is a movement disorder characterized by involuntary sustained or intermittent muscle contractions causing twisting and repetitive movements, abnormal postures, or both (Sanger et al, 2003). Dystonia is a devastating neurological condition that prevents the acquisition of normal motor skills during critical periods of development in children. Moreover, it is particularly debilitating in children when dystonia affects the upper extremities such that learning and consolidation of common daily motor actions are impeded. Thus, the treatment and rehabilitation of dystonia is a challenge that continuously requires exploration of novel interventions. This review will initially describe the underlying neurophysiological mechanisms of the motor impairments found in childhood dystonia followed by the clinical measurement tools that are available to document the presence and severity of symptoms. Finally, we will discuss the state-of-the-art of therapeutic options for childhood dystonia, with particular emphasis on emergent and innovative strategies. PMID:25835254

  13. Current and emerging strategies for treatment of childhood dystonia

    PubMed Central

    Bertucco, Matteo; Sanger, Terence D.

    2014-01-01

    Childhood dystonia is a movement disorder characterized by involuntary sustained or intermittent muscle contractions causing twisting and repetitive movements, abnormal postures, or both (Sanger et al. 2003). Dystonia is a devastating neurological condition that prevents the acquisition of normal motor skills during critical periods of development in children. Moreover, it is particularly debilitating in children when dystonia affects the upper extremities such that learning and consolidation of common daily motor actions are impeded. Thus, the treatment and rehabilitation of dystonia is a challenge that continuously requires exploration of novel interventions. This review will initially describe the underlying neurophysiological mechanisms of the motor impairments found in childhood dystonia followed by the clinical measurement tools that are available to document the presence and severity of symptoms. Finally, we will discuss the state-of-the-art of therapeutic options for childhood dystonia, with particular emphasis on emergent and innovative strategies. PMID:25835254

  14. How Managers' everyday decisions create or destroy your company's strategy.

    PubMed

    Bower, Joseph L; Gilbert, Clark G

    2007-02-01

    Senior executives have long been frustrated by the disconnection between the plans and strategies they devise and the actual behavior of the managers throughout the company. This article approaches the problem from the ground up, recognizing that every time a manager allocates resources, that decision moves the company either into or out of alignment with its announced strategy. A well-known story--Intel's exit from the memory business--illustrates this point. When discussing what businesses Intel should be in, Andy Grove asked Gordon Moore what they would do if Intel were a company that they had just acquired. When Moore answered, "Get out of memory," they decided to do just that. It turned out, though, that Intel's revenues from memory were by this time only 4% of total sales. Intel's lower-level managers had already exited the business. What Intel hadn't done was to shut down the flow of research funding into memory (which was still eating up one-third of all research expenditures); nor had the company announced its exit to the outside world. Because divisional and operating managers-as well as customers and capital markets-have such a powerful impact on the realized strategy of the firm, senior management might consider focusing less on the company's formal strategy and more on the processes by which the company allocates resources. Top managers must know the track record of the people who are making resource allocation proposals; recognize the strategic issues at stake; reach down to operational managers to work across division lines; frame resource questions to reflect the corporate perspective, especially when large sums of money are involved and conditions are highly uncertain; and create a new context that allows top executives to circumvent the regular resource allocation process when necessary. PMID:17345681

  15. Role Management Strategies of Beginning Teachers in Hong Kong

    ERIC Educational Resources Information Center

    Choi, Pik Lin; Tang, Sylvia Yee Fan

    2005-01-01

    Beginning teachers encounter new challenges as the role system in contemporary society has become more and more demanding. By means of the life history method, role management strategies of four Hong Kong beginning teachers employed to cope with role demands and intra-role conflicts were located in their biographical, workplace and wider…

  16. Coping Strategies for Managing Acculturative Stress among Asian International Students

    ERIC Educational Resources Information Center

    Ra, Young-An; Trusty, Jerry

    2015-01-01

    This article examines the effects of specific coping strategies on managing acculturative stress and acculturation of Asian international students, based on a sample of 220 Asian international students in the U.S. The data were analyzed with hierarchical multiple regression using Baron and Kenny's (1986) mediation procedure. The results supported…

  17. Strategic Enrollment Management: Core Strategies and Best Practices

    ERIC Educational Resources Information Center

    Bontrager, Bob

    2004-01-01

    This second of a two-part series builds on the core concepts and structural considerations discussed in the first part (in the Winter 2004 issue of "College and University") to identify the core strategies and best practices that characterize successful enrollment management (SEM) organizations. Successful SEM operations place a high premium on…

  18. Board and Senior Management Alignment on School Strategy

    ERIC Educational Resources Information Center

    Sarros, James C.; Sarros, Anne M.; Cooper, Brian K.; Santora, Joseph C.; Baker, Robin

    2016-01-01

    This study examines the degree to which senior executive members of a school's decision-making team (senior management team and board of directors) are aligned on fundamental principles of school strategy. Our study is based on a conceptual framework of strategic leadership as it applies in an Australian independent school context. We also examine…

  19. Strategies for Talent Management: Greater Philadelphia Companies in Action

    ERIC Educational Resources Information Center

    Council for Adult and Experiential Learning (NJ1), 2008

    2008-01-01

    Human capital is one of the critical issues that impacts the Greater Philadelphia region's ability to grow and prosper. The CEO Council for Growth (CEO Council) is committed to ensuring a steady and talented supply of quality workers for this region. "Strategies for Talent Management: Greater Philadelphia Companies in Action" provides insights…

  20. University Students' Views of Obesity and Weight Management Strategies

    ERIC Educational Resources Information Center

    Okonkwo, Ononuju; While, Alison

    2010-01-01

    Objective: To investigate the knowledge and views of university students regarding obesity and weight management strategies. Design: Online questionnaire-based survey of undergraduate and postgraduate university students in a large London university with a diverse student population. Method: The survey was administered online and circulated…

  1. Urban Teachers' Use of Culturally Responsive Management Strategies

    ERIC Educational Resources Information Center

    Brown, Dave F.

    2003-01-01

    Gaining students' cooperation in urban classrooms involves establishing an environment where teachers address students' cultural and ethnic needs, as well as their social, emotional, and cognitive needs. This article describes the management strategies of 13 1st- through 12th-grade urban teachers from seven cities throughout the United States.…

  2. The Hurried Principal: A Manual of Strategies for Time Management.

    ERIC Educational Resources Information Center

    Furman, Robert L.; Zibrida, Richard J.

    Practical strategies to help principals manage their time more effectively are offered in this guidebook. Because superintendents' expectations of principals' duties often contrast with the amount of time principals actually expend in performing various duties, this lack of understanding and time results in the "hurried principal syndrome."…

  3. Anger Management 2: Counselors Strategies and Skills. ERIC Digest.

    ERIC Educational Resources Information Center

    Hogan, Eileen K.

    Many different strategies and skills for anger management intervention have been tried and tested. Some of the most empirically supported interventions are cognitive-behavioral interventions including relaxation coping skills, cognitive interventions, behavioral coping and social skills training, and problem-solving skills training. This digest…

  4. Sources of Faculty Stress and Strategies for Its Management.

    ERIC Educational Resources Information Center

    Larkin, Paul; Clagett, Craig

    Views on sources of stress on college faculty and strategies for its management were obtained at small-group sessions in the 1980 faculty orientation at Prince George's Community College, Maryland. Sixteen faculty groups generated 218 responses expressing sources of job stress, a complete listing of which is appended. The responses were aggregated…

  5. Partnership as an Intervention Strategy in Self-Managing Schools.

    ERIC Educational Resources Information Center

    Timperley, Helen S.; Robinson, Viviane M. J.

    2003-01-01

    Describes strategy used by New Zealand Ministry of Education to intervene in 26 self-managing schools by developing a partnership with the schools and their communities. Documents difficulties encountered in the first phase (year one) of the intervention and the successes of the second phase (year two). (Contains 1 figure, 3 tables, and 27…

  6. Pain assessment and management strategies for elderly patients.

    PubMed

    MacSorley, Robyn; White, Jill; Conerly, Vicki H; Walker, Jean T; Lofton, Susan; Ragland, Gaye; Davey, DeBrynda; Robertson, Amy

    2014-05-01

    Home healthcare nurses play a critical role in pain assessment and management in elderly patients. People 65 years of age and older are the largest consumers of prescription and nonprescription pain medications in the United States and are at increased risk for adverse reactions and inadequate pain management. This article seeks to explore strategies to assist hospice and home healthcare nurses in assessing and managing elderly patients' pain. The goal is to provide tools to assist nurses in streamlining elderly patient care and improving quality of life while decreasing mortality and morbidity for this patient population. PMID:24802598

  7. Total quality management as a health care corporate strategy.

    PubMed

    Johnson, J A; Omachonu, V K

    1995-01-01

    Total quality management (TQM) must become a part of corporate strategy if it is to become a way of life in health care. TQM should be understood in the context of a cultural transformation. The greatest challenge for top management is to create an organization in which every employee, department and function is linked inextricably to the organization's mission and vision. One of the key benefits of TQM is the use of teams to work on and achieve organizational objectives. Health care managers must understand motivation in order to carry the workforce with them to attain those objectives. PMID:10165402

  8. Current Issues for Higher Education Information Resources Management.

    ERIC Educational Resources Information Center

    CAUSE/EFFECT, 1998

    1998-01-01

    Current and developing issues and trends in college and university information resources management are outlined, including retention/retraining/recruitment of information technology staff; policy and technical issues; growing complexity and cost of enterprise systems; student expectations for technology support and services; distributed learning…

  9. Current concepts in wound management and wound healing products.

    PubMed

    Davidson, Jacqueline R

    2015-05-01

    Current concepts in wound management are summarized. The emphasis is on selection of the contact layer of the bandage to promote a moist wound environment. Selection of an appropriate contact layer is based on the stage of wound healing and the amount of wound exudate. The contact layer can be used to promote autolytic debridement and enhance wound healing. PMID:25744144

  10. Anaesthesia in Von Gierke's disease. Current approach to management.

    PubMed

    Bevan, J C

    1980-07-01

    A case report of a patient with Von Gierke's (glycogen storage disease Cori type (1)1 disease who required femoral osteotomy is presented. Current techniques of management of this condition which are likely to improve the outcome of general anaesthesia and surgery are discussed. PMID:6933867

  11. Tinnitus--Current Concepts in Diagnosis and Management.

    ERIC Educational Resources Information Center

    Epstein, Stephen

    1997-01-01

    This article discusses the causes of tinnitus, sound or noise in the ears or head without any external stimulation. Classification of tinnitus, the essentials of medical evaluation of a patient with tinnitus, essential test procedures, and current concepts in the management of tinnitus are addressed. (CR)

  12. Current strategies for treatment of relapsed/refractory multiple myeloma.

    PubMed

    Laubach, Jacob P; Voorhees, Peter M; Hassoun, Hani; Jakubowiak, Andrzej; Lonial, Sagar; Richardson, Paul G

    2014-02-01

    In spite of significant advances in the management of multiple myeloma (MM), the disease remains incurable and nearly all patients ultimately relapse and require salvage chemotherapy. As such, relapsed and relapsed-refractory MM remains a critical area of research pertaining to biological mechanisms of progression and chemotherapy resistance, as well as to the development of new pharmacologic agents and immunologic approaches for the disease. The immunomodulatory agents and proteasome inhibitors represent the cornerstone of treatment in this setting, with combination regimens incorporating these drugs demonstrating encouraging rates and duration of response, including the newer agents, pomalidomide and carfilzomib. In addition, novel drug classes have shown promising activity in RR MM, including the orally-administered proteasome inhibitors ixazomib and oprozomib; monoclonal antibodies such as the anti-CS1 monoclonal antibody elotuzumab and anti-CD38 monoclonal antibody daratumumab; and histone deacetylase inhibitors such as panobinostat and rocilinostat. PMID:24471924

  13. Reducing hospital readmission rates: current strategies and future directions.

    PubMed

    Kripalani, Sunil; Theobald, Cecelia N; Anctil, Beth; Vasilevskis, Eduard E

    2014-01-01

    New financial penalties for institutions with high readmission rates have intensified efforts to reduce rehospitalization. Several interventions that involve multiple components (e.g., patient needs assessment, medication reconciliation, patient education, arranging timely outpatient appointments, and providing telephone follow-up) have successfully reduced readmission rates for patients discharged to home. The effect of interventions on readmission rates is related to the number of components implemented; single-component interventions are unlikely to reduce readmissions significantly. For patients discharged to postacute care facilities, multicomponent interventions have reduced readmissions through enhanced communication, medication safety, advanced care planning, and enhanced training to manage medical conditions that commonly precipitate readmission. To help hospitals direct resources and services to patients with greater likelihood of readmission, risk-stratification methods are available. Future work should better define the roles of home-based services, information technology, mental health care, caregiver support, community partnerships, and new transitional care personnel. PMID:24160939

  14. Insecticide Resistance and Management Strategies in Urban Ecosystems

    PubMed Central

    Zhu, Fang; Lavine, Laura; O’Neal, Sally; Lavine, Mark; Foss, Carrie; Walsh, Douglas

    2016-01-01

    The increased urbanization of a growing global population makes imperative the development of sustainable integrated pest management (IPM) strategies for urban pest control. This emphasizes pests that are closely associated with the health and wellbeing of humans and domesticated animals. Concurrently there are regulatory requirements enforced to minimize inadvertent exposures to insecticides in the urban environment. Development of insecticide resistance management (IRM) strategies in urban ecosystems involves understanding the status and mechanisms of insecticide resistance and reducing insecticide selection pressure by combining multiple chemical and non-chemical approaches. In this review, we will focus on the commonly used insecticides and molecular and physiological mechanisms underlying insecticide resistance in six major urban insect pests: house fly, German cockroach, mosquitoes, red flour beetle, bed bugs and head louse. We will also discuss several strategies that may prove promising for future urban IPM programs. PMID:26751480

  15. Insecticide Resistance and Management Strategies in Urban Ecosystems.

    PubMed

    Zhu, Fang; Lavine, Laura; O'Neal, Sally; Lavine, Mark; Foss, Carrie; Walsh, Douglas

    2016-01-01

    The increased urbanization of a growing global population makes imperative the development of sustainable integrated pest management (IPM) strategies for urban pest control. This emphasizes pests that are closely associated with the health and wellbeing of humans and domesticated animals. Concurrently there are regulatory requirements enforced to minimize inadvertent exposures to insecticides in the urban environment. Development of insecticide resistance management (IRM) strategies in urban ecosystems involves understanding the status and mechanisms of insecticide resistance and reducing insecticide selection pressure by combining multiple chemical and non-chemical approaches. In this review, we will focus on the commonly used insecticides and molecular and physiological mechanisms underlying insecticide resistance in six major urban insect pests: house fly, German cockroach, mosquitoes, red flour beetle, bed bugs and head louse. We will also discuss several strategies that may prove promising for future urban IPM programs. PMID:26751480

  16. Communication strategies and volunteer management for the IAU-OAD

    NASA Astrophysics Data System (ADS)

    Sankatsing Nava, Tibisay

    2015-08-01

    The IAU Office of Astronomy for Development will be developing a new communication strategy to promote its projects in a way that is relevant to stakeholders and the general public. Ideas include a magazine featuring best practices within the field of astronomy for development and setting up a workflow of communication that integrates the different outputs of the office and effectively uses the information collection tools developed by OAD team members.To accomplish these tasks the OAD will also develop a community management strategy with existing tools to effectively harness the skills of OAD volunteers for communication purposes. This talk will discuss the new communication strategy of the OAD as well the expanded community management plans.

  17. Current strategies for sustaining drug release from electrospun nanofibers.

    PubMed

    Chou, Shih-Feng; Carson, Daniel; Woodrow, Kim A

    2015-12-28

    Electrospun drug-eluting fibers are emerging as a novel dosage form for multipurpose prevention against sexually transmitted infections, including HIV, and unintended pregnancy. Previous work from our lab and others show the versatility of this platform to deliver large doses of physico-chemically diverse agents. However, there is still an unmet need to develop practical fiber formulations for water-soluble small molecule drugs needed at high dosing due to intrinsic low potency or desire for sustained prevention. To date, most sustained release fibers have been restricted to the delivery of biologics or hydrophobic small molecules at low drug loading of typically <1 wt.%, which is often impractical for most clinical applications. For hydrophilic small molecule drugs, their high aqueous solubility and poor partitioning and incompatibility with insoluble polymers make long-term release even more challenging. Here we investigate several existing strategies to sustain release of hydrophilic small molecule drugs that are highly-loaded in electrospun fibers. In particular, we investigate what is known about the design constraints required to realize multi-day release from fibers fabricated from uniaxial and coaxial electrospinning. PMID:26363300

  18. Optimal breast cancer screening strategies for older women: current perspectives

    PubMed Central

    Braithwaite, Dejana; Demb, Joshua; Henderson, Louise M

    2016-01-01

    Breast cancer is a major cause of cancer-related deaths among older women, aged 65 years or older. Screening mammography has been shown to be effective in reducing breast cancer mortality in women aged 50–74 years but not among those aged 75 years or older. Given the large heterogeneity in comorbidity status and life expectancy among older women, controversy remains over screening mammography in this population. Diminished life expectancy with aging may decrease the potential screening benefit and increase the risk of harms. In this review, we summarize the evidence on screening mammography utilization, performance, and outcomes and highlight evidence gaps. Optimizing the screening strategy will involve separating older women who will benefit from screening from those who will not benefit by using information on comorbidity status and life expectancy. This review has identified areas related to screening mammography in older women that warrant additional research, including the need to evaluate emerging screening technologies, such as tomosynthesis among older women and precision cancer screening. In the absence of randomized controlled trials, the benefits and harms of continued screening mammography in older women need to be estimated using both population-based cohort data and simulation models. PMID:26893548

  19. Current Strategies and Challenges in Engineering a Bioartificial Kidney

    PubMed Central

    Kim, Steven; Fissell, William H.; Humes, H. David; Roy, Shuvo

    2015-01-01

    Renal replacement therapy was an early pioneer in both extra-corporeal organ replacement and whole organ transplantation. Today, the success of this pioneering work is directly demonstrated in the millions of patients worldwide successfully treated with dialysis and kidney transplantation. However, there remain significant shortcomings to current treatment modalities that limit clinical outcomes and quality of life. To address these problems, researchers have turned to using cell-based therapies for the development of a bioartificial kidney. These approaches aim to recapitulate the numerous functions of the healthy kidney including solute clearance and fluid homeostasis as well as metabolic and endocrine function. This review will examine the state-of-the-art in kidney bioengineering by evaluating the various techniques currently being utilized to create a bioartificial kidney. These promising new technologies, however, still need to address key issues that may limit the widespread adoption of cell therapy including cell sourcing, organ scaffolding, and immune response. Additionally, while these new methods have shown success in animal models, it remains to be seen whether these techniques can be successfully adapted for clinical treatment in humans. PMID:25553375

  20. Current management for improved railgun performance. Doctoral thesis

    SciTech Connect

    Beno, J.H.

    1989-01-01

    Continued railgun development toward high-energy devices that launch useful projectiles and have a lifetime of hundreds to thousands of shots, requires progress in two related aspects of accelerator design: (1) rail containment structures must be made capable of withstanding greater rail repulsion forces, without causing accelerators to become too bulky for their intended use; and (2) rails must sustain very minor heat-related damage during projectile launch. The potential for managing rail current and its distribution to alleviate the two aforementioned problems is investigated. Techniques for calculating pulsed, rail current distribution, in the infinite-conductivity approximation, and resultant projectile force are developed. Then, passive, current management methods -- involving multiple rail pairs to distribute currents and rail-repulsive forces in a few, evenly-spaced, radial directions, for easier rail containment -- are explored. Optimized multi-rail, railgun cross sectional shapes that produce more projectile force than conventional two-rail railguns operating under the same local peak current density constraints are determined. These railguns have nontraditional bore shapes, i.e., not square or round. The use of neighboring, current-carrying conductors to actively influence rail current distribution is then studied.

  1. Current Controversies in Diagnosis and Management of Cleft Palate and Velopharyngeal Insufficiency

    PubMed Central

    Ysunza, Pablo Antonio; Repetto, Gabriela M.; Pamplona, Maria Carmen; Calderon, Juan F.; Shaheen, Kenneth; Chaiyasate, Konkgrit; Rontal, Matthew

    2015-01-01

    Background. One of the most controversial topics concerning cleft palate is the diagnosis and treatment of velopharyngeal insufficiency (VPI). Objective. This paper reviews current genetic aspects of cleft palate, imaging diagnosis of VPI, the planning of operations for restoring velopharyngeal function during speech, and strategies for speech pathology treatment of articulation disorders in patients with cleft palate. Materials and Methods. An updated review of the scientific literature concerning genetic aspects of cleft palate was carried out. Current strategies for assessing and treating articulation disorders associated with cleft palate were analyzed. Imaging procedures for assessing velopharyngeal closure during speech were reviewed, including a recent method for performing intraoperative videonasopharyngoscopy. Results. Conclusions from the analysis of genetic aspects of syndromic and nonsyndromic cleft palate and their use in its diagnosis and management are presented. Strategies for classifying and treating articulation disorders in patients with cleft palate are presented. Preliminary results of the use of multiplanar videofluoroscopy as an outpatient procedure and intraoperative endoscopy for the planning of operations which aimed to correct VPI are presented. Conclusion. This paper presents current aspects of the diagnosis and management of patients with cleft palate and VPI including 3 main aspects: genetics and genomics, speech pathology and imaging diagnosis, and surgical management. PMID:26273595

  2. Forty project management strategies for the medical practice staff.

    PubMed

    Hills, Laura Sachs

    2010-01-01

    Most every medical practice will embark at one time or another on a large and complex new project. The practice may, for instance, undertake a project in office construction or renovation, practice expansion, new technology, or a new large-scale event. The medical practice staff may find itself creating the project plan, overseeing its execution, and working through the plan day to day until its completion. In short, the staff may find itself responsible for project management. This article contains 40 specific, easy-to-implement project management strategies medical practice employees can use to manage both the large and small projects they undertake on behalf of the practice. It suggests effective project management strategies the staff can use before the onset of a new project as well as strategies to help define the project, to deliver the project, and to close and review the project. This article also describes five reasons medical practices often fail at project management and suggests more effective approaches that will ensure that the projects the medical practice undertakes are completed well, on time, and within budget. PMID:20480774

  3. Blood gas strategies and management during pediatric cardiopulmonary bypass.

    PubMed

    Griffin, Dee Ann

    2005-01-01

    Blood gas management during hypothermic cardiopulmonary bypass may be corrected by pH stat or alpha stat strategy. The pH stat philosophy is to maintain the blood pH constant at any temperature. Carbon dioxide must be introduced to the oxygenator in order to maintain the pH and pCO2 during hypothermic cardiopulmonary bypass. Conversely, during alpha stat blood gas management pH is maintained according to 37 degrees C despite the patient temperature. Alpha stat management preserves intracellular pH and autoregulation of cerebral vasculature by following the natural shift of the oxyhemoglobin dissociation curve. In-line blood gas analysis is a practical tool in assessing adequate blood gas management, because this technology provides immediate detection for modification of air/oxygen/carbon dioxide parameters. Results from several studies favor the pH stat strategy during neonatal cardiopulmonary bypass. This strategy increases tissue oxygenation and cerebral blood flow while cooling. Data also suggest that pH stat management results in better outcomes with shorter ventilation times and intensive care unit stays after pediatric cardiac surgery. PMID:16322734

  4. Nurses' strategies for managing pain in the postoperative setting.

    PubMed

    Manias, Elizabeth; Bucknall, Tracey; Botti, Mari

    2005-03-01

    Acute pain is a significant problem in the postoperative setting. Patients report a lack of information about pain-control measures and ineffective pain control. Nurses continue to rely on pharmacologic measures and tend to under-administer analgesics. The purpose of this study was to determine the strategies nurses used to manage patients' pain in the postoperative setting. It also sought to examine the effect of context, including organization of care, nurses' prioritization of work activities, and pressures during a working shift, on their pain-management strategies. An observational design was used in two surgical units of a metropolitan teaching hospital in Melbourne, Australia. Six fixed observation times were identified as key periods for pain activities, each comprising a 2-hour duration. An observation period was examined at least 12 times, resulting in the completion of 74 observations and the identification of 316 pain cases. Fifty-two nurses were observed during their normal day's work with postoperative patients. Six themes were identified: managing pain effectively; prioritizing pain experiences for pain management; missing pain cues for pain management; regulators and enforcers of pain management; preventing pain; and reactive management of pain. The findings highlighted the critical nature of communication between clinicians and patients and among clinicians. It also demonstrated the influence of time on management strategies and the relative importance that nurses place on nonpharmacologic measures in actual practice. This research, which portrays what happens in actual clinical practice, has facilitated the identification of new data that were not evident from other research studies. PMID:15917741

  5. Wind disasters: A comprehensive review of current management strategies.

    PubMed

    Marchigiani, Raffaele; Gordy, Stephanie; Cipolla, James; Adams, Raeanna C; Evans, David C; Stehly, Christy; Galwankar, Sagar; Russell, Sarah; Marco, Alan P; Kman, Nicholas; Bhoi, Sanjeev; Stawicki, Stanislaw P A; Papadimos, Thomas J

    2013-04-01

    Wind disasters are responsible for tremendous physical destruction, injury, loss of life and economic damage. In this review, we discuss disaster preparedness and effective medical response to wind disasters. The epidemiology of disease and injury patterns observed in the early and late phases of wind disasters are reviewed. The authors highlight the importance of advance planning and adequate preparation as well as prompt and well-organized response to potential damage involving healthcare infrastructure and the associated consequences to the medical response system. Ways to minimize both the extent of infrastructure damage and its effects on the healthcare system are discussed, focusing on lessons learned from recent major wind disasters around the globe. Finally, aspects of healthcare delivery in disaster zones are reviewed. PMID:23961458

  6. Wind disasters: A comprehensive review of current management strategies

    PubMed Central

    Marchigiani, Raffaele; Gordy, Stephanie; Cipolla, James; Adams, Raeanna C; Evans, David C; Stehly, Christy; Galwankar, Sagar; Russell, Sarah; Marco, Alan P; Kman, Nicholas; Bhoi, Sanjeev; Stawicki, Stanislaw P A; Papadimos, Thomas J

    2013-01-01

    Wind disasters are responsible for tremendous physical destruction, injury, loss of life and economic damage. In this review, we discuss disaster preparedness and effective medical response to wind disasters. The epidemiology of disease and injury patterns observed in the early and late phases of wind disasters are reviewed. The authors highlight the importance of advance planning and adequate preparation as well as prompt and well-organized response to potential damage involving healthcare infrastructure and the associated consequences to the medical response system. Ways to minimize both the extent of infrastructure damage and its effects on the healthcare system are discussed, focusing on lessons learned from recent major wind disasters around the globe. Finally, aspects of healthcare delivery in disaster zones are reviewed. PMID:23961458

  7. Sun Protection: Current Management Strategies Addressing UV Exposure.

    PubMed

    Cohen, Leslie E; Grant, Robert T

    2016-07-01

    The use of sunscreen is essential for protection against photoaging and skin cancer. There is no global consensus on rating systems for sunscreens but it is essential to understand what makes a product broad-spectrum. In addition, physicians should have a general understanding that high-quality successful sunscreens should not only provide broad-spectrum ultraviolet A/B protection but should also be formulated so that they are easy to apply, are water resistant, and are photostable in order to increase user compliance. PMID:27363775

  8. Current management strategies and therapeutic targets in chronic constipation

    PubMed Central

    Emmanuel, Anton

    2011-01-01

    Constipated patients who are refractory to simple lifestyle interventions will usually resort to laxatives, whether prescribed or over the counter. Clinical trial evidence is scarce for older medications such as laxatives, especially with a condition as chronic and subjective as constipation. Newer polyethylene glycol-based laxatives have been investigated under rigorous clinical trial settings, but comparisons between different laxatives are not available. Newer prokinetic agents, targeting peristalsis, intestinal secretion and the colonic flora, have been developed for laxative refractory constipation. This review focuses on the evidence for each of these agents, and the relative indications for each of them. PMID:21317993

  9. Pulse and hold strategy for switching current measurements

    NASA Astrophysics Data System (ADS)

    Walter, Jochen; Tholén, Erik; Haviland, David B.; Sjöstrand, Joachim

    2007-03-01

    We investigate by theory and experiment, the Josephson junction switching current detector in an environment with frequency-dependent damping. Analysis of the circuit’s phase space shows that a favorable topology for switching can be obtained with overdamped dynamics at high frequencies. A pulse-and-hold method is described, where a fast switch pulse brings the circuit close to an unstable point in the phase space when biased at the hold level. Experiments are performed on Cooper pair transistors and quantronium circuits, which are overdamped at high frequencies with an on-chip RC shunt. For 20μs switch pulses the switching process is well described by thermal equilibrium escape, based on a generalization of the Kramers formula to the case of frequency-dependent damping. A capacitor bias method is used to create very rapid, 25ns switch pulses, where it is observed that the switching process is not governed by thermal equilibrium noise.

  10. Angiogenesis Inhibitors – Current Strategies and Future Prospects

    PubMed Central

    Cook, Kristina M.; Figg, William D.

    2010-01-01

    Angiogenesis has become an attractive target for drug therapy due to its key role in tumor growth. An extensive array of compounds is currently in pre-clinical development, with many now entering the clinic and/or achieving FDA approval. Several regulatory and signaling molecules governing angiogenesis are of interest, including growth factors (e.g. VEGF, PDGF, FGF, EGF), receptor tyrosine kinases, transcription factors such as HIF, as well as molecules involved in MAPK and PI3K signaling. Pharmacologic agents have been identified that target these pathways, yet for some agents (notably thalidomide), an understanding of the specific mechanisms of anti-tumor action has proved elusive. The following review describes key molecular mechanisms and novel therapies that are on the horizon for anti-angiogenic tumor therapy. PMID:20554717

  11. Ebola virus outbreak, updates on current therapeutic strategies.

    PubMed

    Elshabrawy, Hatem A; Erickson, Timothy B; Prabhakar, Bellur S

    2015-07-01

    Filoviruses are enveloped negative-sense single-stranded RNA viruses, which include Ebola and Marburg viruses, known to cause hemorrhagic fever in humans with a case fatality of up to 90%. There have been several Ebola virus outbreaks since the first outbreak in the Democratic Republic of Congo in 1976 of which, the recent 2013-2015 epidemic in Guinea, Liberia, and Sierra Leone is the largest in recorded history. Within a few months of the start of the outbreak in December 2013, thousands of infected cases were reported with a significant number of deaths. As of March 2015, according to the Centers for Disease Control and Prevention, there have been nearly 25,000 suspected cases, with 15,000 confirmed by laboratory testing, and over 10,000 deaths. The large number of cases and the high mortality rate, combined with the lack of effective Food and Drug Administration-approved treatments, necessitate the development of potent and safe therapeutic measures to combat the current and future outbreaks. Since the beginning of the outbreak, there have been considerable efforts to develop and characterize protective measures including vaccines and antiviral small molecules, and some have proven effective in vitro and in animal models. Most recently, a cocktail of monoclonal antibodies has been shown to be highly effective in protecting non-human primates from Ebola virus infection. In this review, we will discuss what is known about the nature of the virus, phylogenetic classification, genomic organization and replication, disease transmission, and viral entry and highlight the current approaches and efforts, in the development of therapeutics, to control the outbreak. PMID:25962887

  12. Current surgical treatment strategies for hepatocellular carcinoma in North America.

    PubMed

    Khan, Adeel S; Fowler, Kathryn J; Chapman, William C

    2014-11-01

    Hepatocellular carcinoma (HCC) is an aggressive tumor that often occurs in the setting of chronic liver disease. Many patients do not initially manifest any symptoms of HCC and present late when cure with surgical resection or transplantation is no longer possible. For this reason, patients at high risk for developing HCC are subjected to frequent screening processes. The surgical management of HCC is complex and requires an inter-disciplinary approach. Hepatic resection is the treatment of choice for HCC in patients without cirrhosis and is indicated in some patients with early cirrhosis (Child-Pugh A). Liver transplantation has emerged in the past decade as the standard of care for patients with cirrhosis and HCC meeting Milan criteria and in select patients with HCC beyond Milan criteria. Loco-regional therapy with transarterial chemoembolization, transarterial embolization, radiofrequency ablation and other similar local treatments can be used as neo-adjuvant therapy to downstage HCC to within Milan criteria or as a bridge to transplantation in patients on transplant wait list. PMID:25386049

  13. Rule Driven Multi-Objective Management (RDMOM) - An Alternative Form for Describing and Developing Effective Water Resources Management Strategies

    NASA Astrophysics Data System (ADS)

    Sheer, D. P.

    2011-12-01

    Economics provides a model for describing human behavior applied to the management of water resources, but that model assumes, among other things, that managers have a way of directly relating immediate actions to long-term economic outcomes. This is rarely the case in water resources problems where uncertainty has significant impacts on the effectiveness of management strategies and where the management objectives are very difficult to commensurate. The difficulty in using economics is even greater in multiparty disputes, where each party has a different relative value for each of the management objectives, and many of the management objectives are shared. A three step approach to collaborative decision making can overcome these difficulties. The first step involves creating science based performance measures and evaluation tools to estimate the effect of alternative management strategies on each of the non-commensurate objectives. The second step involves developing short-term surrogate operating objectives that implicitly deal with all of the aspects of the long term uncertainty. Management that continually "optimizes" the short-term objectives subject to physical and other constraints that change through time can be characterized as Rule Driven Multi-Objective Management (RDMOM). RDMOM strategies are then tested in simulation models to provide the basis for evaluating performance measures. Participants in the collaborative process then engage in multiparty discussions that create new alternatives, and "barter" a deal. RDMOM does not assume that managers fully understand the link between current actions and long term goals. Rather, it assumes that managers operate to achieve short-term surrogate objectives which they believe will achieve an appropriate balance of both short and long-term incommensurable benefits. A reservoir rule curve is a simple, but often not particularly effective, example of the real-world implementation of RDMOM. Water managers find they

  14. Current Treatment Strategies for Castration-Resistant Prostate Cancer

    PubMed Central

    Kim, Sun Il

    2011-01-01

    Prostate cancer is the most common cancer in men in United States and the fifth most common cancer in men in Korea. Although the majority of patients with metastatic prostate cancer initially respond to androgen deprivation therapy, almost all patients will eventually progress to develop castration-resistant prostate cancer (CRPC). Treatment options for CRPC remain limited. Prostate cancer was considered unresponsive to chemotherapy until the mid-1990s, when mitoxantrone combined with prednisone was shown to play a role in the palliative treatment of patients with CRPC. In 2004, two large randomized clinical trials demonstrated for the first time a small but significant survival advantage of docetaxel-based chemotherapy compared with mitoxantrone in patients with metastatic CRPC. Recently, cabazitaxel was shown to improve survival in patients with metastatic CRPC who progressed after docetaxel-based chemotherapy. Sipuleucel-T was also demonstrated to improve overall survival in patients with asymptomatic or minimally symptomatic metastatic CRPC. Along with mitoxantrone and docetaxel, cabazitaxel and sipuleucel-T are now approved for use in metastatic CRPC by the US Food and Drug Administration. There have been multiple early-phase clinical trials of various agents for the treatment of CRPC, and some are in phase III development. This review focuses on the key clinical trials of various treatment options of CRPC currently in use and under investigation. PMID:21461278

  15. Current perspectives on combination therapy in the management of hypertension

    PubMed Central

    Mallat, Samir G; Itani, Houssam S; Tanios, Bassem Y

    2013-01-01

    , triple SPCs have been approved and provide an attractive option for patients not achieving BP target on dual combination. The effect of such a strategy in the overall management of HTN, especially on further reducing the incidence of CV events, will have to be confirmed in future clinical and population-based studies. PMID:23837009

  16. Overview of current surgical strategies for aortic disease in patients with Marfan syndrome.

    PubMed

    Miyahara, Shunsuke; Okita, Yutaka

    2016-09-01

    Marfan syndrome is a heritable, systemic disorder of the connective tissue with a high penetrance, named after Dr. Antoine Marfan. The most clinically important manifestations of this syndrome are cardiovascular pathologies which cause life-threatening events, such as acute aortic dissections, aortic rupture and regurgitation of the aortic valve or other artrioventricular valves leading to heart failure. These events play important roles in the life expectancy of patients with this disorder, especially prior to the development of effective surgical approaches for proximal ascending aortic disease. To prevent such catastrophic aortic events, a lower threshold has been recommended for prophylactic interventions on the aortic root. After prophylactic root replacement, disease in the aorta beyond the root and distal to the arch remains a cause for concern. Multiple surgeries are required throughout a patient's lifetime that can be problematic due to distal lesions complicated by dissection. Many controversies in surgical strategies remain, such as endovascular repair, to manage such complex cases. This review examines the trends in surgical strategies for the treatment of cardiovascular disease in patients with Marfan syndrome, and current perspectives in this field. PMID:26586198

  17. Leadership Strategies of Performance Measures Impacts in Public Sector Management: A National Content Analysis.

    ERIC Educational Resources Information Center

    Kubala, James Joseph

    A quantitative and qualitative study examined three leadership strategies found in performance-based management (human resource, scientific management and political strategies used in public sector management); a framework by which performance measurement (PM) supports leadership strategies; and how the strategies impact PM. It examined leadership…

  18. Computer-managed instruction: an alternative teaching strategy.

    PubMed

    Day, R; Payne, L

    1987-01-01

    Computer-managed instruction is an instructional strategy whereby the computer is used to provide learning objectives, learning resources, and assessment of learner performance. Computer-managed instruction (CMI) aids the instructor in instructional management without actually doing the teaching. Central CMI themes discussed in the literature are individualization, behavioral objectives, and educational technology. The main objective of this study was to compare the outcomes of two teaching strategies: CMI versus the traditional lecture method. The learning objectives were based on specified theoretical content from a Health Assessment course for baccalaureate nursing students. The design of the study was quasi-experimental incorporating two experimental treatments applied to two groups on two occasions. Data analysis addresses differences between groups using CMI and the traditional lecture method. The variables examined were the cognitive performance of learners, the learner's attitude toward the instructional strategy, the learner's retention of knowledge, the time involved in mastering the learning objectives, and the relationship between learner characteristics and the effectiveness of the instructional strategy. No significant mean difference (p less than 0.05) was found between groups on cognitive performance as measured by written and practical examination scores. For these first-year baccalaureate nursing students, CMI did not prove to be a positive instructional method as assessed by the Attitude Questionnaire. The majority of students preferred a combination of instructional methods. There was no significant difference between groups in the time spent meeting the learning objectives by either teaching strategy. The findings suggested that these students preferred learning strategies that are traditional in nature and teacher directed.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:3029349

  19. Development of Strategies for Sustainable Irrigation Water Management in Russia

    NASA Astrophysics Data System (ADS)

    Zeyliger, Anatoly; Ermolaeva, Olga

    2013-04-01

    During 1960 - 1990 years irrigated areas in Russia have increased rapidly, helping to boost agricultural output. Although the impressive achievements of irrigation in this period its large experience indicates problems and failures of irrigation water management. In addition to large water use and low irrigation water efficiency, environmental concerns (excessive water depletion, water quality reduction, water logging, soil degradation) are usually considered like the most significant problem of the irrigation sector. Despite of considerable shrinking of irrigated areas in Russia and decreasing of water withdrawal for irrigation purposes during two last decades a degradation of environment as well as degradation of soil and water resources in irrigated areas was prolonged and will probably continue if current irrigation practices are maintained. Nowadays, in different regions of Russia there are societal demand to restore agricultural irrigation in Russia as answer to challenges from climate pattern changes and degradation of land & water resources. In the respect of these demands there is a need to develop strategies for sustainability of agricultural irrigation in Russia that should be based on three main societal objectives: costeffective use of water in irrigated agriculture at farm level, and satisfactory preserving the natural environment. Therefore sustainable irrigation water management is not only an objective at farm level but also an overall goal at the local and regional as well. A way to achieve sustainability in irrigation water management is to solve the local conflicts arising from the interactions between water use at irrigation areas and surrounding environment. Thus should be based on the development of irrigation framework program including on the irrigation water management issues, policies & decisions making at federal and regional levels should be based on the indicators of environment & irrigation water efficiency monitoring promoting the

  20. Effective rheumatoid arthritis treatment requires comprehensive management strategies.

    PubMed

    Boomershine, Chad S

    2009-01-01

    Work by Lee and colleagues has shown that decreased sleep quality and increased psychiatric distress increase pain sensitivity at both articular and nonarticular sites in rheumatoid arthritis (RA) patients. This work is consistent with prior studies showing that factors independent of RA disease activity can influence RA outcome measures. Owing to increasing pressure on rheumatologists to use outcome measures to inform treatment decisions, the work by Lee and colleagues highlights the need for comprehensive RA management strategies to understand and address the human factors that influence outcomes measures. Such strategies will ensure appropriate use of increasingly expensive therapies while maximizing patient satisfaction and reimbursement. PMID:20067592

  1. Effective rheumatoid arthritis treatment requires comprehensive management strategies

    PubMed Central

    2009-01-01

    Work by Lee and colleagues has shown that decreased sleep quality and increased psychiatric distress increase pain sensitivity at both articular and nonarticular sites in rheumatoid arthritis (RA) patients. This work is consistent with prior studies showing that factors independent of RA disease activity can influence RA outcome measures. Owing to increasing pressure on rheumatologists to use outcome measures to inform treatment decisions, the work by Lee and colleagues highlights the need for comprehensive RA management strategies to understand and address the human factors that influence outcomes measures. Such strategies will ensure appropriate use of increasingly expensive therapies while maximizing patient satisfaction and reimbursement. PMID:20067592

  2. The Effectiveness of Time Management Strategies Instruction on Students' Academic Time Management and Academic Self Efficacy

    ERIC Educational Resources Information Center

    Kader, Fathi Abdul Hamid Abdul; Eissa, Mourad Ali

    2015-01-01

    This study investigated the effect of using time management strategies instruction on improving first year learning disabled students' academic time management and academic self efficacy. A total of 60 students identified with LD participated. The sample was divided into two groups; experimental (n = 30 boys) and control (n = 30 boys). ANCOVA and…

  3. Current UK practices in the management of subacromial impingement

    PubMed Central

    Drury, Colin; Tait, Gavin R

    2015-01-01

    Background Controversy presently exists surrounding the management of patients with subacromial impingement. This study aims to highlight current UK practices in the management of these patients. Methods BESS members were invited to complete a questionnaire and responses were received from 157 consultant shoulder surgeons. Results Physiotherapy is an integral part of management for 93% of surgeons with a minimum period of 12 weeks being most popular prior to consideration of arthroscopic subacromial decompression. Subacromial steroid injection is used by 95% and 86% repeat this if the patient has failed to respond to a previous injection by the general practioner. From initial presentation, 77% felt there should be at least 3 months of conservative management before proceeding to surgery. Good but transient response to subacromial injection was considered the best predictor of good surgical outcome by 77%. The coracoacromial ligament is fully released by 78%, although there was greater variation in how aggressive surgeons were with acromioplasty. Most (59%) do not include the nontender acromioclavicular joint to any extent in routine acromioplasty. Hospital physiotherapy protocols are used by 63% for postoperative rehabilitation. Conclusions Variation exists in the management regimes offered to patients with subacromial impingement, but most employ a minimum period of 12 weeks of conservative management incorporating physiotherapy and at least 2 subacromial steriod injections.

  4. Clinical management of dilated cardiomyopathy: current knowledge and future perspectives.

    PubMed

    Merlo, Marco; Cannatá, Antonio; Vitagliano, Alice; Zambon, Elena; Lardieri, Gerardina; Sinagra, Gianfranco

    2016-01-01

    Dilated cardiomyopathy (DCM) is a primary heart muscle disease characterized by a progressive dilation and dysfunction of either the left or both ventricles. The management of DCM is currently challenging for clinicians. The persistent lack of knowledge about the etiology and pathophysiology of this disease continues to determine important fields of uncertainty in managing this condition. Molecular cardiology and genetics currently represent the most crucial horizon of increasing knowledge. Understanding the mechanisms underlying the disease allows clinicians to treat this disease more effectively and to further improve outcomes of DCM patients through advancements in etiologic characterization, prognostic stratification and individualized therapy. Left ventricular reverse remodeling predicts a lower rate of major cardiac adverse events independently from other factors. Optimized medical treatment and device implantation are pivotal in inducing left ventricular reverse remodeling. Newly identified targets, such as angiotensin-neprilysin inhibition, phosphodiesterase inhibition and calcium sensitizing are important in improving prognosis in patients affected by DCM. PMID:26606394

  5. Multiparametric magnetic resonance imaging: Current role in prostate cancer management.

    PubMed

    Ueno, Yoshiko; Tamada, Tsutomu; Bist, Vipul; Reinhold, Caroline; Miyake, Hideaki; Tanaka, Utaru; Kitajima, Kazuhiro; Sugimura, Kazuro; Takahashi, Satoru

    2016-07-01

    Digital rectal examination, serum prostate-specific antigen screening and transrectal ultrasound-guided biopsy are conventionally used as screening, diagnostic and surveillance tools for prostate cancer. However, they have limited sensitivity and specificity. In recent years, the role of multiparametric magnetic resonance imaging has steadily grown, and is now part of the standard clinical management in many institutions. In multiparametric magnetic resonance imaging, the morphological assessment of T2-weighted imaging is correlated with diffusion-weighted imaging, dynamic contrast-enhanced imaging perfusion and/or magnetic resonance spectroscopic imaging. Multiparametric magnetic resonance imaging is currently regarded as the most sensitive and specific imaging technique for the evaluation of prostate cancer, including detection, staging, localization and aggressiveness evaluation. This article presents an overview of multiparametric magnetic resonance imaging, and discusses the current role of multiparametric magnetic resonance imaging in the different fields of prostate cancer management. PMID:27184019

  6. Marital Interaction and Marital Conflict: A Critical Evaluation of Current Research Strategies

    ERIC Educational Resources Information Center

    Glick, Bruce R.; Gross, Steven Jay

    1975-01-01

    Methods currently used to investigate interaction during marital conflict limit the validity and generalizability of findings concerning the determinants and consequences of couples' interaction styles. The respective advantages and limitations of two research strategies--questionnaires and simulation strategies--are critically evaluated. Several…

  7. Self-managing teams: a strategy for quality improvement.

    PubMed

    Feifer, Chris; Nocella, Kiki; DeArtola, Ignacio; Rowden, Suzanne; Morrison, Stephen

    2003-01-01

    Organizations are impacted by their environments, and health care settings are no different. Individuals charged with improving a practice are often impeded by environmental barriers, including incomplete information for decision making. One strategy to empower an organization for change is to form a self-managing team. This paper discusses the self-managing team concept and uses a case study to illustrate its application in primary care. Factors contributing to team success are presented as a guide, and a reminder--there is more to an effective team than gathering people in a room. PMID:12674392

  8. Financial coping strategies of mental health consumers: managing social benefits.

    PubMed

    Caplan, Mary Ager

    2014-05-01

    Mental health consumers depend on social benefits in the forms of supplemental security income and social security disability insurance for their livelihood. Although these programs pay meager benefits, little research has been undertaken into how this population makes ends meet. Using a qualitative approach, this study asks what are the financial coping strategies of mental health consumers? Seven approaches were identified: subsidies, cost-effective shopping, budgeting, prioritizing, technology, debt management, and saving money. Results illustrate the resourcefulness of mental health consumers in managing meager social benefits and highlight the need to strengthen community mental health efforts with financial capabilities education. PMID:24346222

  9. Management strategies and financial performance in rural and urban hospitals.

    PubMed

    Wang, B B; Wan, T T; Falk, J A; Goodwin, D

    2001-08-01

    This study identifies the difference in financial performance between rural and urban hospitals and examines whether or not that difference may be attributed to the emphasis of revenue enhancement over cost management strategies. Hospitals in Virginia were included in this study except for the two state university medical centers. Rural and urban hospitals were compared on 10 performance indicators grouped into four categories: revenues, costs, profits, and productivity. The results suggest that rural hospital profitability is dependent on cost management. Since rural hospitals achieved lower cost, better efficiency and productivity level than urban hospitals in Virginia, they demonstrate a significant higher level of profit. PMID:11463201

  10. Current Concepts in the Management of Rheumatoid Hand

    PubMed Central

    Longo, Umile Giuseppe; Petrillo, Stefano; Denaro, Vincenzo

    2015-01-01

    Rheumatoid arthritis (RA) is a chronic inflammatory disease caused by a T cell-driven autoimmune process, which majorly involves the diarthrodial joints. It affects 1% of the US population, and approximately 70% of patients with RA develop pathologies of the hand, especially of the metacarpophalangeal joints (MCP). Furthermore, also the extensor and flexor tendons of the fingers are frequently involved. The first line of treatment should be conservative. Three general classes of drugs are currently available for RA: nonsteroidal anti-inflammatory agents (NSAIDs), corticosteroids, and disease modifying antirheumatic drugs (DMARDs). Encouraging results have been obtained using DMARDs. However, when severe deformities occur or when patients are unresponsive to medical management and injections therapy, surgical intervention should be performed to relieve pain and restore function. Several surgical options have been described for the management of MCP joint deformities, including soft tissue procedures, arthrodesis, and prosthetic replacement. Tendons ruptures are generally managed with tendon transfer surgery, while different surgical procedures are available to treat fingers deformities. The aim of the present review is to report the current knowledge in the management of MCP joint deformities, as well as tendons damage and fingers deformities, in patients with RA. PMID:26236341

  11. Managing benefits for diabetes: changing payer strategies for changing times.

    PubMed

    Tzeel, Albert

    2013-01-01

    Just as there are many ways to treat a condition such as diabetes, there are also many ways for payers to manage the diabetes benefit. Although none of these methods is specifically right or wrong, they are grounded in a payer's philosophy and created in response to the needs of the time. Yet, just as in any other business, new ideas and, for diabetes, new scientific discoveries will surely mandate new strategies to achieve goals. As payers find themselves adapting to new political realities and new partnerships, one cannot be sure if their new strategies will succeed or not. But, in actuality, this becomes moot as the 1 point we can be sure of is that benefit management will continue to evolve. PMID:23725238

  12. Aircrew Discourse: Exploring Strategies of Information and Action Management

    NASA Technical Reports Server (NTRS)

    Irwin, Cheryl M.; Veinott, Elizabeth S.; Shafto, Michael G. (Technical Monitor)

    1995-01-01

    This paper explores methodology issues encountered in the analysis of flightcrew communications in aviation simulation research. Examples are provided by two recent studies which are compared on three issues: level of analysis, data definition, and interpretation of the results. The data discussed were collected in a study comparing two levels of aircraft automation. The first example is an investigation of how pilots' information transfer strategies differed as a function of automation during low and high-workload flight phases. The second study focuses on how crews managed actions in the two aircraft during a ten minute, high-workload flight segment. Results indicated that crews in the two aircraft differed in their strategies of information and action management. The differences are discussed in terms of their operational and research significance.

  13. International Border Management Systems (IBMS) Program : visions and strategies.

    SciTech Connect

    McDaniel, Michael; Mohagheghi, Amir Hossein

    2011-02-01

    Sandia National Laboratories (SNL), International Border Management Systems (IBMS) Program is working to establish a long-term border security strategy with United States Central Command (CENTCOM). Efforts are being made to synthesize border security capabilities and technologies maintained at the Laboratories, and coordinate with subject matter expertise from both the New Mexico and California offices. The vision for SNL is to provide science and technology support for international projects and engagements on border security.

  14. World enough and time. Successful strategies for resource management

    SciTech Connect

    Repetto, R.

    1986-01-01

    This book concentrates on strategies that have proved successful in stabilizing forests, using water and energy supplies efficiently, and managing other major resource systems sustainably. The author cites dozens of models and policies that have already demonstrated their practicability and that are often easier and less expensive than conventional methods. The author also spells out which roles should be taken by governments, international agencies, science, industry, and private groups, and whether particular steps are best taken at the local, national, or international level.

  15. Prevalence, Diagnosis and Management of Pancreatic Cystic Neoplasms: Current Status and Future Directions

    PubMed Central

    Farrell, James J.

    2015-01-01

    Cystic neoplasms of the pancreas are found with increasing prevalence, especially in elderly asymptomatic individuals. Although the overall risk of malignancy is very low, the presence of these pancreatic cysts is associated with a large degree of anxiety and further medical investigation due to concerns about malignancy. This review discusses the different cystic neoplasms of the pancreas and reports diagnostic strategies based on clinical features and imaging data. Surgical and nonsurgical management of the most common cystic neoplasms, based on the recently revised Sendai guidelines, is also discussed, with special reference to intraductal papillary mucinous neoplasm (IPMN; particularly the branch duct variant), which is the lesion most frequently identified incidentally. IPMN pathology, its risk for development into pancreatic ductal adenocarcinoma, the pros and cons of current guidelines for management, and the potential role of endoscopic ultrasound in determining cancer risk are discussed. Finally, surgical treatment, strategies for surveillance of pancreatic cysts, and possible future directions are discussed. PMID:26343068

  16. Sustainability of insect resistance management strategies for transgenic Bt corn.

    PubMed

    Glaser, John A; Matten, Sharlene R

    2003-12-01

    Increasing interest in the responsible management of technology in the industrial and agricultural sectors of the economy has been met thorough the development of broadly applicable tools to assess the "sustainability" of new technologies. An arena ripe for application of such analysis is the deployment of transgenic crops. The new transgenic pesticidal or plant-incorporated protectant (PIP) crops have seen widespread application in the United States based on the features of higher yield, lower applications of insecticides, and control of mycotoxin content. However, open rejection of these new crops in Europe and in other countries has been a surprising message and has limited their worldwide acceptance. The US Environmental Protection Agency's (USEPA) Office of Pesticide Programs (OPP) has worked on the development and analysis of insect resistance management (IRM) strategies and has mandated specific IRM requirements for Bacillus thuringiensis (Bt) crops since 1995 under the Food, Fungicide, Insecticide, and Rodenticide Act. Improvement of data quality and sustainability of IRM strategies have been targeted in an ongoing partnership between the USEPA Office of Research and Development and the Office of Pesticide Programs that will further enhance the agency's ability to develop sustainable insect resistance management strategies for transgenic field corn (Bt corn) producing B. thuringiensis (Bt) insecticidal proteins. PMID:14623043

  17. Chronic pain management strategies used by low income overweight Latinos

    PubMed Central

    Rutledge, Dana N; Cantero, Patricia J; Ruiz, Jeanette E

    2013-01-01

    Objectives In group interviews, we examined strategies used to manage chronic pain from the perspective of the individual. Methods Sixteen low income overweight Latino adults participated in two group interviews facilitated by a trained moderator who inquired about the type of chronic pain suffered by participants, followed by more specific questions about pain management. Interviews were audio-recorded, transcribed verbatim (Spanish), back-translated into English, and analyzed using thematic analysis. Results Participants’ pain varied in type, location, and intensity. Participants discussed pain-related changes in activities and social life, and difficulties with health care providers, and as a result, we discovered five major themes: Pain-related Life Alterations, Enduring the Pain, Trying Different Strategies, Emotional Suffering, and Encounters with Health Care System/Providers. Discussion Findings indicated that there are opportunities for providers to improve care for low income overweight Latinos with chronic pain by listening respectfully to how pain alters their daily lives and assisting them in feasible self management strategies. PMID:23129787

  18. An environmental analysis for comparing waste management options and strategies.

    PubMed

    Marchettini, N; Ridolfi, R; Rustici, M

    2007-01-01

    The debate on different waste management practices has become an issue of utmost importance as human activities have overloaded the assimilative capacity of the biosphere. Recent Italian law on solid waste management recommends an increase in material recycling and energy recovery, and only foresees landfill disposal for inert materials and residues from recovery and recycling. A correct waste management policy should be based on the principles of sustainable development, according to which our refuse is not simply regarded as something to eliminate but rather as a potential resource. This requires the creation of an integrated waste management plan that makes full use of all available technologies. In this context, eMergy analysis is applied to evaluate three different forms of waste treatment and construct an approach capable of assessing the whole strategy of waste management. The evaluation included how much investment is needed for each type of waste management and how much "utility" is extracted from wastes, through the use of two indicators: Environmental yield ratio (EYR) and Net eMergy. Our results show that landfill is the worst system in terms of eMergy costs and eMergy benefits. Composting is the most efficient system in recovering eMergy (highest EYR) from municipal solid waste (MSW) while incineration is capable of saving the greatest quantity of eMergy per gram of MSW (highest net eMergy). This analysis has made it possible to assess the sustainability and the efficiency of individual options but could also be used to assess a greater environmental strategy for waste management, considering a system that might include landfills, incineration, composting, etc. PMID:16765586

  19. Air traffic control resource management strategies and the small aircraft transportation system: A system dynamics perspective

    NASA Astrophysics Data System (ADS)

    Galvin, James J., Jr.

    The National Aeronautics and Space Administration (NASA) is leading a research effort to develop a Small Aircraft Transportation System (SATS) that will expand air transportation capabilities to hundreds of underutilized airports in the United States. Most of the research effort addresses the technological development of the small aircraft as well as the systems to manage airspace usage and surface activities at airports. The Federal Aviation Administration (FAA) will also play a major role in the successful implementation of SATS, however, the administration is reluctant to embrace the unproven concept. The purpose of the research presented in this dissertation is to determine if the FAA can pursue a resource management strategy that will support the current radar-based Air Traffic Control (ATC) system as well as a Global Positioning Satellite (GPS)-based ATC system required by the SATS. The research centered around the use of the System Dynamics modeling methodology to determine the future behavior of the principle components of the ATC system over time. The research included a model of the ATC system consisting of people, facilities, equipment, airports, aircraft, the FAA budget, and the Airport and Airways Trust Fund. The model generated system performance behavior used to evaluate three scenarios. The first scenario depicted the base case behavior of the system if the FAA continued its current resource management practices. The second scenario depicted the behavior of the system if the FAA emphasized development of GPS-based ATC systems. The third scenario depicted a combined resource management strategy that supplemented radar systems with GPS systems. The findings of the research were that the FAA must pursue a resource management strategy that primarily funds a radar-based ATC system and directs lesser funding toward a GPS-based supplemental ATC system. The most significant contribution of this research was the insight and understanding gained of how

  20. Managing temptation in obesity treatment: A neurobehavioral model of intervention strategies.

    PubMed

    Appelhans, Bradley M; French, Simone A; Pagoto, Sherry L; Sherwood, Nancy E

    2016-01-01

    Weight loss outcomes in lifestyle interventions for obesity are primarily a function of sustained adherence to a reduced-energy diet, and most lapses in diet adherence are precipitated by temptation from palatable food. The high nonresponse and relapse rates of lifestyle interventions suggest that current temptation management approaches may be insufficient for most participants. In this conceptual review, we discuss three neurobehavioral processes (attentional bias, temporal discounting, and the cold-hot empathy gap) that emerge during temptation and contribute to lapses in diet adherence. Characterizing the neurobehavioral profile of temptation highlights an important distinction between temptation resistance strategies aimed at overcoming temptation while it is experienced, and temptation prevention strategies that seek to avoid or minimize exposure to tempting stimuli. Many temptation resistance and temptation prevention strategies heavily rely on executive functions mediated by prefrontal systems that are prone to disruption by common occurrences such as stress, insufficient sleep, and even exposure to tempting stimuli. In contrast, commitment strategies are a set of devices that enable individuals to manage temptation by constraining their future choices, without placing heavy demands on executive functions. These concepts are synthesized in a conceptual model that categorizes temptation management approaches based on their intended effects on reward processing and degree of reliance on executive functions. We conclude by discussing the implications of our model for strengthening temptation management approaches in future lifestyle interventions, tailoring these approaches based on key individual difference variables, and suggesting high-priority topics for future research. PMID:26431681

  1. Strategy Guideline: Quality Management in Existing Homes; Cantilever Floor Example

    SciTech Connect

    Taggart, J.; Sikora, J.; Wiehagen, J.; Wood, A.

    2011-12-01

    This guideline is designed to highlight the QA process that can be applied to any residential building retrofit activity. The cantilevered floor retrofit detailed in this guideline is included only to provide an actual retrofit example to better illustrate the QA activities being presented. The goal of existing home high performing remodeling quality management systems (HPR-QMS) is to establish practices and processes that can be used throughout any remodeling project. The research presented in this document provides a comparison of a selected retrofit activity as typically done versus that same retrofit activity approached from an integrated high performance remodeling and quality management perspective. It highlights some key quality management tools and approaches that can be adopted incrementally by a high performance remodeler for this or any high performance retrofit. This example is intended as a template and establishes a methodology that can be used to develop a portfolio of high performance remodeling strategies.

  2. The Future of Nematology: Integration of New and Improved Management Strategies

    PubMed Central

    Roberts, Philip A.

    1993-01-01

    The potential for managing plant-parasitic nenlatodes by combining two or more control strategies in an integrated program is examined. Advantages of this approach include the use of partially effective strategies and protection of highly effective ones vulnerable from nematode adaptation or environmental risk. Strategies can be combined sequentially from season to season or applied simultaneously. Programs that have several strategies available but that are limited in the true integration of control components are used as examples of current management procedures and the potential for their improvement. These include potato cyst nematodes in northern Europe, soybean cyst nematode in North Carolina, and root-knot nematodes on vegetable and field crops in California. A simplified model of the impact of component strategies on the nematode damage function indicates the potential for combining control measures with different efficacies to give acceptable nematode population reduction and crop protection. The likelihood for additive, synergistic, or antagonistic effects from combining strategies is considered with respect to the biological target and component compatibility. PMID:19279784

  3. Risk Preferences, Probability Weighting, and Strategy Tradeoffs in Wildfire Management.

    PubMed

    Hand, Michael S; Wibbenmeyer, Matthew J; Calkin, David E; Thompson, Matthew P

    2015-10-01

    Wildfires present a complex applied risk management environment, but relatively little attention has been paid to behavioral and cognitive responses to risk among public agency wildfire managers. This study investigates responses to risk, including probability weighting and risk aversion, in a wildfire management context using a survey-based experiment administered to federal wildfire managers. Respondents were presented with a multiattribute lottery-choice experiment where each lottery is defined by three outcome attributes: expenditures for fire suppression, damage to private property, and exposure of firefighters to the risk of aviation-related fatalities. Respondents choose one of two strategies, each of which includes "good" (low cost/low damage) and "bad" (high cost/high damage) outcomes that occur with varying probabilities. The choice task also incorporates an information framing experiment to test whether information about fatality risk to firefighters alters managers' responses to risk. Results suggest that managers exhibit risk aversion and nonlinear probability weighting, which can result in choices that do not minimize expected expenditures, property damage, or firefighter exposure. Information framing tends to result in choices that reduce the risk of aviation fatalities, but exacerbates nonlinear probability weighting. PMID:26269258

  4. Breast cancer pain management - A review of current & novel therapies

    PubMed Central

    Satija, Aanchal; Ahmed, Syed Mehmood; Gupta, Rahul; Ahmed, Arif; Rana, Shiv Pratap Singh; Singh, Suraj Pal; Mishra, Seema; Bhatnagar, Sushma

    2014-01-01

    Breast cancer is one of the most prevalent cancers amongst women in the world. Unfortunately, even after adequate treatment, some patients experience severe pain either due to disease progression or due to treatment related side effects. The persistent pain causes a negative physical and psychosocial impact on patients’ lives. Current rational pain management is patient-centred and requires a thorough psychological assessment. Usually adequate analgesia is achieved by adopting the WHO's three step analgesic ladder. As the disease progresses, the pain experienced by the patient also increases. This necessitates the administration of opioids and adjuvant analgesics to the breast cancer patients experiencing severe pain. However, opioid use is associated with intolerable side effects like constipation, nausea, vomiting, fear of dependence, and tolerance. Concomitant medications are required to combat these unacceptable side effects. Adjuvant analgesics need to be added to provide adequate and satisfactory analgesia. These factors worsen the psychological state of patients and deteriorate their quality of life. Hence, there is a need to develop therapeutic modalities to provide adequate analgesia with minimum side effects. This review article focuses on the current treatments available for cancer pain management, their limitations, and novel targets and non-pharmacological measures under investigation which have the potential to produce a radical change in pain management measures for the breast cancer patients. PMID:24718395

  5. Water management: Current and future challenges and research directions

    NASA Astrophysics Data System (ADS)

    Cosgrove, William J.; Loucks, Daniel P.

    2015-06-01

    Water distinguishes our planet compared to all the others we know about. While the global supply of available freshwater is more than adequate to meet all current and foreseeable water demands, its spatial and temporal distributions are not. There are many regions where our freshwater resources are inadequate to meet domestic, economic development and environmental needs. In such regions, the lack of adequate clean water to meet human drinking water and sanitation needs is indeed a constraint on human health and productivity and hence on economic development as well as on the maintenance of a clean environment and healthy ecosystems. All of us involved in research must find ways to remove these constraints. We face multiple challenges in doing that, especially given a changing and uncertain future climate, and a rapidly growing population that is driving increased social and economic development, globalization, and urbanization. How best to meet these challenges requires research in all aspects of water management. Since 1965, the journal Water Resources Research has played an important role in reporting and disseminating current research related to managing the quantity and quality and cost of this resource. This paper identifies the issues facing water managers today and future research needed to better inform those who strive to create a more sustainable and desirable future.

  6. Management of keloids and hypertrophic scars: current and emerging options

    PubMed Central

    Gauglitz, Gerd G

    2013-01-01

    In the context of growing aesthetic awareness, a rising number of patients feel disappointed with their scars and are frequently seeking help for functional and aesthetic improvement. However, excessive scarring following surgery or trauma remains difficult to improve despite a plethora of advocated treatment strategies as frequently observed in daily clinical routine. It is thus still preferable to prevent scarring by minimizing risk factors as much as possible. Hence, it remains crucial for the physician to be aware of basic knowledge of healing mechanisms and skin anatomy, as well as an appreciation of suture material and wound closure techniques to minimize the risk of postoperative scarring. Next to existing, well known prophylactic and therapeutic strategies for the improvement of excessive scarring, this article discusses emerging techniques such as intralesional cryotherapy, intralesional 5-fluorouracil, interferon, and bleomycin. Some of them have been successfully tested in well-designed trials and already have extended or may extend the current spectrum of excessive scar treatment in the near future. Innovative options such as imiquimod 5% cream, photodynamic therapy, or botulinum toxin A may also be of certain importance; however, the data currently available is too contradictory for definite recommendations. PMID:23637546

  7. The Role of Individual Differences and Situational Variables in the Use of Workplace Sexual Identity Management Strategies.

    PubMed

    Reed, Louren; Leuty, Melanie E

    2016-07-01

    Examination of individual difference variables have been largely ignored within research on the use of workplace sexual identity management strategies. The current study examined personality traits (extraversion, openness, and neuroticism), facets of sexual identity development (identity confusion, internalized heterosexism), and situational variables (e.g., perceptions of workplace climate and heterosexism) in explaining the use of management strategies, as well as possible interactions between individual and situational factors. Perceptions of the workplace climate toward lesbian and gay individuals significantly related to the use each of the management strategies, and Internalized Heterosexism was found to significantly predict the use of the Explicitly Out strategy. Most interactions between individual difference and situational variables were not supported, with the exception of an interaction between workplace heterosexism and internalized homophobia in explaining the use of the Explicitly Out strategy. PMID:26563765

  8. Current therapeutic strategies for advanced pancreatic cancer: A review for clinicians

    PubMed Central

    Spadi, Rosella; Brusa, Federica; Ponzetti, Agostino; Chiappino, Isabella; Birocco, Nadia; Ciuffreda, Libero; Satolli, Maria Antonietta

    2016-01-01

    Pancreatic cancer (PC) would become the second leading cause of cancer death in the near future, despite representing only 3% of new cancer diagnosis. Survival improvement will come from a better knowledge of risk factors, earlier diagnosis, better integration of locoregional and systemic therapies, as well as the development of more efficacious drugs rising from a deeper understanding of disease biology. For patients with unresectable, non-metastatic disease, combined strategies encompassing primary chemotherapy and radiation seems to be promising. In fit patients, new polychemotherapy regimens can lead to better outcomes in terms of slight but significant survival improvement associated with a positive impact on quality of life. The upfront use of these regimes can also increase the rate of radical resections in borderline resectable and locally advanced PC. Second line treatments showed to positively affect both overall survival and quality of life in fit patients affected by metastatic disease. At present, oxaliplatin-based regimens are the most extensively studied. Nonetheless, other promising drugs are currently under evaluation. Presently, in addition to surgery and conventional radiation therapy, new locoregional treatment techniques are emerging as alternative options in the multimodal approach to patients or diseases not suitable for radical surgery. As of today, in contrast with other types of cancer, targeted therapies failed to show relevant activity either alone or in combination with chemotherapy and, thus, current clinical practice does not include them. Up to now, despite the fact of extremely promising results in different tumors, also immunotherapy is not in the actual therapeutic armamentarium for PC. In the present paper, we provide a comprehensive review of the current state of the art of clinical practice and research in PC aiming to offer a guide for clinicians on the most relevant topics in the management of this disease. PMID:26862489

  9. Current therapeutic strategies for advanced pancreatic cancer: A review for clinicians.

    PubMed

    Spadi, Rosella; Brusa, Federica; Ponzetti, Agostino; Chiappino, Isabella; Birocco, Nadia; Ciuffreda, Libero; Satolli, Maria Antonietta

    2016-02-10

    Pancreatic cancer (PC) would become the second leading cause of cancer death in the near future, despite representing only 3% of new cancer diagnosis. Survival improvement will come from a better knowledge of risk factors, earlier diagnosis, better integration of locoregional and systemic therapies, as well as the development of more efficacious drugs rising from a deeper understanding of disease biology. For patients with unresectable, non-metastatic disease, combined strategies encompassing primary chemotherapy and radiation seems to be promising. In fit patients, new polychemotherapy regimens can lead to better outcomes in terms of slight but significant survival improvement associated with a positive impact on quality of life. The upfront use of these regimes can also increase the rate of radical resections in borderline resectable and locally advanced PC. Second line treatments showed to positively affect both overall survival and quality of life in fit patients affected by metastatic disease. At present, oxaliplatin-based regimens are the most extensively studied. Nonetheless, other promising drugs are currently under evaluation. Presently, in addition to surgery and conventional radiation therapy, new locoregional treatment techniques are emerging as alternative options in the multimodal approach to patients or diseases not suitable for radical surgery. As of today, in contrast with other types of cancer, targeted therapies failed to show relevant activity either alone or in combination with chemotherapy and, thus, current clinical practice does not include them. Up to now, despite the fact of extremely promising results in different tumors, also immunotherapy is not in the actual therapeutic armamentarium for PC. In the present paper, we provide a comprehensive review of the current state of the art of clinical practice and research in PC aiming to offer a guide for clinicians on the most relevant topics in the management of this disease. PMID:26862489

  10. Profiles of classroom behavior in high schools: associations with teacher behavior management strategies and classroom composition.

    PubMed

    Pas, Elise T; Cash, Anne H; O'Brennan, Lindsey; Debnam, Katrina J; Bradshaw, Catherine P

    2015-04-01

    Although there has been considerable attention to the issue of classroom management and processes in educational reform models, there has been relatively limited research on these factors in high schools. The current study utilized observational data from 1262 classrooms in 52 high schools to examine teacher classroom management strategies and ratings of student compliance, engagement, and social disruption. Latent profile analysis (LPA) was conducted to examine specific patterns of classroom-wide student behavior in relation to teachers' use of classroom management strategies and classroom composition. The LPA revealed three distinct classroom behavioral profiles where students consistently met behavioral expectations (71%), inconsistently met expectations (23%), and were noncompliant (6%). Analyses indicated a functional association between patterns of student behavior and teachers' classroom management. In classrooms where students consistently met expectations, teachers provided more opportunities to respond and less disapproval and reactive behavioral management. Classrooms with noncompliant students had teachers who used the most disapproval and reactive behavior management. In addition, classrooms characterized as consistent had fewer males and more White students than classrooms characterized by inconsistent and noncompliant behaviors. These findings highlight the link between student patterns of behavior and teacher classroom management and have important implications for screening and professional development. PMID:25746823

  11. Current approach in diagnosis and management of anterior uveitis

    PubMed Central

    Agrawal, Rupesh V; Murthy, Somasheila; Sangwan, Virender; Biswas, Jyotirmay

    2010-01-01

    Uveitis is composed of a diverse group of disease entities, which in total has been estimated to cause approximately 10% of blindness. Uveitis is broadly classified into anterior, intermediate, posterior and panuveitis based on the anatomical involvement of the eye. Anterior uveitis is, however, the commonest form of uveitis with varying incidences reported in worldwide literature. Anterior uveitis can be very benign to present with but often can lead to severe morbidity if not treated appropriately. The present article will assist ophthalmologists in accurately diagnosing anterior uveitis, improving the quality of care rendered to patients with anterior uveitis, minimizing the adverse effects of anterior uveitis, developing a decision-making strategy for management of patients at risk of permanent visual loss from anterior uveitis, informing and educating patients and other healthcare practitioners about the visual complications, risk factors, and treatment options associated with anterior uveitis. PMID:20029142

  12. Current concepts in the diagnosis and management of Parkinson's disease

    PubMed Central

    Guttman, Mark; Kish, Stephen J.; Furukawa, Yoshiaki

    2003-01-01

    PARKINSON'S DISEASE IS A PROGRESSIVE NEUROLOGICAL disorder characterized by rest tremor, bradykinesia, rigidity and postural instability. The cause is unknown, but growing evidence suggests that it may be due to a combination of environmental and genetic factors. Treatment during the early stage of Parkinson's disease has evolved, and evidence suggests that dopamine agonist monotherapy may prevent the response fluctuations that are associated with disease progression. L-dopa therapy, however, remains the most efficacious treatment. Treatment during the advanced stage focuses on improving control of a number of specific clinical problems. Successful management of motor response fluctuations (e.g., “wearing off,” on–off fluctuations, nighttime deterioration, early morning deterioration and dyskinesias) and of psychiatric problems is often possible with specific treatment strategies. Surgical treatment is an option for a defined patient population. PMID:12566335

  13. Current trends in diagnosis and management of cardiac amyloidosis.

    PubMed

    Esplin, Brandt L; Gertz, Morie A

    2013-02-01

    Amyloidosis is a rare disease in which insoluble extracellular protein fibrils in β-pleated sheets infiltrate multiple organs, causing organ dysfunction and failure. Amyloidoses are generally classified into light chain or primary systemic amyloidosis, hereditary amyloidosis (most commonly, transthyretin amyloidosis), senile systemic amyloidosis, secondary amyloidosis, and isolated atrial amyloidosis. At least 100 different amyloidogenic proteins have been identified in humans and can be differentiated by mass spectroscopy after laser capture microdissection and genetic testing. Organ involvement can include kidneys, skin, blood vessels, central and peripheral nervous systems, lungs, liver, intestines, and heart. Developments in noninvasive techniques are facilitating earlier and more accurate diagnosis. Management depends on the specific disease type, thus early and accurate diagnosis is imperative. Prognosis generally correlates with degree of cardiac involvement but varies widely with specific amyloid protein type. New treatment strategies involving chemotherapy and organ transplantation are improving survival, but prognosis is guarded. PMID:23337445

  14. Assertive Classroom Management Strategies and Students' Performance: The Case of EFL Classroom

    ERIC Educational Resources Information Center

    Aliakbari, Mohammad; Bozorgmanesh, Bafrin

    2015-01-01

    Ample research findings support the effective role that classroom management strategies play in enhancing students' learning. Drawing upon Iranian high school teachers' classroom management strategies, this article is intended to examine the extent to which these teachers follow assertive classroom management strategies and if these strategies…

  15. Identifying Key Vulnerabilities in Current Management of California Central Valley for the California Water Plan

    NASA Astrophysics Data System (ADS)

    Bloom, E.; Groves, D.; Joyce, B. A.; Juricich, R.

    2012-12-01

    The California Department of Water Resources (DWR), for its 2013 Update of the California Water Plan (CWP), is building new analytic capabilities for developing and evaluating regional and state-wide water management strategies. These strategies are intended to address growing and diverse water needs coupled with uncertain future hydrologic conditions and available supplies. Recognizing the significant uncertainty about future water management conditions, DWR is utilizing new robust decision methods to identify robust and adaptive water management strategies. This talk will describe a recently completed application of Robust Decision Making (RDM) for long-term water planning as part of the 2013 CWP Update. This analysis utilizes a new hydrologic / water management model of the Sacramento River, San Joaquin River, and Tulare hydrologic regions, running the model under hundreds of potential futures. These futures consider potential variation in demographic growth, land-use patterns, drought length and timing, and other climate factors from projections generated by downscaled global circulation models. Cluster-finding "scenario discovery" algorithms, applied to the resulting database of simulation model results, identify the key characteristics of future conditions where current management fails to meet a wide range of policy objectives. These "vulnerabilities" provide the foundation for developing more robust and adaptive response packages and the considering tradeoffs between such response packages. This analysis will provide guidance for considering response packages to meet the challenges posed by future conditions in the California Central Valley and provides a widely applicable new approach for making water management plans more cognizant and responsive to a wide range of uncertainties.

  16. Regional economic analysis of current and proposed management alternatives for Rappahannock River Valley National Wildlife Refuge

    USGS Publications Warehouse

    Koontz, Lynne; Sexton, Natalie; Donovan, Ryan

    2009-01-01

    The National Wildlife Refuge System Improvement Act of 1997 requires all units of the National Wildlife Refuge System to be managed under a Comprehensive Conservation Plan. The Comprehensive Conservation Plan must describe the desired future conditions of a refuge and provide long-range guidance and management direction to achieve refuge purposes. The Rappahannock River Valley National Wildlife Refuge (refuge) is in the process of developing a range of management goals, objectives, and strategies for the Comprehensive Conservation Plan. The Comprehensive Conservation Plan for the refuge must contain an analysis of expected effects associated with current and proposed refuge management strategies. The purpose of this study was to assess the regional economic implications associated with draft Comprehensive Conservation Plan management strategies. Special interest groups and local residents often criticize a change in refuge management, especially if there is a perceived negative impact to the local economy. Having objective data on economic impacts may show that these fears are overstated. Quite often, the extent of economic benefits a refuge provides to a local community is not fully recognized, yet at the same time the effects of negative changes is overstated. Spending associated with refuge recreational activities, such as wildlife viewing and hunting, can generate considerable tourist activity for surrounding communities. Additionally, refuge personnel typically spend considerable amounts of money purchasing supplies in local stores, repairing equipment and purchasing fuel at the local service stations, and reside and spend their salaries in the local community. For refuge Comprehensive Conservation Plan planning, a regional economic assessment provides a means of estimating how current management (no action alternative) and proposed management activities (alternatives) could affect the local economy. This type of analysis provides two critical pieces of

  17. Acute rhinosinusitis in adults: an update on current management

    PubMed Central

    Masood, Ajmal; Moumoulidis, Ioannis; Panesar, Jaan

    2007-01-01

    Acute rhinosinusitis is a common disease with worldwide prevalence. It is a significant burden on the health services. It is most commonly caused by viruses and is self‐limiting in nature. The diagnosis of acute rhinosinusitis is clinical and sinus radiography is not indicated routinely. Most cases of acute rhinosinusitis are treated symptomatically. However, symptoms may persist beyond 10 days when secondary bacterial infection prevails. Antibiotics are reserved for moderate or severe cases or when there is development of complications of acute rhinosinusitis. This paper provides an update on the current management of acute rhinosinusitis. PMID:17551072

  18. Optimal management strategies in variable environments: Stochastic optimal control methods

    USGS Publications Warehouse

    Williams, B.K.

    1985-01-01

    Dynamic optimization was used to investigate the optimal defoliation of salt desert shrubs in north-western Utah. Management was formulated in the context of optimal stochastic control theory, with objective functions composed of discounted or time-averaged biomass yields. Climatic variability and community patterns of salt desert shrublands make the application of stochastic optimal control both feasible and necessary. A primary production model was used to simulate shrub responses and harvest yields under a variety of climatic regimes and defoliation patterns. The simulation results then were used in an optimization model to determine optimal defoliation strategies. The latter model encodes an algorithm for finite state, finite action, infinite discrete time horizon Markov decision processes. Three questions were addressed: (i) What effect do changes in weather patterns have on optimal management strategies? (ii) What effect does the discounting of future returns have? (iii) How do the optimal strategies perform relative to certain fixed defoliation strategies? An analysis was performed for the three shrub species, winterfat (Ceratoides lanata), shadscale (Atriplex confertifolia) and big sagebrush (Artemisia tridentata). In general, the results indicate substantial differences among species in optimal control strategies, which are associated with differences in physiological and morphological characteristics. Optimal policies for big sagebrush varied less with variation in climate, reserve levels and discount rates than did either shadscale or winterfat. This was attributed primarily to the overwintering of photosynthetically active tissue and to metabolic activity early in the growing season. Optimal defoliation of shadscale and winterfat generally was more responsive to differences in plant vigor and climate, reflecting the sensitivity of these species to utilization and replenishment of carbohydrate reserves. Similarities could be seen in the influence of both

  19. Floodplain Management Strategies for Flood Attenuation in the River Po

    NASA Astrophysics Data System (ADS)

    Brath, A.; Castellarin, A.; di Baldassarre, G.

    2009-12-01

    This paper analyses the effects of different floodplain management policies on flood hazard using a 350km reach of the River Po (Italy) as a case study. The River Po is the longest Italian river, and the largest in terms of streamflow. The middle-lower Po flows East some 350km in the Pianura Padana (Po Valley), a very important agricultural region and industrial heart of Northern Italy. This portion of the river consists of a main channel (200-500m wide) and a floodplain (overall width from 200m to 5km) confined by two continuous artificial embankments. Floodplains are densely cultivated, and a significant portion of these areas is protected against frequent flooding by a system of minor dikes, which impacts significantly the hydraulic behaviour of the middle-lower Po during major flood events. This study aims at investigating the effects of the adoption of different floodplain management strategies (e.g., raising, lowering or removal of the minor dike system) on the hydrodynamics of the middle-lower Po and, in particular, on flood-risk mitigation. This is a crucial task for institutions and public bodies in charge of formulating robust flood risk management strategies for the Po River. Furthermore, the results of the study is of interest for other European water related public bodies managing large river basins, in the light of the recent Directive 2007/60/EC on the assessment and management of flood risks (European Parliament, 2007). The analysis is performed by means of a quasi-2D hydraulic model, which has been developed on the basis of a laser-scanning DTM and a large amount of calibration data recorded during the significant flood event of October 2000.

  20. Risk evaluation mitigation strategies: the evolution of risk management policy.

    PubMed

    Hollingsworth, Kristen; Toscani, Michael

    2013-04-01

    The United States Food and Drug Administration (FDA) has the primary regulatory responsibility to ensure that medications are safe and effective both prior to drug approval and while the medication is being actively marketed by manufacturers. The responsibility for safe medications prior to marketing was signed into law in 1938 under the Federal Food, Drug, and Cosmetic Act; however, a significant risk management evolution has taken place since 1938. Additional federal rules, entitled the Food and Drug Administration Amendments Act, were established in 2007 and extended the government's oversight through the addition of a Risk Evaluation and Mitigation Strategy (REMS) for certain drugs. REMS is a mandated strategy to manage a known or potentially serious risk associated with a medication or biological product. Reasons for this extension of oversight were driven primarily by the FDA's movement to ensure that patients and providers are better informed of drug therapies and their specific benefits and risks prior to initiation. This article provides an historical perspective of the evolution of medication risk management policy and includes a review of REMS programs, an assessment of the positive and negative aspects of REMS, and provides suggestions for planning and measuring outcomes. In particular, this publication presents an overview of the evolution of the REMS program and its implications. PMID:23113627

  1. Financial management and dental school strength, Part I: Strategy.

    PubMed

    Chambers, David W; Bergstrom, Roy

    2004-04-01

    The ultimate goal of financial management in a dental school is to accumulate assets that are available for strategic growth, which is a parallel objective to the profit motive in business. Budget development is often grounded in an income statement framework where the goal is to match revenues and expenses. Only when a balance sheet perspective (assets = liabilities + equity) is adopted can strategic growth be fully addressed. Four views of budgeting are presented in this article: 1) covering expenses, 2) shopping, 3) strategic support, and 4) budgeting as strategy. These perceptions of the budgeting process form a continuum, moving from a weak strategic position (covering expenses) to a strong one (budgeting as strategy) that encourages the accumulation of assets that build equity in the organization. PMID:15112920

  2. A bed management strategy for overcrowding in the emergency department.

    PubMed

    Barrett, Lynn; Ford, Suzanne; Ward-Smith, Peggy

    2012-01-01

    In 2006, the Institute of Medicine cited growing visit volumes, hospital closures, financial pressures, and operational inefficiencies as the principal reasons for emergency department (ED) overcrowding and called for regulatory measures to resolve the problem. A Midwest medical center with 59,000 annual ED visits instituted a bed management strategy to decrease the need to board, or hold, admitted hospital patients in the ED awaiting transfer to an inpatient care unit. This strategy was successful in improving the hold time from an average of 216 minutes to 103 minutes, or by 52%. This allowed the staff at the hospital to care for an additional 2,936 patients. During this same time, the overall hospital mortality decreased by 0.07% and patient satisfaction scores improved 1%. The greatest outcome from this intervention was realized in the potential revenue increase of over $2 million. PMID:22558725

  3. A strategy for monitoring and managing declines in an amphibian community.

    PubMed

    Grant, Evan H Campbell; Zipkin, Elise F; Nichols, James D; Campbell, J Patrick

    2013-12-01

    Although many taxa have declined globally, conservation actions are inherently local. Ecosystems degrade even in protected areas, and maintaining natural systems in a desired condition may require active management. Implementing management decisions under uncertainty requires a logical and transparent process to identify objectives, develop management actions, formulate system models to link actions with objectives, monitor to reduce uncertainty and identify system state (i.e., resource condition), and determine an optimal management strategy. We applied one such structured decision-making approach that incorporates these critical elements to inform management of amphibian populations in a protected area managed by the U.S. National Park Service. Climate change is expected to affect amphibian occupancy of wetlands and to increase uncertainty in management decision making. We used the tools of structured decision making to identify short-term management solutions that incorporate our current understanding of the effect of climate change on amphibians, emphasizing how management can be undertaken even with incomplete information. Estrategia para Monitorear y Manejar Disminuciones en una Comunidad de Anfibios. PMID:24001175

  4. Urethral recurrence after cystectomy: current preventative measures, diagnosis and management.

    PubMed

    Chan, Yvonne; Fisher, Patrick; Tilki, Derya; Evans, Christopher P

    2016-04-01

    To summarise the current literature on the diagnosis and management of urethral recurrence (UR) after radical cystectomy (RC), as UR after RC is rare but associated with high mortality. With the recently increased use of orthotopic bladder substitution and the questionable benefit of prophylactic urethrectomy, identification of patients at high risk of UR, management of the remnant urethra, and treatment of UR become critical questions. A review of the PubMed database from 1980 to 2014 was performed to identify studies evaluating recurrent urothelial cancer of the urethra after RC. The search terms used included 'urethral recurrence', 'cystectomy' or 'cystoprostatectomy'. Selected studies provided information on the type of urinary diversion performed, the incidence of UR, and the time to UR. Incidence of UR after RC ranges from 1% to 8% with most recurrences occurring within the first 2 years after surgery. Increased risk of UR is associated with involvement of the prostate, tumour multifocality, bladder neck involvement, and cutaneous diversion. The median overall survival after UR ranges from 6 to 54 months and the 5-year disease-specific survival after UR is reported to be between zero and 83%. UR remains a relatively rare event. Current literature suggests that urethral wash cytology may be useful in patients with intermediate- to high-risk of recurrence to enable early detection of non-invasive disease, which may be amenable to conservative therapy before urethrectomy. PMID:26556525

  5. Management strategies for problem behaviors in the patient with dementia.

    PubMed

    Lehninger, F W; Ravindran, V L; Stewart, J T

    1998-04-01

    Psychiatric and behavioral problems are present in most patients with dementia and are usually the clinician's main focus of management. Differential diagnosis of these problems can be challenging, but the effort is essential for planning appropriate therapy. Pharmacologic interventions are available for treatment of depression, agitation, aggression, psychotic symptoms, wandering, and sleep disorders. Given the less than favorable risk-benefit ratio of most psychotropic drugs in the population of older patients with dementia, the importance of nonpharmacologic strategies and limiting treatment goals should not be overlooked. PMID:9559028

  6. Responsible, Renewable, Recyclable: An Energy Management Strategy for Modern Accelerators

    NASA Astrophysics Data System (ADS)

    Jansson, Andreas

    2011-04-01

    The European Spallation Source (ESS), which will be built in the south of Sweden, uses a 5 MW proton beam from a 2.5 GeV superconducting linac. When completed, it will be the world's most powerful cold neutron source. The ESS has set the objective to be carbon neutral and as energy efficient as possible. This will be achieved in part by energy saving measures, but also by investing in renewable energy sources and re-using the excess heat through the local district heating system. This talk will give an overview of the ESS project and its energy management strategy.

  7. The current role of thiazolidinediones in diabetes management.

    PubMed

    Rizos, Christos V; Kei, Anastazia; Elisaf, Moses S

    2016-08-01

    Among the epidemics of modern time, type 2 diabetes mellitus (T2DM) is one of the main contributors to overall morbidity as well as mortality. A number of different treatment options are available for the management of diabetes. Among them thiazolidinediones (TZDs) is an interesting drug class since it does not target the result of T2DM, i.e., hyperglycemia but rather some of the core mechanisms of the disease. Indeed, glitazones increase insulin sensitivity by activating the peroxisome proliferator-activated receptor γ, which plays an important role in regulating various metabolic parameters. Although TZDs have an established efficacy in T2DM treatment, their usage during the past years was questioned following the emergence of some alarming data regarding their safety and especially the cardiovascular safety of rosiglitazone. As a result, there is often some skepticism about the current role of TZDs in T2DM management. This mainly affects rosiglitazone even leading to its withdrawal from several markets in contrast to pioglitazone, which has shown a beneficial cardiovascular profile. A comprehensive assessment of the benefit-to-risk ratio of TZDs is required in order to better understand the place of these drugs in T2DM management. PMID:27165418

  8. Improvised explosive devices: pathophysiology, injury profiles and current medical management.

    PubMed

    Ramasamy, A; Hill, A M; Clasper, J C

    2009-12-01

    The improvised explosive device (IED), in all its forms, has become the most significant threat to troops operating in Afghanistan and Iraq. These devices range from rudimentary home made explosives to sophisticated weapon systems containing high-grade explosives. Within this broad definition they may be classified as roadside explosives and blast mines, explosive formed pojectile (EFP) devices and suicide bombings. Each of these groups causeinjury through a number of different mechanisms and can result in vastly different injury profiles. The "Global War on Terror" has meant that incidents which were previously exclusively seen in conflict areas, can occur anywhere, and clinicians who are involved in emergency trauma care may be required to manage casualties from similar terrorist attacks. An understanding of the types of devices and their pathophysiological effects is necessary to allow proper planning of mass casualty events and to allow appropriate management of the complex poly-trauma casualties they invariably cause. The aim of this review article is to firstly describe the physics and injury profile from these different devices and secondly to present the current clinical evidence that underpins their medical management. PMID:20397601

  9. Restless legs syndrome-current therapies and management of augmentation.

    PubMed

    Trenkwalder, Claudia; Winkelmann, Juliane; Inoue, Yuichi; Paulus, Walter

    2015-08-01

    Idiopathic restless legs syndrome (RLS) can severely affect quality of life and disturb sleep, so that pharmacological treatment is necessary, especially for elderly patients. Treatment guidelines recommend initiation of therapy with dopamine agonists (pramipexole, ropinirole or the rotigotine transdermal patch, all approved in most countries) or α-2-δ ligands (gabapentin enacarbil, approved in the USA and Japan), depending on the country and availability. Where approved, opioids (prolonged release oxycodone-naloxone, approved in Europe) are also recommended as a second-line therapy for severe RLS. Several iron formulations can be effective but are not yet approved for RLS therapy, whereas benzodiazepines and other anticonvulsants are not recommended or approved. Less is known about effective management of RLS that is associated with other conditions, such as uraemia or pregnancy. Furthermore, very little data are available on the management of RLS when first-line treatment fails or patients experience augmentation. In this Review, we summarize state-of-the-art therapies for RLS in the context of the diagnostic criteria and available guidelines, based on knowledge ranging from Class I evidence for the treatment of idiopathic RLS to Class IV evidence for the treatment of complications such as augmentation. We consider therapies, including combination therapies, that are used in clinical practice for long-term management of RLS, despite a lack of trials and approval, and highlight the need for practical long-term evaluation of current trials. PMID:26215616

  10. Multiple sclerosis: current and emerging disease-modifying therapies and treatment strategies.

    PubMed

    Wingerchuk, Dean M; Carter, Jonathan L

    2014-02-01

    Multiple sclerosis (MS) is a chronic inflammatory demyelinating central nervous system disease that typically strikes young adults, especially women. The pathobiology of MS includes inflammatory and neurodegenerative mechanisms that affect both white and gray matter. These mechanisms underlie the relapsing, and often eventually progressive, course of MS, which is heterogeneous; confident prediction of long-term individual prognosis is not yet possible. However, because revised MS diagnostic criteria that incorporate neuroimaging data facilitate early diagnosis, most patients are faced with making important long-term treatment decisions, most notably the use and selection of disease-modifying therapy (DMT). Currently, there are 10 approved MS DMTs with varying degrees of efficacy for reducing relapse risk and preserving neurological function, but their long-term benefits remain unclear. Moreover, available DMTs differ with respect to the route and frequency of administration, tolerability and likelihood of treatment adherence, common adverse effects, risk of major toxicity, and pregnancy-related risks. Thorough understanding of the benefit-risk profiles of these therapies is necessary to establish logical and safe treatment plans for individuals with MS. We review the available evidence supporting risk-benefit profiles for available and emerging DMTs. We also assess the place of individual DMTs within the context of several different MS management strategies, including those currently in use (sequential monotherapy, escalation therapy, and induction and maintenance therapy) and others that may soon become feasible (combination approaches and "personalized medicine"). We conducted this review using a comprehensive search of MEDLINE, PubMed, EMBASE, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials, from January 1, 1990, to August 31, 2013. The following search terms were used: multiple sclerosis, randomized controlled trials

  11. Current concepts in the management of recurrent anterior gleno-humeral joint instability with bone loss

    PubMed Central

    Ramhamadany, Eamon; Modi, Chetan S

    2016-01-01

    The management of recurrent anterior gleno-humeral joint instability is challenging in the presence of bone loss. It is often seen in young athletic patients and dislocations related to epileptic seizures and may involve glenoid bone deficiency, humeral bone deficiency or combined bipolar lesions. It is critical to accurately identify and assess the amount and position of bone loss in order to select the most appropriate treatment and reduce the risk of recurrent instability after surgery. The current literature suggests that coracoid and iliac crest bone block transfers are reliable for treating glenoid defects. The treatment of humeral defects is more controversial, however, although good early results have been reported after arthroscopic Remplissage for small defects. Larger humeral defects may require complex reconstruction or partial resurfacing. There is currently very limited evidence to support treatment strategies when dealing with bipolar lesions. The aim of this review is to summarise the current evidence regarding the best imaging modalities and treatment strategies in managing this complex problem relating particularly to contact athletes and dislocations related to epileptic seizures. PMID:27335809

  12. Current concepts in the management of recurrent anterior gleno-humeral joint instability with bone loss.

    PubMed

    Ramhamadany, Eamon; Modi, Chetan S

    2016-06-18

    The management of recurrent anterior gleno-humeral joint instability is challenging in the presence of bone loss. It is often seen in young athletic patients and dislocations related to epileptic seizures and may involve glenoid bone deficiency, humeral bone deficiency or combined bipolar lesions. It is critical to accurately identify and assess the amount and position of bone loss in order to select the most appropriate treatment and reduce the risk of recurrent instability after surgery. The current literature suggests that coracoid and iliac crest bone block transfers are reliable for treating glenoid defects. The treatment of humeral defects is more controversial, however, although good early results have been reported after arthroscopic Remplissage for small defects. Larger humeral defects may require complex reconstruction or partial resurfacing. There is currently very limited evidence to support treatment strategies when dealing with bipolar lesions. The aim of this review is to summarise the current evidence regarding the best imaging modalities and treatment strategies in managing this complex problem relating particularly to contact athletes and dislocations related to epileptic seizures. PMID:27335809

  13. Evaluation and Management of Hepatic Encephalopathy: Current Status and Future Directions.

    PubMed

    Suraweera, Duminda; Sundaram, Vinay; Saab, Sammy

    2016-07-15

    Hepatic encephalopathy is a spectrum of neurocognitive manifestations often seen in patients with liver injury or rarely in patients with portosystemic shunting without liver injury. It can be divided into minimal (covert) hepatic encephalopathy and overt hepatic encephalopathy, depending on the severity. Patients with hepatic encephalopathy have compromised clinical outcomes, decreased quality of life, and increased healthcare utilization, often resulting in a heavy financial and personal burden on caregivers. The diagnosis remains largely clinical, with the exclusion of possible other causes for the altered mental status. Current treatment strategies include nonabsorbable disaccharides and antibiotics. This review will focus on the diagnosis, management and clinical impact of hepatic encephalopathy. PMID:27377741

  14. Evaluation and Management of Hepatic Encephalopathy: Current Status and Future Directions

    PubMed Central

    Suraweera, Duminda; Sundaram, Vinay; Saab, Sammy

    2016-01-01

    Hepatic encephalopathy is a spectrum of neurocognitive manifestations often seen in patients with liver injury or rarely in patients with portosystemic shunting without liver injury. It can be divided into minimal (covert) hepatic encephalopathy and overt hepatic encephalopathy, depending on the severity. Patients with hepatic encephalopathy have compromised clinical outcomes, decreased quality of life, and increased healthcare utilization, often resulting in a heavy financial and personal burden on caregivers. The diagnosis remains largely clinical, with the exclusion of possible other causes for the altered mental status. Current treatment strategies include nonabsorbable disaccharides and antibiotics. This review will focus on the diagnosis, management and clinical impact of hepatic encephalopathy. PMID:27377741

  15. Pulpal and periradicular response to caries: current management and regenerative options.

    PubMed

    Chogle, Sami M A; Goodis, Harold E; Kinaia, Bassam Michael

    2012-07-01

    The pulp-dentin complex is a strategic and dynamic barrier to various insults that plague the dentition. Researchers have yet to understand the complete potential of this shifting junction and its components. The most common cause of injury to the pulp-dentin complex is carious breakdown of enamel and dentin. In recent years, there has been a change in restorative management of caries. The emphasis is on strategies to preserve dentin and protect the pulp. This article provides a brief review of the effect of caries on the pulp, of subsequent events on the periradicular tissues, and of current understanding of treatment modalities. PMID:22835535

  16. Strategies for Managing Mobile Devices for Use by Hospitalized Inpatients.

    PubMed

    Dykes, Patricia C; Stade, Diana; Dalal, Anuj; Clements, Marsha; Collins, Sarah; Chang, Frank; Fladger, Anne; Getty, George; Hanna, John; Kandala, Ravali; Lehmann, Lisa S; Leone, Kathleen; Massaro, Anthony F; Mlaver, Eli; McNally, Kelly; Ravindran, Sucheta; Schnock, Kumiko; Bates, David W

    2015-01-01

    Despite the potential advantages, implementation of mobile devices and ongoing management pose challenges in the hospital environment. Our team implemented the PROSPECT (Promoting Respect and Ongoing Safety through Patient-centeredness, Engagement, Communication and Technology) project at Brigham and Women's Hospital. The goal of PROSPECT is to transform the hospital environment by providing a suite of e-tools to facilitate teamwork among nurses, physicians, patients and to engage patients and care partners in their plan of care. In this paper, we describe the device-related decisions and challenges faced including device and accessory selection, integration, information and device security, infection control, user access, and ongoing operation and maintenance. We relate the strategies that we used for managing mobile devices and lessons learned based on our experiences. PMID:26958185

  17. Strategies for Managing Mobile Devices for Use by Hospitalized Inpatients

    PubMed Central

    Dykes, Patricia C.; Stade, Diana; Dalal, Anuj; Clements, Marsha; Collins, Sarah; Chang, Frank; Fladger, Anne; Getty, George; Hanna, John; Kandala, Ravali; Lehmann, Lisa S.; Leone, Kathleen; Massaro, Anthony F.; Mlaver, Eli; McNally, Kelly; Ravindran, Sucheta; Schnock, Kumiko; Bates, David W.

    2015-01-01

    Despite the potential advantages, implementation of mobile devices and ongoing management pose challenges in the hospital environment. Our team implemented the PROSPECT (Promoting Respect and Ongoing Safety through Patient-centeredness, Engagement, Communication and Technology) project at Brigham and Women’s Hospital. The goal of PROSPECT is to transform the hospital environment by providing a suite of e-tools to facilitate teamwork among nurses, physicians, patients and to engage patients and care partners in their plan of care. In this paper, we describe the device-related decisions and challenges faced including device and accessory selection, integration, information and device security, infection control, user access, and ongoing operation and maintenance. We relate the strategies that we used for managing mobile devices and lessons learned based on our experiences. PMID:26958185

  18. Clinical Decision Support Knowledge Management: Strategies for Success.

    PubMed

    Khalifa, Mohamed; Alswailem, Osama

    2015-01-01

    Clinical Decision Support Systems have been shown to increase quality of care, patient safety, improve adherence to guidelines for prevention and treatment, and avoid medication errors. Such systems depend mainly on two types of content; the clinical information related to patients and the medical knowledge related to the specialty that informs the system rules and alerts. At King Faisal Specialist Hospital and Research Center, Saudi Arabia, the Health Information Technology Affairs worked on identifying best strategies and recommendations for successful CDSS knowledge management. A review of literature was conducted to identify main areas of challenges and factors of success. A qualitative survey was used over six months' duration to collect opinions, experiences and suggestions from both IT and healthcare professionals. Recommendations were categorized into ten main topics that should be addressed during the development and implementation of CDSS knowledge management tools in the hospital. PMID:26152955

  19. Managing differences: the central challenge of global strategy.

    PubMed

    Ghemawat, Pankaj

    2007-03-01

    The main goal of any international strategy should be to manage the large differences that arise at the borders of markets. Yet executives often fail to exploit market and production discrepancies, focusing instead on the tensions between standardization and localization. In this article, Pankaj Ghemawat presents a new framework that encompasses all three effective responses to the challenges of globalization. He calls it the AAA Triangle. The A's stand for the three distinct types of international strategy. Through adaptation, companies seek to boost revenues and market share by maximizing their local relevance. Through aggregation, they attempt to deliver economies of scale by creating regional, or sometimes global, operations. And through arbitrage, they exploit disparities between national or regional markets, often by locating different parts of the supply chain in different places--for instance, call centers in India, factories in China, and retail shops in Western Europe. Ghemawat draws on several examples that illustrate how organizations use and balance these strategies and describes the trade-offs they make as they do so. Because most enterprises should draw from all three A's to some extent, the framework can be used to develop a summary scorecard indicating how well the company is globalizing. However, given the tensions among the strategies, it's not enough simply to tick off the corresponding boxes. Strategic choice requires some degree of prioritization--and the framework can help with that as well. While it is possible to make progress on all three strategies, companies usually must focus on one or two when trying to build competitive advantage. PMID:17348170

  20. Regional governance: strategies and disputes in health region management

    PubMed Central

    dos Santos, Adriano Maia; Giovanella, Ligia

    2014-01-01

    OBJECTIVE To analyze the regional governance of the health systemin relation to management strategies and disputes. METHODOLOGICAL PROCEDURES A qualitative study with health managers from 19 municipalities in the health region of Bahia, Northeastern Brazil. Data were drawn from 17 semi-structured interviews of state, regional, and municipal health policymakers and managers; a focus group; observations of the regional interagency committee; and documents in 2012. The political-institutional and the organizational components were analyzed in the light of dialectical hermeneutics. RESULTS The regional interagency committee is the chief regional governance strategy/component and functions as a strategic tool for strengthening governance. It brings together a diversity of members responsible for decision making in the healthcare territories, who need to negotiate the allocation of funding and the distribution of facilities for common use in the region. The high turnover of health secretaries, their lack of autonomy from the local executive decisions, inadequate technical training to exercise their function, and the influence of party politics on decision making stand as obstacles to the regional interagency committee’s permeability to social demands. Funding is insufficient to enable the fulfillment of the officially integrated agreed-upon program or to boost public supply by the system, requiring that public managers procure services from the private market at values higher than the national health service price schedule (Brazilian Unified Health System Table). The study determined that “facilitators” under contract to health departments accelerated access to specialized (diagnostic, therapeutic and/or surgical) services in other municipalities by direct payment to physicians for procedure costs already covered by the Brazilian Unified Health System. CONCLUSIONS The characteristics identified a regionalized system with a conflictive pattern of governance and

  1. Current management of Paget-Schroetter syndrome in the UK.

    PubMed Central

    Khan, Shaukat N.; Stansby, Gerard

    2004-01-01

    INTRODUCTION: Untreated symptomatic patients with Paget-Schroetter syndrome (PSS) can sustain chronic disability from venous obstruction, with arm swelling, pain and early exercise fatigue. This may result in significant loss of occupational productivity and quality of life. For this reason, active management is recommended in the majority of the recent literature. The objective of the this study was to assess current trends of management of PSS in the UK. METHODS: A 9-part questionnaire was sent to 90 ordinary members of the Vascular Surgical Society of Great Britain and Ireland (VSS-GBI). Names and addresses were selected by highlighting every fourth ordinary member from the UK, in the 2000 VSS-GBI handbook. Ordinary members of the VSS-GBI who were clearly radiologists were excluded. RESULTS: Of the 90 questionnaires sent, 60 were returned (66.67%). The majority of respondents used both duplex and venography (61%) as the major investigative tools though some employed duplex only (17%). Multimodality treatment (radiological and operative) was the favoured approach. Only 17% still favoured conservative management alone. Thrombolysis was the most common intervention (86.7%) usually followed by elective thoracic outlet decompression. Most favoured a delayed approach for surgery of 6-12 weeks. First rib resection was the most commonly performed operation (58%), usually by the transaxillary approach (55%). Most of the respondents were doubtful of the role of stenting in this condition and did not use it. CONCLUSIONS: There is no definite consensus on treatment of this condition in the UK. A majority tend to favour a multimodal approach. Thrombolysis is the most common form of treatment employed and first rib resection via the transaxillary approach remains the most popular surgical procedure. The lack of consensus of this potentially disabling condition highlights the need for randomised clinical trials to guide management. PMID:15005942

  2. Non-endoscopic management strategies for acute esophagogastric variceal bleeding

    PubMed Central

    Satapathy, Sanjaya K.; Sanyal, Arun J

    2014-01-01

    Acute variceal bleeding is a potentially life threatening complication of portal hypertension. Management consists of emergent hemostasis, therapy directed at hemodynamic resuscitation, protection of the airway, and prevention and treatment of complications including prophylactic use of antibiotics. Endoscopic treatment remains the mainstay in the management of acute variceal bleeding in combination with pharmacotherapy aimed at reducing portal pressure. Patients failing first-line therapy are triaged for non-endoscopic means of achieving hemostasis such as TIPS, BRTO or surgically created shunt procedures as rescue procedures, the choice depends on the source of bleeding (esophageal or gastric), size of the varices, portal vein patency, presence or absence of gastro-renal shunt, hepatic reserve and local expertise. The current chapter, intends to highlight only the current non endoscopic treatment approaches for control of acute variceal bleeding. PMID:25440928

  3. A Review of Enrollment Management: Issues and Strategies. Management/Marketing Special Project.

    ERIC Educational Resources Information Center

    O'Brien, Ed; And Others

    This report presents findings and recommendations from a project undertaken by the Maricopa County Community College District (MCCCD) to determine reasons for a decline in business course enrollments and develop strategies to increase enrollments in management and marketing programs throughout the district. Following background information on the…

  4. Intervention strategies for the management of human error

    NASA Technical Reports Server (NTRS)

    Wiener, Earl L.

    1993-01-01

    This report examines the management of human error in the cockpit. The principles probably apply as well to other applications in the aviation realm (e.g. air traffic control, dispatch, weather, etc.) as well as other high-risk systems outside of aviation (e.g. shipping, high-technology medical procedures, military operations, nuclear power production). Management of human error is distinguished from error prevention. It is a more encompassing term, which includes not only the prevention of error, but also a means of disallowing an error, once made, from adversely affecting system output. Such techniques include: traditional human factors engineering, improvement of feedback and feedforward of information from system to crew, 'error-evident' displays which make erroneous input more obvious to the crew, trapping of errors within a system, goal-sharing between humans and machines (also called 'intent-driven' systems), paperwork management, and behaviorally based approaches, including procedures, standardization, checklist design, training, cockpit resource management, etc. Fifteen guidelines for the design and implementation of intervention strategies are included.

  5. Current use of PSMA-PET in prostate cancer management.

    PubMed

    Maurer, Tobias; Eiber, Matthias; Schwaiger, Markus; Gschwend, Jürgen E

    2016-04-01

    Currently, the findings of imaging procedures used for detection or staging of prostate cancer depend on morphology of lymph nodes or bone metabolism and do not always meet diagnostic needs. Prostate-specific membrane antigen (PSMA), a transmembrane protein that has considerable overexpression on most prostate cancer cells, has gained increasing interest as a target molecule for imaging. To date, several small compounds for labelling PSMA have been developed and are currently being investigated as imaging probes for PET with the (68)Ga-labelled PSMA inhibitor Glu-NH-CO-NH-Lys(Ahx)-HBED-CC being the most widely studied agent. (68)Ga-PSMA-PET imaging in combination with multiparametric MRI (mpMRI) might provide additional molecular information on cancer localization within the prostate. In patients with primary prostate cancer of intermediate-risk to high-risk, PSMA-based imaging has been reported to improve detection of metastatic disease compared with CT or mpMRI, rendering additional cross-sectional imaging or bone scintigraphy unnecessary. Furthermore, in patients with biochemically recurrent prostate cancer, use of (68)Ga-PSMA-PET imaging has been shown to increase detection of metastatic sites, even at low serum PSA values, compared with conventional imaging or PET examination with different tracers. Thus, although current knowledge is still limited and derived mostly from retrospective series, PSMA-based imaging holds great promise to improve prostate cancer management. PMID:26902337

  6. Management strategy evaluation of pheromone-baited trapping techniques to improve management of invasive sea lamprey

    USGS Publications Warehouse

    Dawson, Heather; Jones, Michael L.; Irwin, Brian J.; Johnson, Nicholas; Wagner, Michael C.; Szymanski, Melissa

    2016-01-01

    We applied a management strategy evaluation (MSE) model to examine the potential cost-effectiveness of using pheromone-baited trapping along with conventional lampricide treatment to manage invasive sea lamprey. Four pheromone-baited trapping strategies were modeled: (1) stream activation wherein pheromone was applied to existing traps to achieve 10−12 mol/L in-stream concentration, (2) stream activation plus two additional traps downstream with pheromone applied at 2.5 mg/hr (reverse-intercept approach), (3) trap activation wherein pheromone was applied at 10 mg/hr to existing traps, and (4) trap activation and reverse-intercept approach. Each new strategy was applied, with remaining funds applied to conventional lampricide control. Simulating deployment of these hybrid strategies on fourteen Lake Michigan streams resulted in increases of 17 and 11% (strategies 1 and 2) and decreases of 4 and 7% (strategies 3 and 4) of the lakewide mean abundance of adult sea lamprey relative to status quo. MSE revealed performance targets for trap efficacy to guide additional research because results indicate that combining lampricides and high efficacy trapping technologies can reduce sea lamprey abundance on average without increasing control costs.

  7. Flexible and robust strategies for waste management in Sweden.

    PubMed

    Finnveden, Göran; Björklund, Anna; Reich, Marcus Carlsson; Eriksson, Ola; Sörbom, Adrienne

    2007-01-01

    Treatment of solid waste continues to be on the political agenda. Waste disposal issues are often viewed from an environmental perspective, but economic and social aspects also need to be considered when deciding on waste strategies and policy instruments. The aim of this paper is to suggest flexible and robust strategies for waste management in Sweden, and to discuss different policy instruments. Emphasis is on environmental aspects, but social and economic aspects are also considered. The results show that most waste treatment methods have a role to play in a robust and flexible integrated waste management system, and that the waste hierarchy is valid as a rule of thumb from an environmental perspective. A review of social aspects shows that there is a general willingness among people to source separate wastes. A package of policy instruments can include landfill tax, an incineration tax which is differentiated with respect to the content of fossil fuels and a weight based incineration tax, as well as support to the use of biogas and recycled materials. PMID:17412580

  8. A mathematically guided strategy for risk assessment and management.

    SciTech Connect

    Cooper, James Arlin

    2005-03-01

    Strategies for risk assessment and management of high consequence operations are often based on factors such as physical analysis, analysis of software and other logical processing, and analysis of statistically determined human actions. Conventional analysis methods work well for processing objective information. However, in practical situations, much or most of the data available are subjective. Also, there are potential resultant pitfalls where conventional analysis might be unrealistic, such as improperly using event tree and fault tree failure descriptions where failures or events are soft (partial) rather than crisp (binary), neglecting or misinterpreting dependence (positive, negative, correlation), and aggregating nonlinear contributions linearly. There are also personnel issues that transcend basic human factors statistics. For example, sustained productivity and safety in critical operations can depend on the morale of involved personnel. In addition, motivation is significantly influenced by 'latent effects', which are pre-occurring influences. This paper addresses these challenges and proposes techniques for subjective risk analysis, latent effects risk analysis and a hybrid analysis that also includes objective risk analysis. The goal is an improved strategy for risk management.

  9. Flexible and robust strategies for waste management in Sweden

    SciTech Connect

    Finnveden, Goeran Bjoerklund, Anna; Reich, Marcus Carlsson; Eriksson, Ola; Soerbom, Adrienne

    2007-07-01

    Treatment of solid waste continues to be on the political agenda. Waste disposal issues are often viewed from an environmental perspective, but economic and social aspects also need to be considered when deciding on waste strategies and policy instruments. The aim of this paper is to suggest flexible and robust strategies for waste management in Sweden, and to discuss different policy instruments. Emphasis is on environmental aspects, but social and economic aspects are also considered. The results show that most waste treatment methods have a role to play in a robust and flexible integrated waste management system, and that the waste hierarchy is valid as a rule of thumb from an environmental perspective. A review of social aspects shows that there is a general willingness among people to source separate wastes. A package of policy instruments can include landfill tax, an incineration tax which is differentiated with respect to the content of fossil fuels and a weight based incineration tax, as well as support to the use of biogas and recycled materials.

  10. Regulations, Policies and Strategies for LLRW Management in Bangladesh - 12368

    SciTech Connect

    Mollah, A.S.

    2012-07-01

    Low level radioactive waste (LLW) is generated from various nuclear applications in Bangladesh. The major sources of radioactive waste in the country are at present: (a) the 3 MW TRIGA Mark-II research reactor; (b) the radioisotope production facility; (c) the medical, industrial and research facilities that use radionuclides; and (d) the industrial facility for processing monazite sands. Radioactive waste needs to be safely managed because it is potentially hazardous to human health and the environment. According to Nuclear Safety and Radiation Control Act-93, the Bangladesh Atomic Energy Commission (BAEC) is the governmental body responsible for the receipt and final disposal of radioactive wastes in the whole country. Waste management policy has become an important environmental, social, and economical issue for LLW in Bangladesh. Policy and strategies will serve as a basic guide for radioactive waste management in Bangladesh. The waste generator is responsible for on-site collection, conditioning and temporary storage of the waste arising from his practice. The Central Waste Processing and Storage Unit (CWPSU) of BAEC is the designated national facility with the requisite facility for the treatment, conditioning and storage of radioactive waste until a final disposal facility is established and becomes operational. The Regulatory Authority is responsible for the enforcement of compliance with provisions of the waste management regulation and other relevant requirements by the waste generator and the CWPSU. The objective of this paper is to present, in a concise form, basic information about the radioactive waste management infrastructure, regulations, policies and strategies including the total inventory of low level radioactive waste in the country. For improvement and strengthening in terms of operational capability, safety and security of RW including spent radioactive sources and overall security of the facility (CWPSF), the facility is expected to serve

  11. Habitat Demonstration Unit Project Leadership and Management Strategies

    NASA Technical Reports Server (NTRS)

    Kennedy, Kriss J.

    2011-01-01

    This paper gives an overview of the National Aeronautics and Space Administration (NASA) led multi-center Habitat Demonstration Unit (HDU) project leadership and management strategies. The HDU project team constructed and tested an analog prototype lunar surface habitat/laboratory called the Pressurized Excursion Module (PEM) during 2010. The prototype unit subsystems were integrated in a short amount of time, utilizing a tiger team approach that brought together over 20 habitation-related technologies and innovations from a variety of NASA centers. This paper describes the leadership and management strategies as well as lessons learned pertaining to leading and managing a multi-center diverse team in a rapid prototype environment. The PEM configuration went from a paper design to an operational surface habitat demonstration unit in less than 12 months. The HDU project is part of the strategic plan from the Exploration Systems Mission Directorate (ESMD) Directorate Integration Office (DIO) and the Exploration Mission Systems Office (EMSO) to test destination elements in analog environments. The 2011 HDU-Deep Space Habitat (DSH) configuration will build upon the PEM work, and emphasize validity of crew operations (remote working and living), EVA operations, mission operations, logistics operations, and science operations that might be required in a deep space context for Near Earth Object (NEO) exploration mission architectures. The 2011 HDU-DSH will be field-tested during the 2011 Desert Research and Technologies Studies (DRaTS) field tests. The HDU project is a "technology-pull" project that integrates technologies and innovations from multiple NASA centers. This project will repurpose the HDU 2010 demo unit that was field tested in the 2010 DRaTS, adding habitation functionality to the prototype unit. This paper will describe the strategy of establishing a multi-center project management team that put in place the key multi-center leadership skills and

  12. Epidemic keratoconjunctivitis: A review of current concepts in management

    PubMed Central

    Pihos, Andria M.

    2012-01-01

    Epidemic keratoconjunctivitis (EKC) is an ocular surface infection caused by adenovirus. To date, there are no approved topical antiadenoviral therapeutics to treat EKC. Recent research reveals that treatment with topical corticosteroids for symptomatic relief of EKC enhances adenovirus replication and delays cell shedding from the ocular surface which delays adenovirus elimination. The current management of EKC largely revolves around accurate diagnosis of the condition and implementation of disinfection protocol to prevent its spread. Development of an effective antiviral treatment that addresses inflammation and does not prolong viral shedding would provide significant benefit. The literature reports on a variety of therapeutics that could potentially satisfy this deficiency. Topical ganciclovir and povidone-iodine combination drops have shown the most recent potential, but both therapeutics need to be investigated in larger scale studies. Until an antiadenoviral option is produced, the treatment of EKC should maintain a judicious case by case approach aiming to contain its dissemination and prevent visual consequences.

  13. Acute Compartment Syndrome of the Limbs: Current Concepts and Management

    PubMed Central

    Mabvuure, Nigel Tapiwa; Malahias, Marco; Hindocha, Sandip; Khan, Wasim; Juma, Ali

    2012-01-01

    Acute compartment syndrome (ACS) of the limb refers to a constellation of symptoms, which occur following a rise in the pressure inside a limb muscle compartment. A failure or delay in recognising ACS almost invariably results in adverse outcomes for patients. Unrecognised ACS can leave patients with nonviable limbs requiring amputation and can also be life–threatening. Several clinical features indicate ACS. Where diagnosis is unclear there are several techniques for measuring intracompartmental pressure described in this review. As early diagnosis and fasciotomy are known to be the best determinants of good outcomes, it is important that surgeons are aware of the features that make this diagnosis likely. This clinical review discusses current knowledge on the relevant clinical anatomy, aetiology, pathophysiology, risk factors, clinical features, diagnostic procedures and management of an acute presentation of compartment syndrome. PMID:23248724

  14. Defining a data management strategy for USGS Chesapeake Bay studies

    USGS Publications Warehouse

    Ladino, Cassandra

    2013-01-01

    The mission of U.S. Geological Survey’s (USGS) Chesapeake Bay studies is to provide integrated science for improved understanding and management of the Chesapeake Bay ecosystem. Collective USGS efforts in the Chesapeake Bay watershed began in the 1980s, and by the mid-1990s the USGS adopted the watershed as one of its national place-based study areas. Great focus and effort by the USGS have been directed toward Chesapeake Bay studies for almost three decades. The USGS plays a key role in using “ecosystem-based adaptive management, which will provide science to improve the efficiency and accountability of Chesapeake Bay Program activities” (Phillips, 2011). Each year USGS Chesapeake Bay studies produce published research, monitoring data, and models addressing aspects of bay restoration such as, but not limited to, fish health, water quality, land-cover change, and habitat loss. The USGS is responsible for collaborating and sharing this information with other Federal agencies and partners as described under the President’s Executive Order 13508—Strategy for Protecting and Restoring the Chesapeake Bay Watershed signed by President Obama in 2009. Historically, the USGS Chesapeake Bay studies have relied on national USGS databases to store only major nationally available sources of data such as streamflow and water-quality data collected through local monitoring programs and projects, leaving a multitude of other important project data out of the data management process. This practice has led to inefficient methods of finding Chesapeake Bay studies data and underutilization of data resources. Data management by definition is “the business functions that develop and execute plans, policies, practices and projects that acquire, control, protect, deliver and enhance the value of data and information.” (Mosley, 2008a). In other words, data management is a way to preserve, integrate, and share data to address the needs of the Chesapeake Bay studies to better

  15. Management strategies in apple orchards influence earwig community.

    PubMed

    Malagnoux, Laure; Marliac, Gaëlle; Simon, Sylvaine; Rault, Magali; Capowiez, Yvan

    2015-04-01

    Our aim was to assess whether different apple orchard management strategies (low-input, organic, Integrated Pest Management (IPM)) would have an effect on earwigs, which are important natural enemies of apple pests. These commercial orchards were as well compared to abandoned orchards. The density of Forficula auricularia and Forficula pubescens was studied for three years in 74 orchards around Avignon. The pesticide usage, some orchard characteristics and two small-scale landscape parameters were characterized. Pesticide use was significantly different between low-input, organic and IPM orchards with particularly significant differences in the number of insecticide applications (2.2, 4.9 and 9.2 respectively). Pesticide use had a much stronger impact on earwig community than other characteristics. F. auricularia density was significantly lower in IPM orchards (0.47 individuals per tree) compared to organic, low-input and abandoned orchards (3.1, 4.5 and 1.6 individuals per tree, respectively). F. pubescens was almost absent from IPM orchards and its abundance was higher in abandoned or low-input orchards compared to organic orchards (1.5 and 2.8 vs 0.8 individuals per tree). The percentage of F. pubescens in the earwig community decreased from abandoned (52%) to low-input (40%), organic (15%) and IPM orchards (0.5%). These results were confirmed by LD50 assays showing that for the two pesticides causing mortality close to normal application rates (chlorpyrifos-ethyl and acetamiprid), F. pubescens was significantly more sensitive than F. auricularia. Since earwigs are also easy to capture and identify, they may be useful to estimate the effects of management strategies and their modification in pome fruit orchards. PMID:25577700

  16. Immunotherapy in the management of melanoma: current status

    PubMed Central

    Alston, Dylan; Brewer, Jerry D

    2013-01-01

    As the rate of melanoma continues to increase, so does the need for more effective and durable therapies. Despite considerable research, the management of advanced disease remains challenging. Numerous therapies are being investigated, many of which aim at upregulating the immune system’s innate ability to attack the tumor. Cytotoxic T lymphocyte antigen 4 antibodies are immune stimulants that act as negative regulators of the immune system by modifying an antitumor T-cell response. Ipilimumab, one such cytotoxic T lymphocyte antigen 4 antibody, and vemurafenib, a BRAF competitive inhibitor, were approved as first-line therapies in 2011 due to improved survival rates versus standard chemotherapy. Allovectin-7 is a lipid plasmid that encodes for major histone compatibility complex DNA sequences. It has led to increases in cytotoxic T-cell production, which subsequently attacks the tumor. OncoVEX, an oncolytic herpes virus, and PV-10, a chemoablative agent, have yielded promising results in metastatic lesions and have demonstrated a unique “bystander” phenomenon. In this paper we review the basics of melanoma from the pathophysiology, risk factors, signs, diagnostic approaches, and current status of immunologic management of melanoma.

  17. Current and emerging treatment options in the management of lupus.

    PubMed

    Jordan, Natasha; D'Cruz, David

    2016-01-01

    Systemic lupus erythematosus (SLE) is a complex autoimmune disease with variable clinical manifestations. While the clearest guidelines for the treatment of SLE exist in the context of lupus nephritis, patients with other lupus manifestations such as neuropsychiatric, hematologic, musculoskeletal, and severe cutaneous lupus frequently require immunosuppression and/or biologic therapy. Conventional immunosuppressive agents such as mycophenolate mofetil, azathioprine, and cyclophosphamide are widely used in the management of SLE with current more rationalized treatment regimens optimizing the use of these agents while minimizing potential toxicity. The advent of biologic therapies has advanced the treatment of SLE particularly in patients with refractory disease. The CD20 monoclonal antibody rituximab and the anti-BLyS agent belimumab are now widely in use in clinical practice. Several other biologic agents are in ongoing clinical trials. While immunosuppressive and biologic agents are the foundation of inflammatory disease control in SLE, the importance of managing comorbidities such as cardiovascular risk factors, bone health, and minimizing susceptibility to infection should not be neglected. PMID:27529058

  18. Current evidence on atypical odontalgia: diagnosis and clinical management.

    PubMed

    Abiko, Yoshihiro; Matsuoka, Hirofumi; Chiba, Itsuo; Toyofuku, Akira

    2012-01-01

    Patients with atypical odontalgia (AO) complain of medically unexplained toothache. No evidence-based diagnostic criteria or treatment guidelines are yet available. The present paper addresses seven clinical questions about AO based on current knowledge in the literature and discusses diagnostic criteria and guidelines for treatment and management. The questions are (i) What is the prevalence of AO in the community? (ii) What psychological problems are experienced by patients with AO? (iii) Are there any comorbidities of AO? (iv) Is local anesthesia effective for the relief of pain in AO? (v) Are there any characteristic symptoms of AO other than spontaneous pain? (vi) Are antidepressants effective for treatment of AO? (vii) Are anticonvulsants effective for treatment of AO? Our literature search provided answers for these questions; however, there is insufficient evidence-based data to establish guidelines for the diagnosis and treatment of AO. Overall, some diagnostic criteria for neuropathic pain and persistent dentoalveolar pain disorder may be applied to AO patients. The patient's psychogenic background should always be considered in the treatment and/or management of AO. The clinicians may need to treat AO patients using Patient-Oriented Evidence that Matters approach. PMID:22844283

  19. Current and emerging treatment options in the management of lupus

    PubMed Central

    Jordan, Natasha; D’Cruz, David

    2016-01-01

    Systemic lupus erythematosus (SLE) is a complex autoimmune disease with variable clinical manifestations. While the clearest guidelines for the treatment of SLE exist in the context of lupus nephritis, patients with other lupus manifestations such as neuropsychiatric, hematologic, musculoskeletal, and severe cutaneous lupus frequently require immunosuppression and/or biologic therapy. Conventional immunosuppressive agents such as mycophenolate mofetil, azathioprine, and cyclophosphamide are widely used in the management of SLE with current more rationalized treatment regimens optimizing the use of these agents while minimizing potential toxicity. The advent of biologic therapies has advanced the treatment of SLE particularly in patients with refractory disease. The CD20 monoclonal antibody rituximab and the anti-BLyS agent belimumab are now widely in use in clinical practice. Several other biologic agents are in ongoing clinical trials. While immunosuppressive and biologic agents are the foundation of inflammatory disease control in SLE, the importance of managing comorbidities such as cardiovascular risk factors, bone health, and minimizing susceptibility to infection should not be neglected. PMID:27529058

  20. Management of achilles tendon injury: A current concepts systematic review

    PubMed Central

    Gulati, Vivek; Jaggard, Matthew; Al-Nammari, Shafic Said; Uzoigwe, Chika; Gulati, Pooja; Ismail, Nizar; Gibbons, Charles; Gupte, Chinmay

    2015-01-01

    Achilles tendon rupture has been on the rise over recent years due to a variety of reasons. It is a debilitating injury with a protracted and sometimes incomplete recovery. Management strategy is a controversial topic and evidence supporting a definite approach is limited. Opinion is divided between surgical repair and conservative immobilisation in conjunction with functional orthoses. A systematic search of the literature was performed. Pubmed, Medline and EmBase databases were searched for Achilles tendon and a variety of synonymous terms. A recent wealth of reporting suggests that conservative regimens with early weight bearing or mobilisation have equivalent or improved rates of re-rupture to operative regimes. The application of dynamic ultrasound assessment of tendon gap may prove crucial in minimising re-rupture and improving outcomes. Studies employing functional assessments have found equivalent function between operative and conservative treatments. However, no specific tests in peak power, push off strength or athletic performance have been reported and whether an advantage in operative treatment exists remains undetermined. PMID:25992315

  1. Management of achilles tendon injury: A current concepts systematic review.

    PubMed

    Gulati, Vivek; Jaggard, Matthew; Al-Nammari, Shafic Said; Uzoigwe, Chika; Gulati, Pooja; Ismail, Nizar; Gibbons, Charles; Gupte, Chinmay

    2015-05-18

    Achilles tendon rupture has been on the rise over recent years due to a variety of reasons. It is a debilitating injury with a protracted and sometimes incomplete recovery. Management strategy is a controversial topic and evidence supporting a definite approach is limited. Opinion is divided between surgical repair and conservative immobilisation in conjunction with functional orthoses. A systematic search of the literature was performed. Pubmed, Medline and EmBase databases were searched for Achilles tendon and a variety of synonymous terms. A recent wealth of reporting suggests that conservative regimens with early weight bearing or mobilisation have equivalent or improved rates of re-rupture to operative regimes. The application of dynamic ultrasound assessment of tendon gap may prove crucial in minimising re-rupture and improving outcomes. Studies employing functional assessments have found equivalent function between operative and conservative treatments. However, no specific tests in peak power, push off strength or athletic performance have been reported and whether an advantage in operative treatment exists remains undetermined. PMID:25992315

  2. Current management of diabetes mellitus and future directions in care.

    PubMed

    Chatterjee, Sudesna; Davies, Melanie J

    2015-11-01

    The last 90 years have seen considerable advances in the management of type 1 and type 2 diabetes. Prof MacLean of Guy's Hospital wrote in the Postgraduate Medical Journal in 1926 about the numerous challenges that faced patients and their healthcare professionals in delivering safe and effective diabetes care at that time. The discovery of insulin in 1922 heralded a new age in enabling long-term glycaemic control, which reduced morbidity and mortality. Thirty years later, the first oral agents for diabetes, the biguanides and sulfonylureas, appeared and freed type 2 patients from having to inject insulin following diagnosis. Improvements in insulin formulations over the decades, including rapid-acting and long-acting insulin analogues that more closely mimic physiological insulin secretion, have increased the flexibility and efficacy of type 1 diabetes management. The last two decades have seen major advances in technology, which has manifested in more accurate glucose monitoring systems and insulin delivery devices ('insulin pump'). Increased understanding of the pathophysiological deficits underlying type 2 diabetes has led to the development of targeted therapeutic approaches such as on the small intestine (glucagon-like peptide-1 receptor analogues and dipeptidyl-peptidase IV inhibitors) and kidneys (sodium-glucose cotransporter-2 inhibitors). A patient-centred approach delivered by a multidisciplinary team is now advocated. Glycaemic targets are set according to individual circumstances, taking into account factors such as weight, hypoglycaemia risk and patient preference. Stepwise treatment guidelines devised by international diabetes organisations standardise and rationalise management. Structured education programmes and psychological support are now well-established as essential for improving patient motivation and self-empowerment. Large multicentre randomised trials have confirmed the effectiveness of intensive glycaemic control on microvascular

  3. Parent Retrospective Recollections of Bullying and Current Views, Concerns, and Strategies to Cope with Children's Bullying

    ERIC Educational Resources Information Center

    Cooper, Leigh A.; Nickerson, Amanda B.

    2013-01-01

    In this study, parent history of bullying was examined in terms of general involvement with bullying, specific types of bullying experienced, level of hurtfulness associated with the experience, and when bullying occurred. Parent current views, levels of concern, and strategies used to cope with bullying were also evaluated. Finally, the…

  4. Preventing unwanted pregnancy: management strategies to improve postabortion care.

    PubMed

    Benson, J; Gringle, R; Winkler, J

    1996-01-01

    This journal, which presents management strategies to improve postabortion care, opens by noting that many women seek postabortion care repeatedly and by describing impediments to the provision of family planning (FP) services to postabortal women. The next section covers important points to consider when establishing services, including 1) the fact that FP services designed for both postpartum and postabortion women often fail to meet the needs of one of these groups and 2) ways that managers can train staff to achieve positive interpersonal relations with patients. Next, clinical concerns are briefly addressed, and the appropriateness of most FP methods for postabortal women is stressed. The minimum facility space requirements are then identified as are necessary instruments, supplies, and commodities. The manual continues by discussing when to offer services, client flow, staff supervision, linkage and referral, cost, and policy issues. Boxed information highlights the manager's role in establishing information and counseling services, the elements of high-quality FP counseling services, and a reproduction of the section of the Plan of Action of the 1994 International Conference on Population and Development covering abortion. The journal ends with a case study of the creative solutions adopted to incorporate FP services as a routine part of postabortal care at two hospitals in Zimbabwe. PMID:12294203

  5. Current Clinical Practice Scenario of Osteoporosis Management in India

    PubMed Central

    Jhaveri, Shailesh; Upashani, Tejas; Bhadauria, Jitendra; Patel, Kamlesh

    2015-01-01

    Background Various osteoporosis guidelines are available for practice. Aim To understand the current clinical practice scenario from the perspective of Indian orthopaedicians, especially about the epidemiology, clinical manifestations, approach to diagnosis and management and patient compliance patterns to long term treatment. Materials and Methods A pre-validated structured questionnaire containing questions (mostly objective, some open-ended) catering to various objectives of the study was circulated amongst orthopaedic surgeons across India by means of post/courier, after giving a brief overview of the study telephonically. Data was extracted from the completed questionnaires, and analysed using Microsoft Excel software. Results The questionnaire was filled by a total of 84 orthopaedicians throughout India. The prevalence of osteoporosis in India according to the orthopaedic surgeons was 38.4% and there was a female preponderance. Most of the respondents felt out of every 100 osteoporosis patients in India, less than 20 patients are actually diagnosed and treated for osteoporosis. The most common initial presenting feature of established osteoporosis cases was general symptoms. Most respondents preferred Dual-energy X-ray absorptiometry (DEXA) as the initial investigation for the diagnosis of osteoporosis in a patient presenting with typical features. While most respondents preferred once-a-month oral over intravenous (IV) bisphosphonates, they agreed that IV administration had advantages such as lower gastrointestinal side effects and improved compliance. The average duration of therapy of oral bisphosphonates was the longest (27.04 months) among the other anti- osteoporosis therapies that they used. On an average, the patient compliance rate in osteoporosis management was around 64%. IV Zoledronic acid (ZA) and intranasal calcitonin were infrequently used than other anti- osteoporosis therapies. While concerns about cost and availability deterred more frequent

  6. Therapeutic Management of Familial Hypercholesterolemia: Current and Emerging Drug Therapies.

    PubMed

    Patel, Roshni S; Scopelliti, Emily M; Savelloni, Julie

    2015-12-01

    Familial hypercholesterolemia (FH) is a genetic disorder characterized by significantly elevated low-density lipoprotein cholesterol (LDL-C) concentrations that result from mutations of the LDL receptor, apolipoprotein B (apo B-100), and proprotein convertase subtilisin/kexin type 9 (PCSK9). Early and aggressive treatment can prevent premature atherosclerotic cardiovascular disease in these high-risk patients. Given that the cardiovascular consequences of FH are similar to typical hypercholesterolemia, traditional therapies are utilized to decrease LDL-C levels. Patients with FH should receive statins as first-line treatment; high-potency statins at high doses are often required. Despite the use of statins, additional treatments are often necessary to achieve appropriate LDL-C lowering in this patient population. Novel drug therapies that target the pathophysiologic defects of the condition are continuously emerging. Contemporary therapies including mipomersen (Kynamro, Genzyme), an oligonucleotide inhibitor of apo B-100 synthesis; lomitapide (Juxtapid, Aegerion), a microsomal triglyceride transfer protein inhibitor; and alirocumab (Praluent, Sanofi-Aventis/Regeneron) and evolocumab (Repatha, Amgen), PCSK9 inhibitors, are currently approved by the U.S. Food and Drug Administration for use in FH. This review highlights traditional as well as emerging contemporary therapies with supporting clinical data to evaluate current recommendations and discuss the future direction of FH management. PMID:26684558

  7. Current standings in diagnostic management of acute venous thromboembolism: Still rough around the edges.

    PubMed

    van der Hulle, T; Dronkers, C E A; Huisman, M V; Klok, F A

    2016-01-01

    Signs and symptoms of acute deep vein thrombosis (DVT) and pulmonary embolism (PE) are notoriously non-specific. Therefore, diagnostic management algorithms have been developed, consisting of a clinical decision rule (CDR), D-dimer testing and an imaging test, that allow safe diagnostic management and the exclusion of VTE in clinical practice. However, several challenges still remain: adherence to the diagnostic algorithms, accurate diagnosis of recurrent VTE and reducing the radiation exposure associated with computed tomography pulmonary angiography for suspected PE. In this clinically oriented review, we will provide an overview of current diagnostic algorithms for suspected DVT and PE and focus on recent advances including strategies to improve adherence to recommended algorithms, age-dependent D-dimer threshold and novel imaging techniques. PMID:26233662

  8. Current Management of Alcoholic Hepatitis and Future Therapies

    PubMed Central

    Saberi, Behnam; Dadabhai, Alia S.; Jang, Yoon-Young; Gurakar, Ahmet; Mezey, Esteban

    2016-01-01

    Abstract Alcohol is one of the most common etiologies of liver disease, and alcoholic liver disease overall is the second most common indication for liver transplantation in the United States. It encompasses a spectrum of disease, including fatty liver disease, alcoholic hepatitis (AH), and alcoholic cirrhosis. AH can range from mild to severe disease, with severe disease being defined as: Discriminant Function (DF) ≥ 32, or Model for End-stage Liver Disease (MELD) ≥ 21, or presence of hepatic encephalopathy. Management of the mild disease consists mainly of abstinence and supportive care. Severe AH is associated with significant mortality. Currently, there is no ideal medical treatment for this condition. Besides alcohol cessation, corticosteroids have been used with conflicting results and are associated with an inherent risk of infection. Overall steroids have shown short term benefit when compared to placebo, but they have no obvious long term benefits. Pentoxifylline does not improve survival in patients with severe AH and is no longer recommended based on the results of the STOPAH (Steroid Or Pentoxifylline for Alcoholic Hepatitis) trial. Anti-tumor necrosis factor (TNF) agents are associated with increased risk of life threatening infections and death. Currently, early stage trials are underway, mainly targeting novel pathways based on disease pathogenesis, including modulation of innate immune system, inhibition of gut-liver axis and cell death pathways, and activation of transcription factor farnesyl X receptor (FXR). Future treatment may lie in human induced pluripotent stem cell (iPSC) technology, which is currently under investigation for the study of pathogenesis, drug discovery, and stem cell transplantation. Liver transplantation has been reported with good results in highly selected patients but is controversial due to limited organ supply. PMID:27350941

  9. Household energy management strategies in Bulgaria's transitioning energy sector

    NASA Astrophysics Data System (ADS)

    Carper, Mark Daniel Lynn

    Recent transition literature of post-socialist states has addressed the shortcomings of a rapid blanket implementation of neo-liberal policies and practices placed upon a landscape barren of the needed institutions and experiences. Included in these observations are the policy-making oversight of spatial socioeconomic variations and their individual and diverse methods of coping with their individual challenges. Of such literature addressing the case of Bulgaria, a good portion deals with the spatial consequences of restructuring as well as with embedded disputes over access to and control of resources. With few exceptions, studies of Bulgaria's changing energy sector have largely been at the state level and have not been placed within the context of spatial disparities of socioeconomic response. By exploring the variations of household energy management strategies across space, my dissertation places this resource within such a theoretical context and offers analysis based on respective levels of economic and human development, inherited material infrastructures, the organization and activities of institutions, and fuel and technological availability. A closed survey was distributed to explore six investigational themes across four geographic realms. The investigational themes include materials of housing construction, methods of household heating, use of electrical appliances, energy conservation strategies, awareness and use of energy conservation technologies, and attitudes toward the transitioning energy sector. The geographic realms include countrywide results, the urban-rural divide, regional variations, and urban divisions of the capital city, Sofia. Results conclude that, indeed, energy management strategies at the household level have been shaped by multiple variables, many of which differ across space. These variables include price sensitivity, degree of dependence on remnant technologies, fuel and substitute availability, and level of human and

  10. Comparison of shortened and conventional dry period management strategies.

    PubMed

    Cermakova, J; Kudrna, V; Simeckova, M; Vyborna, A; Dolezal, P; Illek, J

    2014-09-01

    The aim of this study was to compare 2 dry-cow management strategies and evaluate the effect of shortened dry period strategy on feed intake, metabolism, and postpartum performance of dairy cows in early lactation. Twenty-nine high-yielding dairy cows were divided into 2 groups. The control (CON) group (n=14) was assigned to a traditional dry period of approximately 60 d (57±5.9 d) and was fed a far-off dry cow ration from dry-off to -21 d relative to expected parturition. From d -21 relative to expected parturition, the cows were switched to a precalving ration containing an additional 3kg of concentrates. The cows of the experimental group (n=15) were assigned to a shortened dry period (SDP; 35±6.3 d) and were continuously fed a late-lactation diet from d -60 d relative to expected parturition until calving. After calving, both groups were fed the same lactation diet corresponding to their lactation requirements and cows were followed for 100 d of lactation. Prepartum dry matter intake of the cows assigned to an SDP and fed a late-lactation diet was approximately 4.11kg/cow per day greater compared with the CON group during the 60 d. However, no effect of dry period strategy on postpartum dry matter intake was detected. The cows with an SDP produced approximately 2.78kg/d (6.9%) less milk in the first 100 d of lactation than CON cows; the difference was not statistically significant. No differences were observed in live body weight, body condition score, or back-fat thickness between the treatments. Similarly, no differences existed in concentrations of plasma metabolites. The cows of the SDP group showed lower pH and increased concentrations of lactic acid and volatile fatty acids prepartum than the CON cows. Postpartum concentrations of lactic acid, volatile fatty acids, and NH3 and pH in rumen fluid did not differ between the treatments. Shortening of the dry period did not affect the colostrum quality or birth weights of the calves. Based on the results of

  11. Turnaround Management Strategies: The Adaptive Model and the Constructive Model. ASHE 1983 Annual Meeting Paper.

    ERIC Educational Resources Information Center

    Chaffee, Ellen E.

    The use of two management strategies by 14 liberal arts and comprehensive colleges attempting to recover from serious financial decline during 1973-1976 were studied. The adaptive model of strategy, based on resource dependence, involves managing demands in order to satisfy critical-resource providers. The constructive model of strategy, based on…

  12. History of the current understanding and management of tethered spinal cord.

    PubMed

    Safavi-Abbasi, Sam; Mapstone, Timothy B; Archer, Jacob B; Wilson, Christopher; Theodore, Nicholas; Spetzler, Robert F; Preul, Mark C

    2016-07-01

    An understanding of the underlying pathophysiology of tethered cord syndrome (TCS) and modern management strategies have only developed within the past few decades. Current understanding of this entity first began with the understanding and management of spina bifida; this later led to the gradual recognition of spina bifida occulta and the symptoms associated with tethering of the filum terminale. In the 17th century, Dutch anatomists provided the first descriptions and initiated surgical management efforts for spina bifida. In the 19th century, the term "spina bifida occulta" was coined and various presentations of spinal dysraphism were appreciated. The association of urinary, cutaneous, and skeletal abnormalities with spinal dysraphism was recognized in the 20th century. Early in the 20th century, some physicians began to suspect that traction on the conus medullaris caused myelodysplasia-related symptoms and that prophylactic surgical management could prevent the occurrence of clinical manifestations. It was not, however, until later in the 20th century that the term "tethered spinal cord" and the modern management of TCS were introduced. This gradual advancement in understanding at a time before the development of modern imaging modalities illustrates how, over the centuries, anatomists, pathologists, neurologists, and surgeons used clinical examination, a high level of suspicion, and interest in the subtle and overt clinical appearances of spinal dysraphism and TCS to advance understanding of pathophysiology, clinical appearance, and treatment of this entity. With the availability of modern imaging, spinal dysraphism can now be diagnosed and treated as early as the intrauterine stage. PMID:26967990

  13. Ascent, dominance, and decline of the alewife in the Great Lakes: Food web interactions and management strategies

    USGS Publications Warehouse

    O'Gorman, Robert; Stewart, Thomas J.

    1999-01-01

    This article chronicles the ascent, dominance, and decline of the alewife (Alosa pseudoharengus) in the Great Lakes and tracks the gradual accumulation of knowledge on the fish's effect on the aquatic community. Changes in management strategies for alewife are followed, and the current management dilemma is framed in light of the alewife's effect on inidigenous fishes and the changing biota and trophic status of the Great Lakes.

  14. Contract management of Ontario's cancer surgery wait times strategy.

    PubMed

    Cheng, Siu Mee; Irish, Jonathan C; Thompson, Leslee J

    2007-01-01

    The province of Ontario, as a result of the First Ministers' Meeting, was committed to addressing surgery wait times in Ontario. The Ministry of Health and Long-Term Care's response to this commitment was the Wait Times Strategy (WTS) initiative, which addressed access issues with the aim of positively impacting wait times in cancer surgery. Cancer Care Ontario (CCO) was tasked with managing the cancer surgery WTS. CCO engaged in accountability agreements with Ontario hospitals to provide incremental cancer surgery volumes, in return for one-time funding. Through the use of accountability agreements, CCO was able to tie service volume delivery, quality care initiatives and reporting requirements to funding. Other elements of the cancer surgery WTS implementation included the development of wait times definitions, guidelines and targets; the use of a performance management system; facilitation by existing regional cancer leads and continued development of regional cancer programs. Eight key lessons were learned: (1) baseline volume guarantees are critical to ensuring that wait times are positively impacted; (2) there is a need to create a balance between accountability and systems management; (3) clinical quality initiatives can be tied to funding initiatives; (4) allocations of services should be informed by many factors; (5) regional leadership is key to ensuring that local needs are met; (6) data are invaluable in improving performance; (7) there is regional disparity in service delivery, capacity and resources across the province; and (8) program sustainability is an underlying goal of the WTS for cancer surgery. The implication is that accountability agreements can be leveraged to create sustainable health management systems. PMID:18019899

  15. Diabetes and haemochromatosis: current concepts, management and prevention.

    PubMed

    Yaouanq, J M

    1995-12-01

    Haemochromatosis is a common autosomal recessive disorder of iron metabolism caused by a gene in tight linkage with HLA class I genes. Despite intensive research, the molecular defect and underlying biochemical anomaly are still unknown. Diabetes, a serious complication of haemochromatosis, is frequently associated with cirrhosis which reduces life expectancy. Its development is related to iron excess, directly or through associated liver involvement, although the precise mechanisms of iron toxicity remain unclear. New concepts concerning its pathogenesis include insulin resistance and beta-cell dysfunction which are apparent well before insulin deficiency and can be reversed if iron depletion is promptly initiated. Today, earlier recognition of iron overload through active diagnostic approaches has a direct impact in reducing the frequency of diabetes among hemochromatosis patients. Presymptomatic diagnosis in the general population and among relatives of affected subjects currently relies on the detection of increased iron stores through medical awareness and family screening. Indirect gene diagnosis with serological and molecular markers of the HLA region can be provided for relatives of proven cases. As part of a genetic counselling process, this allows the identification of at-risk subjects before the onset of iron accumulation. Isolation of the gene and identification of the metabolic defect leading to increased iron absorption may have significant implications for future diagnostic procedures and preventive strategies in haemochromatosis. PMID:8586148

  16. Strategies, methods and tools for managing nanorisks in construction

    NASA Astrophysics Data System (ADS)

    López de Ipiña, J. M.; Vaquero, C.; Boutry, D.; Damlencourt, J. F.; Neofytou, P.; Pilou, M.; Jankowska, E.; Larraza, I.; Pina, R.; Fernández, S.; Contreras, S.; Romero, A.; Calderon, M.; Swiezewsk, P.; Otkallo, K.; Pintea, A.; Salazar, C.; Oroz, T.; Hargreaves, B.; Ciobanu, R.; Tabrea, A.; Hazebrouck, B.; Salvi, O.; Stockmann-Juvala, H.; Vaananen, V.; Pui, D. H. Y.; Thompson, Drew

    2015-05-01

    This paper presents a general overview of the work carried out by European project SCAFFOLD (GA 280535) during its 30 months of life, with special emphasis on risk management component. The research conducted by SCAFFOLD is focused on the European construction sector and considers 5 types of nanomaterials (TiO2, SiO2, carbon nanofibres, cellulose nanofibers and nanoclays), 6 construction applications (Depollutant mortars, selfcompacting concretes, coatings, self-cleaning coatings, fire resistant panels and insulation materials) and 26 exposure scenarios, including lab, pilot and industrial scales. The document focuses on the structure, content and operation modes of the Risk Management Toolkit developed by the project to facilitate the implementation of “nano-management” in construction companies. The tool deploys and integrated approach OHSAS 18001 - ISO 31000 and is currently being validated on 5 industrial case studies.

  17. STRATEGIES AND TECHNOLOGY FOR MANAGING HIGH-CARBON ASH

    SciTech Connect

    Robert Hurt; Eric Suuberg; John Veranth; Xu Chen

    2003-05-20

    The overall objective of the present project is to identify and assess strategies and solutions for the management of industry problems related to carbon in ash. Specific research issues to be addressed include: (1) the effect of parent fuel selection on ash properties and adsorptivity, including a first ever examination of the air entrainment behavior of ashes from alternative (non-coal) fuels; (2) the effect of various low-NOx firing modes on ash properties and adsorptivity; and (3) the kinetics and mechanism of ash ozonation. This data will provide scientific and engineering support of the ongoing process development activities. During this fourth project period we completed the characterization of ozone-treated carbon surfaces and wrote a comprehensive report on the mechanism through which ozone suppresses the adsorption of concrete surfactants.

  18. Antioxidant Strategies in the Management of Diabetic Neuropathy

    PubMed Central

    Oyenihi, Ayodeji Babatunde; Ayeleso, Ademola Olabode; Masola, Bubuya

    2015-01-01

    Chronic hyperglycaemia (an abnormally high glucose concentration in the blood) resulting from defects in insulin secretion/action, or both, is the major hallmark of diabetes in which it is known to be involved in the progression of the condition to different complications that include diabetic neuropathy. Diabetic neuropathy (diabetes-induced nerve damage) is the most common diabetic complication and can be devastating because it can lead to disability. There is an increasing body of evidence associating diabetic neuropathy with oxidative stress. Oxidative stress results from the production of oxygen free radicals in the body in excess of its ability to eliminate them by antioxidant activity. Antioxidants have different mechanisms and sites of actions by which they exert their biochemical effects and ameliorate nerve dysfunction in diabetes by acting directly against oxidative damage. This review will examine different strategies for managing diabetic neuropathy which rely on exogenous antioxidants. PMID:25821809

  19. STRATEGIES AND TECHNOLOGY FOR MANAGING HIGH-CARBON ASH

    SciTech Connect

    Robert Hurt; Eric Suuberg; John Veranth; Xu Chen

    2002-09-10

    The overall objective of the present project is to identify and assess strategies and solutions for the management of industry problems related to carbon in ash. Specific research issues to be addressed include: (1) the effect of parent fuel selection on ash properties and adsorptivity, including a first ever examination of the air entrainment behavior of ashes from alternative (non-coal) fuels; (2) the effect of various low-NOx firing modes on ash properties and adsorptivity; and (3) the kinetics and mechanism of ash ozonation. This data will provide scientific and engineering support of the ongoing process development activities. During this fourth project period we completed the characterization of ozone-treated carbon surfaces and wrote a comprehensive report on the mechanism through which ozone suppresses the adsorption of concrete surfactants.

  20. Management Strategies in Advanced Uterine Leiomyosarcoma: Focus on Trabectedin

    PubMed Central

    Amant, Frédéric; Lorusso, Domenica; Duffaud, Florence; Pautier, Patricia

    2015-01-01

    The treatment of advanced uterine leiomyosarcomas (U-LMS) represents a considerable challenge. Radiological diagnosis prior to hysterectomy is difficult, with the diagnosis frequently made postoperatively. Whilst a total abdominal hysterectomy is the cornerstone of management of early disease, the role of routine adjuvant pelvic radiotherapy and adjuvant chemotherapy is less clear, since they may improve local tumor control in high risk patients but are not associated with an overall survival benefit. For recurrent or disseminated U-LMS, cytotoxic chemotherapy remains the mainstay of treatment. There have been few active chemotherapy drugs approved for advanced disease, although newer drugs such as trabectedin with its pleiotropic mechanism of actions represent an important addition to the standard front-line systemic therapy with doxorubicin and ifosfamide. In this review, we outline the therapeutic potential and in particular the emerging evidence-based strategy of therapy with trabectedin in patients with advanced U-LMS. PMID:26089739

  1. Blending Effective Behavior Management and Literacy Strategies for Preschoolers Exhibiting Negative Behavior

    ERIC Educational Resources Information Center

    Smith, Jaime

    2009-01-01

    Sometimes students will exhibit various aggressive behaviors in the preschool classroom. Early childhood educators need to have behavior management strategies to manage the students' negative behaviors within the classroom setting. This article will provide a rationale for embedding literacy instruction within behavior management strategies to…

  2. Preservice Teachers' Knowledge and Perceptions of Effective Behavior Management Strategies

    ERIC Educational Resources Information Center

    Nields, Allison N.

    2014-01-01

    This study examined student teachers' perceptions and knowledge of behavior management strategies. A questionnaire that included questions about broad behavior management techniques, behavioral learning theory, and behavior management strategies related to behavioral learning theory was given to sixty-one student teacher candidates at a large…

  3. Integrated design strategy for product life-cycle management

    NASA Astrophysics Data System (ADS)

    Johnson, G. Patrick

    2001-02-01

    Two major trends suggest new considerations for environmentally conscious manufacturing (ECM) -- the continuation of dematerialization and the growing trend toward goods becoming services. A diversity of existing research could be integrated around those trends in ways that can enhance ECM. Major research-based achievements in information, computation, and communications systems, sophisticated and inexpensive sensing capabilities, highly automated and precise manufacturing technologies, and new materials continue to drive the phenomenon of dematerialization - the reduction of the material and energy content of per capita GDP. Knowledge is also growing about the sociology, economics, mathematics, management and organization of complex socio-economic systems. And that has driven a trend towards goods evolving into services. But even with these significant trends, the value of material, energy, information and human resources incorporated into the manufacture, use and disposal of modern products and services often far exceeds the benefits realized. Multi-disciplinary research integrating these drivers with advances in ECM concepts could be the basis for a new strategy of production. It is argued that a strategy of integrating information resources with physical and human resources over product life cycles, together with considering products as streams of service over time, could lead to significant economic payoff. That strategy leads to an overall design concept to minimize costs of all resources over the product life cycle to more fully capture benefits of all resources incorporated into modern products. It is possible by including life cycle monitoring, periodic component replacement, re-manufacture, salvage and human factor skill enhancement into initial design.

  4. Contemporary Strategies in the Diagnosis and Management of Heart Failure

    PubMed Central

    Dunlay, Shannon M.; Pereira, Naveen L.; Kushwaha, Sudhir S.

    2016-01-01

    Heart failure (HF) is an important public health problem in need of strategies to improve outcomes and decrease healthcare resource utilization and costs. The prevalence has risen as the population ages and HF continues to be associated with a high mortality and frequent need for hospitalization. The total cost of care for patients with HF is $30.7 billion, and estimated to more than double to $69.8 billion by 2030. Given this reality, there has been recent investigation into ways of identifying and preventing HF in patients at risk (stage A HF) and those with cardiac structural and functional abnormalities but no clinical HF symptoms (Stage B). For patients who have developed symptoms of HF (Stage C), there has been important research into the most effective ways to decongest patients admitted with acute decompensated HF and prevent future hospital readmissions. We continue to search for successful strategies to treat patients with HF and preserved ejection fraction, which has risen in prevalence. We are in the midst of a rapid evolution in our ability to care for patients with end stage HF (Stage D) due to the introduction and improvement in mechanical circulatory support. Left ventricular assist devices used as destination therapy offer an important therapeutic option to patients who don’t qualify for heart transplantation due to advanced age or excess comorbidity. This review will provide a thorough update on contemporary strategies in the diagnosis and management of HF by stage (A to D) that have emerged in the last several years. PMID:24684781

  5. Gastric cancer in Africa: current management and outcomes.

    PubMed

    Asombang, Akwi W; Rahman, Rubayat; Ibdah, Jamal A

    2014-04-14

    Gastric cancer is the fourth most common cancer and second most common cause of cancer death worldwide. Globally, gastric cancer poses a significant public health burden - both economically and socially. In 2008, the economic burden from premature cancer deaths and disability was $895 billion and gastric cancer was the second highest cancer responsible for healthy life lost. With the expected increase in cancer deaths and non-communicable diseases, these costs are expected to rise and impact patient care. World Health Organization, estimates a 15% increase in non-communicable disease worldwide, with more than 20% increase occurring in Africa between 2010 and 2020. Mali, West Africa, is ranked 15(th) highest incidence of gastric cancer worldwide at a rate of 20.3/100000, yet very scarce published data evaluating etiology, prevention or management exist. It is understood that risk factors of gastric cancer are multifactorial and include infectious agents (Helicobacter pylori, Epstein-Barr virus), genetic, dietary, and environmental factors (alcohol, smoking). Interestingly, African patients with gastric cancer are younger, in their 3(rd)-4(th) decade, and present at a late stage of the disease. There is sparse data regarding gastric cancer in Africa due to lack of data collection and under-reporting, which impacts incidence and mortality rates. Currently, GLOBOCAN, an International Agency for Research on Cancer resource, is the most comprehensive available resource allowing comparison between nations. In resource limited settings, with already restricted healthcare funding, data is needed to establish programs in Africa that increase gastric cancer awareness, curtail the economic burden, and improve patient management and survival outcomes. PMID:24833842

  6. Gastric cancer in Africa: Current management and outcomes

    PubMed Central

    Asombang, Akwi W; Rahman, Rubayat; Ibdah, Jamal A

    2014-01-01

    Gastric cancer is the fourth most common cancer and second most common cause of cancer death worldwide. Globally, gastric cancer poses a significant public health burden - both economically and socially. In 2008, the economic burden from premature cancer deaths and disability was $895 billion and gastric cancer was the second highest cancer responsible for healthy life lost. With the expected increase in cancer deaths and non-communicable diseases, these costs are expected to rise and impact patient care. World Health Organization, estimates a 15% increase in non-communicable disease worldwide, with more than 20% increase occurring in Africa between 2010 and 2020. Mali, West Africa, is ranked 15th highest incidence of gastric cancer worldwide at a rate of 20.3/100000, yet very scarce published data evaluating etiology, prevention or management exist. It is understood that risk factors of gastric cancer are multifactorial and include infectious agents (Helicobacter pylori, Epstein-Barr virus), genetic, dietary, and environmental factors (alcohol, smoking). Interestingly, African patients with gastric cancer are younger, in their 3rd-4th decade, and present at a late stage of the disease. There is sparse data regarding gastric cancer in Africa due to lack of data collection and under-reporting, which impacts incidence and mortality rates. Currently, GLOBOCAN, an International Agency for Research on Cancer resource, is the most comprehensive available resource allowing comparison between nations. In resource limited settings, with already restricted healthcare funding, data is needed to establish programs in Africa that increase gastric cancer awareness, curtail the economic burden, and improve patient management and survival outcomes. PMID:24833842

  7. Information Management Strategies in Early Adolescence: Developmental Change in Use and Transactional Associations with Psychological Adjustment

    ERIC Educational Resources Information Center

    Laird, Robert D.; Marrero, Matthew D.; Melching, Jessica A.; Kuhn, Emily S.

    2013-01-01

    Adolescents use various strategies to manage their parents' access to information. This study tested developmental change in strategy use, longitudinal associations between disclosing and concealing strategies, and longitudinal associations linking disclosing and concealing strategies with antisocial behavior and depressive symptoms. Self-report…

  8. Fluorescent Labeling of Plasmid DNA and mRNA: Gains and Losses of Current Labeling Strategies.

    PubMed

    Rombouts, K; Braeckmans, K; Remaut, K

    2016-02-17

    Live-cell imaging has provided the life sciences with insights into the cell biology and dynamics. Fluorescent labeling of target molecules proves to be indispensable in this regard. In this Review, we focus on the current fluorescent labeling strategies for nucleic acids, and in particular mRNA (mRNA) and plasmid DNA (pDNA), which are of interest to a broad range of scientific fields. By giving a background of the available techniques and an evaluation of the pros and cons, we try to supply scientists with all the information needed to come to an informed choice of nucleic acid labeling strategy aimed at their particular needs. PMID:26670733

  9. Biosolids management strategies: an evaluation of energy production as an alternative to land application.

    PubMed

    Egan, Maureen

    2013-07-01

    Currently, more than half of the biosolids produced within the USA are land applied. Land application of biosolids introduces organic contaminants into the environment. There are potential ecological and human health risks associated with land application of biosolids. Biosolids may be used as a renewable energy source. Nutrients may be recovered from biosolids used for energy generation for use as fertilizer. The by-products of biosolids energy generation may be used beneficially in construction materials. It is recommended that energy generation replace land application as the leading biosolids management strategy. PMID:23529399

  10. Strategies for the Use of Tidal Stream Currents for Power Generation

    NASA Astrophysics Data System (ADS)

    Orhan, Kadir; Mayerle, Roberto

    2015-04-01

    Indonesia is one of the priority countries in Southeast Asia for the development of ocean renewable energy facilities and The National Energy Council intends to increase the role of ocean energy significantly in the energy mix for 2010-2050. To this end, the joint German-Indonesian project "Ocean Renewable Energy ORE-12" aims at the identification of marine environments in the Indonesian Archipelago, which are suitable for the efficient generation of electric power by converter facilities. This study, within the ORE-12 project, is focused on the tidal stream currents on the straits between the Indian Ocean and Flores Sea to estimate the energy potentials and to develop strategies for producing renewable energy. FLOW module of Delft3D has been used to run hydrodynamic models for site assessment and design development. In site assessment phase, 2D models have been operated for a-month long periods and with a resolution of 500 m. Later on, in design development phase, detailed 3D models have been developed and operated for three-month long periods and with a resolution of 50 m. Bathymetric data for models have been obtained from the GEBCO_08 Grid and wind data from the Global Forecast System of NOAA's National Climatic Data Center. To set the boundary conditions of models, tidal forcing with 11 harmonic constituents was supplied from TPXO Indian Ocean Atlas (1/12° regional model) and data from HYCOM+NCODA Global 1/12° Analysis have been used to determine salinity and temperature on open boundaries. After the field survey is complete, water level time-series supplied from a tidal gauge located in the domain of interest (8° 20΄ 9.7" S, 122° 54΄ 51.9" E) have been used to verify the models and then energy potentials of the straits have been estimated. As a next step, correspondence between model outputs and measurements taken by the radar system of TerraSAR-X satellite (DLR) will be analysed. Also for the assessment of environmental impacts caused by tidal stream

  11. Practical Strategies to Enhance Executive Functioning and Strengthen Diabetes Management Across the Lifespan

    PubMed Central

    Hilliard, Marisa E.; Schwartz, David D.; Anderson, Barbara J.

    2015-01-01

    The complex type 1 diabetes (T1D) management regimen places extra demands on one's ability to plan, organize, and problem-solve, a set of skills described as executive functioning (EF). Research on the relation between EF and T1D management has been mounting and suggest that deficits in EF skills likely interfere with optimal management. However, given the substantial EF demands of T1D management, any person with T1D, including those without clinically significant deficits, could likely benefit from strategies to improve diabetes-related EF skills. The current review outlines typical EF development across the lifespan and suggests behavioral strategies (e.g., environmental modifications) from the EF literature and clinical experience to enhance EF skills at each period of development. When executive dysfunction is suspected, formal neuropsychological assessment is recommended as EF concerns can be a significant problem of their own, or they could be an indicator of another psychological disorder, such as depression or dementia. PMID:26084581

  12. Retaining Staff Employees: The Relationship between Human Resources Management Strategies and Organizational Commitment.

    ERIC Educational Resources Information Center

    Buck, Jeffrey M.; Watson, John L.

    2002-01-01

    Explored whether an institution's human resources management (HRM) strategies can influence individuals' organizational commitment levels, which ultimately can affect staff turnover rates. Found significant relationship between certain HRM strategies and commitment constructs. (EV)

  13. Cataplexy--clinical aspects, pathophysiology and management strategy.

    PubMed

    Dauvilliers, Yves; Siegel, Jerry M; Lopez, Regis; Torontali, Zoltan A; Peever, John H

    2014-07-01

    Cataplexy is the pathognomonic symptom of narcolepsy, and is the sudden uncontrollable onset of skeletal muscle paralysis or weakness during wakefulness. Cataplexy is incapacitating because it leaves the individual awake but temporarily either fully or partially paralyzed. Occurring spontaneously, cataplexy is typically triggered by strong positive emotions such as laughter and is often underdiagnosed owing to a variable disease course in terms of age of onset, presenting symptoms, triggers, frequency and intensity of attacks. This disorder occurs almost exclusively in patients with depletion of hypothalamic orexin neurons. One pathogenetic mechanism that has been hypothesized for cataplexy is the activation, during wakefulness, of brainstem circuitry that normally induces muscle tone suppression in rapid eye movement sleep. Muscle weakness during cataplexy is caused by decreased excitation of noradrenergic neurons and increased inhibition of skeletal motor neurons by γ-aminobutyric acid-releasing or glycinergic neurons. The amygdala and medial prefrontal cortex contain neural pathways through which positive emotions probably trigger cataplectic attacks. Despite major advances in understanding disease mechanisms in cataplexy, therapeutic management is largely symptomatic, with antidepressants and γ-hydroxybutyrate being the most effective treatments. This Review describes the clinical and pathophysiological aspects of cataplexy, and outlines optimal therapeutic management strategies. PMID:24890646

  14. Implications for local and global climate of alternative forest management strategies in Norway

    NASA Astrophysics Data System (ADS)

    Bright, Ryan M.; Antón-Fernández, Clara; Astrup, Rasmus; Cherubini, Francesco; Kvalevåg, Maria; Hammer Strømman, Anders

    2014-05-01

    We applied a mix of observation and empirical models to evaluate both local and global climate effects of three realistic alternative forest management scenarios in the boreal forests of Norway's largest logging region. The alternative management scenarios embraced strategies aimed at increasing harvest intensities and allowing harvested conifer sites to regenerate naturally with broadleaved species. Stand-level analysis was firstly executed to attribute differences in daily, seasonal, and annual mean surface temperatures to differences in surface intrinsic biophysical properties across coniferous, deciduous, and clear-cut sites. Relative to a coniferous site, we observed a slight local cooling of 0.13 °C at a deciduous site and 0.25 °C at a clear-cut site over a 6-year period which was mostly attributed to a higher albedo throughout the year. When monthly mean albedo trajectories over the entire managed forest landscape were taken into consideration, we found that strategies promoting natural regeneration of coniferous sites with native deciduous species led to substantial global direct climate cooling benefits relative to those maintaining current silviculture regimes - despite predicted long-term regional warming feedbacks and a reduced albedo in spring and autumn months. The magnitude and duration of the cooling benefit depended largely on whether management strategies simultaneously promoted an enhanced material supply over business-as-usual levels. While additional climate impact linked to changes in life-cycle emissions and to changes in the global supply and demand of timber products ought to be factored into any mitigation-oriented climate policy involving the forestry sector, our analysis demonstrates that - within the boundaries of the managed forest ecosystem - excluding important biogeophysical considerations like surface albedo change may lead to sub-optimal climate policy.

  15. Ebola hemorrhagic fever outbreaks: strategies for effective epidemic management, containment and control.

    PubMed

    Matua, Gerald Amandu; Van der Wal, Dirk Mostert; Locsin, Rozzano C

    2015-01-01

    Ebola hemorrhagic fever, caused by the highly virulent RNA virus of the filoviridae family, has become one of the world's most feared pathogens. The virus induces acute fever and death, often associated with hemorrhagic symptoms in up to 90% of infected patients. The known sub-types of the virus are Zaire, Sudan, Taï Forest, Bundibugyo and Reston Ebola viruses. In the past, outbreaks were limited to the East and Central African tropical belt with the exception of Ebola Reston outbreaks that occurred in animal facilities in the Philippines, USA and Italy. The on-going outbreak in West Africa that is causing numerous deaths and severe socio-economic challenges has resulted in widespread anxiety globally. This panic may be attributed to the intense media interest, the rapid spread of the virus to other countries like United States and Spain, and moreover, to the absence of an approved treatment or vaccine. Informed by this widespread fear and anxiety, we analyzed the commonly used strategies to manage and control Ebola outbreaks and proposed new approaches that could improve epidemic management and control during future outbreaks. We based our recommendations on epidemic management practices employed during recent outbreaks in East, Central and West Africa, and synthesis of peer-reviewed publications as well as published "field" information from individuals and organizations recently involved in the management of Ebola epidemics. The current epidemic management approaches are largely "reactive", with containment efforts aimed at halting spread of existing outbreaks. We recommend that for better outcomes, in addition to "reactive" interventions, "pre-emptive" strategies also need to be instituted. We conclude that emphasizing both "reactive" and "pre-emptive" strategies is more likely to lead to better epidemic preparedness and response at individual, community, institutional, and government levels, resulting in timely containment of future Ebola outbreaks. PMID

  16. Current Issues in Malignant Pleural Mesothelioma Evaluation and Management

    PubMed Central

    Ai, Jing

    2014-01-01

    Malignant pleural mesothelioma (MPM) is an uncommon disease most often associated with occupational asbestos exposure and is steadily increasing in worldwide incidence. Patients typically present at an older age, with advanced clinical stage and other medical comorbidities, making management quite challenging. Despite great efforts, the prognosis of MPM remains poor, especially at progression after initial treatment. Macroscopic complete resection of MPM can be achieved through extrapleural pneumonectomy (EPP) or extended (ie, radical) pleurectomy (e-P/D) in selected patients and can result in prolonged survival when incorporated into a multimodality approach. Given the morbidity associated with surgical resection of MPM, optimizing identification of appropriate patients is essential. Unfortunately, most patients are not candidates for EPP or e-P/D due to advanced stage, age, and/or medical comorbidity. Pemetrexed and platinum combination chemotherapy has become the cornerstone of therapy for patients with unresectable disease because the combination is associated with improved survival and quality of life in treated patients. However, MPM eventually becomes resistant to initial therapy, and benefit to further lines of therapy has not been substantiated in randomized clinical trials. Translational research has provided exciting insights into tumorigenesis, biomarkers, and immune response in MPM, leading to the development of multiple novel therapeutic agents that are currently in clinical trials. These advances hold the promise of a new era in the treatment of MPM and suggest that this disease will not be left behind in the war on cancer. PMID:25061089

  17. Managing ankle ligament sprains and tears: current opinion

    PubMed Central

    McGovern, Ryan P; Martin, RobRoy L

    2016-01-01

    The purpose of this paper is to present a current review of pathoanatomical features, differential diagnosis, objective assessment, intervention, and clinical course associated with managing lateral ankle ligament sprains. Proper diagnosis and identification of affected structures should be obtained through history and objective assessment. From this information, an individualized evidence-based intervention plan can be developed to enable recovery while decreasing the risk of reinjury. An appropriate evaluation is needed not only to determine the correct diagnosis but also to allow for grading and determining the prognosis of the injury in those with an acute lateral ankle sprain. Examination should include an assessment of impairments as well as a measure of activity and participation. Evidence-based interventions for those with an acute lateral ankle sprain should include weight bearing with bracing, manual therapy, progressive therapeutic exercises, and cryotherapy. For those with chronic ankle instability (CAI), interventions should include manual therapy and a comprehensive rehabilitation program. It is essential to understand the normal clinical course for athletes who sustain a lateral ankle sprain as well as risk factors for an acute injury and CAI. Risk factors for both an acute lateral ankle sprain and CAI include not using an external support and not participating in an appropriate exercise program. Incorporating the latest evidence-based rehabilitation techniques provides the best course of treatment for athletes with an acute ankle sprain or CAI. PMID:27042147

  18. Targeted temperature management: Current evidence and practices in critical care

    PubMed Central

    Saigal, Saurabh; Sharma, Jai Prakash; Dhurwe, Ritika; Kumar, Sanjay; Gurjar, Mohan

    2015-01-01

    Targeted temperature management (TTM) in today's modern era, especially in intensive care units represents a promising multifaceted therapy for a variety of conditions. Though hypothermia is being used since Hippocratic era, the renewed interest of late has been since early 21st century. There have been multiple advancements in this field and varieties of cooling devices are available at present. TTM requires careful titration of its depth, duration and rewarming as it is associated with side-effects. The purpose of this review is to find out the best evidence-based clinical practice criteria of therapeutic hypothermia in critical care settings. TTM is an unique therapeutic modality for salvaging neurological tissue viability in critically ill patients viz. Post-cardiac arrest, traumatic brain injury (TBI), meningitis, acute liver failure and stroke. TTM is standard of care in post-cardiac arrest situations; there has been a lot of controversy of late regarding temperature ranges to be used for the same. In patients with TBI, it reduces intracranial pressure, but has not shown any favorable neurologic outcome. Hypothermia is generally accepted treatment for hypoxic ischemic encephalopathy in newborns. The current available technology to induce and maintain hypothermia allows for precise temperature control. Future studies should focus on optimizing hypothermic treatment to full benefit of our patients and its application in other clinical scenarios. PMID:26430341

  19. Pituitary tumors. Current concepts in diagnosis and management.

    PubMed Central

    Aron, D C; Tyrrell, J B; Wilson, C B

    1995-01-01

    Diagnostic advances have resulted in earlier and more frequent recognition of pituitary tumors. Pituitary tumors cause problems owing to the hormones they secrete or the effects of an expanding sellar mass--hypopituitarism, visual field abnormalities, and neurologic deficits. Prolactin-secreting tumors (prolactinomas), which cause amenorrhea, galactorrhea, and hypogonadism, constitute the most common type of primary pituitary tumors, followed by growth hormone-secreting tumors, which cause acromegaly, and corticotropin-secreting tumors, which cause Cushing's syndrome. Hypersecretion of thyroid-stimulating hormone, the gonadotrophins, or alpha-subunits is unusual. Nonfunctional tumors currently represent only 10% of all clinically diagnosed pituitary adenomas, and some of these are alpha-subunit-secreting adenomas. Insights into the pathogenesis and biologic behavior of these usually benign tumors have been gained from genetic studies. We review some of the recent advances and salient features of the diagnosis and management of pituitary tumors, including biochemical and radiologic diagnosis, transsphenoidal surgery, radiation therapy, and medical therapy. Each type of lesion requires a comprehensive but individualized treatment approach, and regardless of the mode of therapy, careful follow-up is essential. Images PMID:7747500

  20. Managing ankle ligament sprains and tears: current opinion.

    PubMed

    McGovern, Ryan P; Martin, RobRoy L

    2016-01-01

    The purpose of this paper is to present a current review of pathoanatomical features, differential diagnosis, objective assessment, intervention, and clinical course associated with managing lateral ankle ligament sprains. Proper diagnosis and identification of affected structures should be obtained through history and objective assessment. From this information, an individualized evidence-based intervention plan can be developed to enable recovery while decreasing the risk of reinjury. An appropriate evaluation is needed not only to determine the correct diagnosis but also to allow for grading and determining the prognosis of the injury in those with an acute lateral ankle sprain. Examination should include an assessment of impairments as well as a measure of activity and participation. Evidence-based interventions for those with an acute lateral ankle sprain should include weight bearing with bracing, manual therapy, progressive therapeutic exercises, and cryotherapy. For those with chronic ankle instability (CAI), interventions should include manual therapy and a comprehensive rehabilitation program. It is essential to understand the normal clinical course for athletes who sustain a lateral ankle sprain as well as risk factors for an acute injury and CAI. Risk factors for both an acute lateral ankle sprain and CAI include not using an external support and not participating in an appropriate exercise program. Incorporating the latest evidence-based rehabilitation techniques provides the best course of treatment for athletes with an acute ankle sprain or CAI. PMID:27042147

  1. Management strategies in the treatment of neonatal and pediatric gastroenteritis

    PubMed Central

    Ciccarelli, Simona; Stolfi, Ilaria; Caramia, Giuseppe

    2013-01-01

    Acute gastroenteritis, characterized by the onset of diarrhea with or without vomiting, continues to be a major cause of morbidity and mortality in children in mostly resource-constrained nations. Although generally a mild and self-limiting disease, gastroenteritis is one of the most common causes of hospitalization and is associated with a substantial disease burden. Worldwide, up to 40% of children aged less than 5 years with diarrhea are hospitalized with rotavirus. Also, some microorganisms have been found predominantly in resource-constrained nations, including Shigella spp, Vibrio cholerae, and the protozoan infections. Prevention remains essential, and the rotavirus vaccines have demonstrated good safety and efficacy profiles in large clinical trials. Because dehydration is the major complication associated with gastroenteritis, appropriate fluid management (oral or intravenous) is an effective and safe strategy for rehydration. Continuation of breastfeeding is strongly recommended. New treatments such as antiemetics (ondansetron), some antidiarrheal agents (racecadotril), and chemotherapeutic agents are often proposed, but not yet universally recommended. Probiotics, also known as “food supplement,” seem to improve intestinal microbial balance, reducing the duration and the severity of acute infectious diarrhea. The European Society for Paediatric Gastroenterology, Hepatology and Nutrition and the European Society of Paediatric Infectious Diseases guidelines make a stronger recommendation for the use of probiotics for the management of acute gastroenteritis, particularly those with documented efficacy such as Lactobacillus rhamnosus GG, Lactobacillus reuteri, and Saccharomyces boulardii. To date, the management of acute gastroenteritis has been based on the option of “doing the least”: oral rehydration-solution administration, early refeeding, no testing, no unnecessary drugs. PMID:24194646

  2. Technical strategy for the management of INEEL spent nuclear fuel

    SciTech Connect

    1997-03-01

    This report presents evaluations, findings, and recommendations of the Idaho National Engineering and Environmental Laboratory (INEEL) Spent Nuclear Fuel Task Team. The technical strategy developed by the Task Team includes stabilization, near term storage, packaging, transport, and ultimate disposal. Key issues identified and discussed include waste characterization, criticality, packaging, waste form performance, and special fuels. Current plans focus on onsite needs, and include three central elements: (1) resolution of near-term vulnerabilities, (2) consolidation of storage locations, and (3) achieving dry storage in transportable packages. In addition to the Task Team report, appendices contain information on the INEEL spent fuel inventory; regulatory decisions and agreements; and analyses of criticality, packaging, storage, transportation, and system performance of a geological repository. 16 refs., 6 figs., 4 tabs.

  3. Risk management of seasonal influenza during pregnancy: current perspectives

    PubMed Central

    Yudin, Mark H

    2014-01-01

    Influenza poses unique risks to pregnant women, who are particularly susceptible to morbidity and mortality. Historically, pregnant women have been overrepresented among patients with severe illness and complications from influenza, and have been more likely to require hospitalization and intensive care unit admission. An increased risk of adverse outcomes is also present for fetuses/neonates born to women affected by influenza during pregnancy. These risks to mothers and babies have been observed during both nonpandemic and pandemic influenza seasons. During the H1N1 influenza pandemic of 2009–2010, pregnant women were more likely to be hospitalized or admitted to intensive care units, and were at higher risk of death compared to nonpregnant adults. Vaccination remains the most effective intervention to prevent severe illness, and antiviral medications are an important adjunct to ameliorate disease when it occurs. Unfortunately, despite national guidelines recommending universal vaccination for women who are pregnant during influenza season, actual vaccination rates do not achieve desired targets among pregnant women. Pregnant women are also sometimes reluctant to use antiviral medications during pregnancy. Some of the barriers to use of vaccines and medications during pregnancy are a lack of knowledge of recommendations and of safety data. By improving knowledge and understanding of influenza and vaccination recommendations, vaccine acceptance rates among pregnant women can be improved. Currently, the appropriate use of vaccination and antiviral medications is the best line of defense against influenza and its sequelae among pregnant women, and strategies to increase acceptance are crucial. This article will review the importance of influenza in pregnancy, and discuss vaccination and antiviral medications for pregnant women. PMID:25114593

  4. An integrated water resources management strategy for Al-Ain City, United Arab Emirates

    NASA Astrophysics Data System (ADS)

    Mohamed, M. M.

    2014-09-01

    Al-Ain is the second largest city in the Emirate of Abu Dhabi and the third in the UAE. Currently, desalination plants are the only source of drinking water in the city with an average daily supply of 170 MIG. Recently, Abu Dhabi Urban Planning Council (UPC) released Al-Ain 2030 Plan. Projects suggested in this plan, over and above the expected natural population growth, will certainly put additional stress on the water resources in the city. Therefore, Al-Ain city seems to be in urgent need for an integrated water resources management strategy towards achieving sustainable development. This strategy will contain three main components; namely, a Water Demand Forecasting Model (WDFM), a Water Budget Model (WBM), and a Water Resources Optimization Model (WROM). The main aim of this paper is to present the WBM that estimates all inflows and outflows to assess water resources sustainability in the city.

  5. Case Management in Community Corrections: Current Status and Future Directions

    ERIC Educational Resources Information Center

    Day, Andrew; Hardcastle, Lesley; Birgden, Astrid

    2012-01-01

    Case management is commonly regarded as the foundation of effective service provision across a wide range of human service settings. This article considers the case management that is offered to clients of community corrections, identifying the distinctive features of case management in this particular setting, and reviewing the empirical evidence…

  6. The management of anthelmintic resistance in grazing ruminants in Australasia--strategies and experiences.

    PubMed

    Leathwick, D M; Besier, R B

    2014-07-30

    In many countries the presence of anthelmintic resistance in nematodes of small ruminants, and in some cases also in those infecting cattle and horses, has become the status quo rather than the exception. It is clear that consideration of anthelmintic resistance, and its management, should be an integral component of anthelmintic use regardless of country or host species. Many years of research into understanding the development and management of anthelmintic resistance in nematodes of small ruminants has resulted in an array of strategies for minimising selection for resistance and for dealing with it once it has developed. Importantly, many of these strategies are now supported by empirical science and some have been assessed and evaluated on commercial farms. In sheep the cost of resistance has been measured at about 10% of the value of the lamb at sale which means that losses due to undetected resistance far outweigh the cost of testing anthelmintic efficacy. Despite this many farmers still do not test for anthelmintic resistance on their farm. Many resistance management strategies have been developed and some of these have been tailored for specific environments and/or nematode species. However, in general, most strategies can be categorised as either; identify and mitigate high risk management practices, maintain an anthelmintic-susceptible population in refugia, choose the optimal anthelmintic (combinations and formulations), or prevent the introduction of resistant nematodes. Experiences with sheep farmers in both New Zealand and Australia indicate that acceptance and implementation of resistance management practices is relatively easy as long as the need to do so is clear and the recommended practices meet the farmer's criteria for practicality. A major difference between Australasia and many other countries is the availability and widespread acceptance of combination anthelmintics as a resistance management tool. The current situation in cattle and horses

  7. Strategies of bringing drug product marketing applications to meet current regulatory standards.

    PubMed

    Wu, Yan; Freed, Anita; Lavrich, David; Raghavachari, Ramesh; Huynh-Ba, Kim; Shah, Ketan; Alasandro, Mark

    2015-08-01

    In the past decade, many guidance documents have been issued through collaboration of global organizations and regulatory authorities. Most of these are applicable to new products, but there is a risk that currently marketed products will not meet the new compliance standards during audits and inspections while companies continue to make changes through the product life cycle for continuous improvement or market demands. This discussion presents different strategies to bringing drug product marketing applications to meet current and emerging standards. It also discusses stability and method designs to meet process validation and global development efforts. PMID:26024722

  8. Mathematics, Pricing, Market Risk Management and Trading Strategies for Financial Derivatives (2/3)

    SciTech Connect

    2009-11-04

    Market Trading and Risk Management of Vanilla FX Options - Measures of Market Risk - Implied Volatility - FX Risk Reversals, FX Strangles - Valuation and Risk Calculations - Risk Management - Market Trading Strategies

  9. Mathematics, Pricing, Market Risk Management and Trading Strategies for Financial Derivatives (2/3)

    ScienceCinema

    None

    2011-10-06

    Market Trading and Risk Management of Vanilla FX Options - Measures of Market Risk - Implied Volatility - FX Risk Reversals, FX Strangles - Valuation and Risk Calculations - Risk Management - Market Trading Strategies

  10. Current and emerging formulation strategies for the effective transdermal delivery of HIV inhibitors

    PubMed Central

    Ham, Anthony S; Buckheit, Robert W

    2015-01-01

    Current and emerging formulation strategies for skin permeation are poised to open the transdermal drug delivery to a broader range of small molecule compounds that do not fit the traditional requirements for successful transdermal drug delivery, allowing the development of new patch technologies to deliver antiretroviral drugs that were previously incapable of being delivered through transdermal means. Transdermal drug delivery offers several distinct advantages over traditional dosage forms. Current antiretroviral drugs used for the treatment of HIV infection include a variety of highly active small molecule compounds with significantly limited skin permeability, and thus new and novel means of enhancing transport through the skin are needed. Current and emerging formulation strategies are poised to open the transdermal drug delivery to a broader range of compounds that do not fit the traditional requirements for successful transdermal drug delivery, allowing the development of new patch technologies to deliver antiretroviral drugs that were previously incapable of being delivered through transdermal means. Thus, with continuing research into skin permeability and patch formulation strategies, there is a large potential for antiretroviral transdermal drug delivery. PMID:25690088

  11. An Integrated Modeling and Data Management Strategy for Cellulosic Biomass Production Decisions

    SciTech Connect

    David J. Muth Jr.; K. Mark Bryden; Joshua B. Koch

    2012-07-01

    Emerging cellulosic bioenergy markets can provide land managers with additional options for crop production decisions. Integrating dedicated bioenergy crops such as perennial grasses and short rotation woody species within the agricultural landscape can have positive impacts on several environmental processes including increased soil organic matter in degraded soils, reduced sediment loading in watersheds, lower green house gas (GHG) fluxes, and reduced nutrient loading in watersheds. Implementing this type of diverse bioenergy production system in a way that maximizes potential environmental benefits requires a dynamic integrated modeling and data management strategy. This paper presents a strategy for designing diverse bioenergy cropping systems within the existing row crop production landscape in the midwestern United States. The integrated model developed quantifies a wide range environmental processes including soil erosion from wind and water, soil organic matter changes, and soil GHG fluxes within a geospatial data management framework. This framework assembles and formats information from multiple spatial and temporal scales. The data assembled includes yield and productivity data from harvesting equipment at the 1m scale, surface topography data from LiDAR mapping at the less than 1m scale, soil data from US soil survey databases at the 10m to 100m scale, and climate data at the county scale. These models and data tools are assembled into an integrated computational environment that is used to determine sustainable removal rates for agricultural residues for bioenergy production at the sub-field scale under a wide range of land management practices. Using this integrated model, innovative management practices including cover cropping are then introduced and evaluated for their impact on bioenergy production and important environmental processes. The impacts of introducing dedicated energy crops onto high-risk landscape positions currently being manage in

  12. Current nanotechnology approaches for the treatment and management of diabetic retinopathy.

    PubMed

    Fangueiro, Joana F; Silva, Amélia M; Garcia, Maria L; Souto, Eliana B

    2015-09-01

    Diabetic retinopathy (DR) is a consequence of diabetes mellitus at the ocular level, leading to vision loss, and contributing to the decrease of patient's life quality. The biochemical and anatomic abnormalities that occur in DR are discussed in this review to better understand and manage the development of new therapeutic strategies. The use of new drug delivery systems based on nanoparticles (e.g. liposomes, dendrimers, cationic nanoemulsions, lipid and polymeric nanoparticles) is discussed along with the current traditional treatments, pointing out the advantages of the proposed nanomedicines to target this ocular disease. Despite the multifactorial nature of DR, which is not entirely understood, some strategies based on nanoparticles are being exploited for a more efficient drug delivery to the posterior segment of the eye. On the other hand, the use of some nanoparticles also seems to contribute to the development of DR symptoms (e.g. retinal neovascularization), which are also discussed in light of an efficient management of this ocular chronic disease. PMID:25536109

  13. Management strategy for bilateral complex vertebral artery aneurysms.

    PubMed

    Saito, Norihiro; Kamiyama, Hiroyasu; Takizawa, Katsumi; Takebayashi, Seiji; Asano, Takeshi; Kobayashi, Tohru; Kobayashi, Rina; Kubota, Shunsuke; Ito, Yasuhiro; Karagiozov, Kostadin L

    2016-04-01

    Bilateral complex vertebral artery aneurysms (BCoVAAns) have no established strategy of management. We retrospectively reviewed five consecutive patients with unruptured BCoVAAns between January 2006 and December 2012. Considering surgical risks of lower cranial nerve (LCN) injuries and eventual growth of an opposite side lesion after unilateral vertebral artery (VA) occlusion, we proposed a strategy of combined open and interventional treatment using revascularization. We applied the following several specific techniques: (1) proximal clipping and occipital artery-posterior inferior cerebellar artery (OA-PICA) and/or superficial temporary artery (STA)-superior cerebellar artery (SCA) bypasses; (2) Distal blood pressure, motor evoked potentials (MEPs), and somatosensory evoked potentials (SEPs) monitoring after parent artery temporary occlusion for safe permanent occlusion of the proximal portions of VA and PICA; (3) V3 to V4 bypass using radial artery (RA) graft with proximal clipping or trapping, two of them combined with OA-PICA bypass; (4) VA fenestration as an opportunity to preserve the flow of the parent artery. Two patients were treated bilaterally and 3 unilaterally, with modified Rankin scale assessed at 39 months postoperatively in average 0 in 2, 1 in 2, and 2 in 1, respectively, and the untreated opposite side lesions without regrowth or bleeding. Two patients with patent V3-RA-V4 bypass complained of dysphagia due to LCN palsies. One of them however suffered a cerebellar infarction due to occlusion of the OA-PICA bypass. When BCoVAAns require surgical treatment, revascularization or preservation of the VA should be considered at the first operation. By doing so, the opposite aneurysm can be effectively occluded by coil embolization, even with VA sacrifice if required. PMID:26564148

  14. Current state of hereditary angioedema management: A patient survey

    PubMed Central

    Busse, Paula; Christiansen, Sandra C.; Li, Henry; Lumry, William; Davis-Lorton, Mark; Bernstein, Jonathan A.; Frank, Michael; Castaldo, Anthony; Long, Janet F.; Zuraw, Bruce L.; Riedl, Marc

    2015-01-01

    Hereditary angioedema (HAE) is a chronic disease with a high burden of disease that is poorly understood and often misdiagnosed. Availability of treatments, including C1 esterase inhibitor (C1INH) replacement, ecallantide, and icatibant, marks a significant advance for HAE patients. We aimed to better understand the current state of HAE care, from a patient perspective, after the introduction of several novel therapies. One session of the United States Hereditary Angioedema Association 2013 patient summit was devoted to data collection for this study. Patients attending the summit were self-selected, and HAE diagnosis was self-reported. Survey questions assessed patient characteristics, burden of disease, and treatment. Participant responses were captured using an audience response system. We surveyed 149 (80%) type I and II HAE (HAE-C1INH) and 37 (20%) HAE with normal C1INH (HAE-nlC1INH) patients. HAE-C1INH (72%) and HAE-nlCINH patients (76%) equally reported that HAE had a significant impact on quality of life (QOL). A third of HAE-C1INH patients were diagnosed within one year of their first HAE attack, but another third reported a delay of more than 10 years. Most HAE-C1INH (88%) and HAE-nlC1INH (76%) patients had on-demand treatment available. HAE-C1INH patients frequently had an individual treatment plan (76%) compared with 50% of HAE-nlC1INH patients. Most HAE-C1INH patients went to the emergency department (ED) or were hospitalized less than once every six months (80%). Our findings show that HAE management is improving with good access to on-demand and prophylactic treatment options. However, HAE patients still have a significant burden of disease and continued research and educational efforts are needed. PMID:25976438

  15. Land use and management in PR China: problems and strategies.

    PubMed

    Cai, Y

    1990-10-01

    The conflict between population and land in China results from high population density, declining availability of arable land, decrease in cropland, overgrazing, inability to afford imported grain, and expansion of land use for urbanization. Unwise decisions have been made. These decisions have resulted in land degradation, soil erosion, deforestation, degradation of grasslands, waste of land for freight storage or waste disposal due to low grain prices, and nonagricultural constructions on croplands. Ineffective land management problems are identified as: 1) the lack of an economic means of guiding land use and land is not valued; the lack of any mechanism to ensure economic land use including public lands which are not accounted for with rent; 2) the lack of integration of departments into the decision making structure and too many departments making decisions about the same land; 3) the lack of choice in land use which results in higher government departments being unaware of local conditions, and the lack of appropriate investment which results in short-term exploitation; and 4) surveys are inadequate for decision making. The strategies suggested for improvement in land use management include low resources expenditure in production and appropriate goods consumption. The goal is to sustain subsistence with gradual improvement through development. Land resources must be conserved and the environment protected. The solutions to depend on food imports or reduce the nutritional level deny the equally plausible solution to generate a higher level of input. The profit motive and scientific agricultural practices could accomplish this end. Reclamation for cropland is possible for 8 million hectares of wasteland in wide areas in Sanjiang Plain and 3.4 million hectares in small pockets in Eastern Monsoon China. Traditional agriculture must be transformed and an optimum scale of land operation established. Land tenure reform is necessary. Regional conditions must prevail

  16. Update on Pharmaceutical and Minimally Invasive Management Strategies for Chronic Obstructive Pulmonary Disease

    PubMed Central

    Rafii, Rokhsara; Albertson, Timothy E.; Louie, Samuel; Chan, Andrew L.

    2011-01-01

    Chronic obstructive pulmonary disease (COPD) is a debilitating pulmonary disorder with systemic effects, and it is the fourth leading cause of death in the United States. COPD patients not only develop respiratory limitations, but can also demonstrate systemic wasting, features of depression, and can succumb to social isolation. Smoking cessation is crucial, and pharmacotherapy with bronchodilators is helpful in symptom management. Inhaled corticosteroids may be beneficial in some patients. In addition, pulmonary rehabilitation and palliative care are important components under the right clinical circumstance. This review highlights current guidelines and management strategies for COPD and emphasizes novel pharmacotherapy and minimally invasive (nonsurgical) lung-volume reduction interventions that may prove to be of significant benefit in the future. PMID:21660228

  17. Ecologically Significant Monitoring Strategies for Watershed Managers and Applied Ecohydrologists

    NASA Astrophysics Data System (ADS)

    Buchanan, B. P.; Walter, T.

    2007-12-01

    Upper Klamath Lake in Southern Oregon is home to a unique and increasingly rare strain of redband rainbow trout (Oncorhynchus mykiss newberrii). Populations connected to perennial lake systems such as the Upper Klamath have evolved adfluvial life histories and may possess unique adaptations that underscore their importance as units of conservation. Anthropogenic disturbance including stream channelization, timber harvest, livestock grazing and irrigation diversion have resulted in a 41 percent reduction in the redband's historic habitat and the disappearance of 11 redband trout populations throughout Oregon, Washington, and Idaho. In an effort to actively conserve this sensitive subspecies, a stream creation project was undertaken with the goal of increasing viable spawning and rearing habitat in Crooked Creek, a tributary to Upper Klamath Lake. A combination of analogue, empirical and analytical techniques were employed in the design of the created channel morphology (i.e. channel planform, profile, and cross-section), the sizing of bed substrate and spawning gravels and the design of in-stream habitat and scour structures. The project, completed in the fall of 1996, was qualitatively judged a success (e.g. trout were observed actively spawning and young-of-the-year were collected during unsystematic surveys). Unfortunately, as is often the case in the stream enhancement/restoration field, funding and personnel time were lacking for the implementation of a robust post-construction monitoring plan. Thus, project success was ascertained through cursory analyses and anecdotal reports. An opportunity to implement a similar stream creation project in a nearby watershed has afforded us the chance to return to the project site and conduct a more comprehensive, quantitative analysis of the project's success. A discussion of the original design methods and a review of several state of the art monitoring strategies are provided to assist watershed managers and applied

  18. Human resource management in general practice: survey of current practice.

    PubMed Central

    Newton, J; Hunt, J; Stirling, J

    1996-01-01

    BACKGROUND: The organization and management of general practice is changing as a result of government policies designed to expand primary health care services. One aspect of practice management which has been underresearched concerns staffing: the recruitment, retention, management and motivation of practice managers. AIM: A study set out to find out who is routinely involved in making decisions about staffing matters in general practice, to establish the extent to which the human resource management function is formalized and specialized, and to describe the characteristics of the practice managers. METHOD: A postal questionnaire was sent to a stratified random sample of 750 general practices in England and Wales in February 1994 enquiring about the practice (for example, the fundholding status and number of general practitioner partners), how the practice dealt with a range of staffing matters and about the practice manager (for example, employment background and training in human resource management). Practices were classed as small (single-handed and two or three general practitioner partners), medium (four or five partners) or large (six or more partners). RESULTS: Replies were received from 477 practices (64%). Practice managers had limited authority to make decisions alone in the majority of practices although there was a greater likelihood of them taking independent action as the size of practice increased. Formality in handling staffing matters (as measured by the existence and use of written policies and procedures) also increased with practice size. Larger practices were more likely than smaller practices to have additional tiers in their management structure through the creation of posts with the titles assistant practice manager, fund manager and senior receptionist. Most practice managers had been recruited from within general practice but larger practices were more likely than smaller practices to recruit from outwith general practice. Three quarters

  19. Vermicomposting as manure management strategy for urban small-holder animal farms - Kampala case study.

    PubMed

    Lalander, Cecilia Helena; Komakech, Allan John; Vinnerås, Björn

    2015-05-01

    Inadequate organic waste management can contribute to the spread of diseases and have negative impacts on the environment. Vermicomposting organic waste could have dual beneficial effects by generating an economically viable animal feed protein in the form of worm biomass, while alleviating the negative effects of poor organic waste management. In this study, a low-maintenance vermicomposting system was evaluated as manure and food waste management system for small-holder farmers. A vermicomposting system using the earthworm species Eudrilus eugeniae and treating cow manure and food waste was set up in Kampala, Uganda, and monitored for 172days. The material degradation and protein production rates were evaluated after 63days and at the end of the experiment. The material reduction was 45.9% and the waste-to-biomass conversion rate was 3.5% in the vermicomposting process on a total solids basis. A possible increase in the conversion rate could be achieved by increasing the frequency of worm harvesting. Vermicomposting was found to be a viable manure management method in small-scale urban animal agriculture; the return of investment was calculated to be 280% for treating the manure of a 450kg cow. The vermicompost was not sanitised, although hygiene quality could be improved by introducing a post-stabilisation step in which no fresh material is added. The value of the animal feed protein generated in the process can act as an incentive to improve current manure management strategies. PMID:25728090

  20. Myocarditis And Pericarditis In The Pediatric Patient: Validated Management Strategies.

    PubMed

    Bergmann, Kelly R; Kharbanda, Anupam; Haveman, Lauren

    2015-07-01

    Myocarditis and pericarditis are inflammatory conditions of the heart commonly caused by viral and autoimmune etiologies, although many cases are idiopathic. Emergency clinicians must maintain a high index of suspicion for these conditions, given the rarity and often nonspecific presentation in the pediatric population. Children with myocarditis may present with a variety of symptoms, ranging from mild flu-like symptoms to overt heart failure and shock, whereas children with pericarditis typically present with chest pain and fever. The cornerstone of therapy for myocarditis includes aggressive supportive management of heart failure, as well as administration of inotropes and antidysrhythmic medications, as indicated. Children often require admission to an intensive care setting. The acute management of pericarditis includes recognition of tamponade and, if identified, the performance of pericardiocentesis. Medical therapies may include nonsteroidal anti-inflammatory drugs and colchicine, with steroids reserved for specific populations. This review focuses on the evaluation and treatment of children with myocarditis and/or pericarditis, with an emphasis on currently available medical evidence. PMID:26197653

  1. Assessment of regional management strategies for controlling seawater intrusion

    USGS Publications Warehouse

    Reichard, E.G.; Johnson, T.A.

    2005-01-01

    Simulation-optimization methods, applied with adequate sensitivity tests, can provide useful quantitative guidance for controlling seawater intrusion. This is demonstrated in an application to the West Coast Basin of coastal Los Angeles that considers two management options for improving hydraulic control of seawater intrusion: increased injection into barrier wells and in lieu delivery of surface water to replace current pumpage. For the base-case optimization analysis, assuming constant groundwater demand, in lieu delivery was determined to be most cost effective. Reduced-cost information from the optimization provided guidance for prioritizing locations for in lieu delivery. Model sensitivity to a suite of hydrologic, economic, and policy factors was tested. Raising the imposed average water-level constraint at the hydraulic-control locations resulted in nonlinear increases in cost. Systematic varying of the relative costs of injection and in lieu water yielded a trade-off curve between relative costs and injection/in lieu amounts. Changing the assumed future scenario to one of increasing pumpage in the adjacent Central Basin caused a small increase in the computed costs of seawater intrusion control. Changing the assumed boundary condition representing interaction with an adjacent basin did not affect the optimization results. Reducing the assumed hydraulic conductivity of the main productive aquifer resulted in a large increase in the model-computed cost. Journal of Water Resources Planning and Management ?? ASCE.

  2. STRATEGIES AND TECHNOLOGY FOR MANAGING HIGH-CARBON ASH

    SciTech Connect

    Robert Hurt; Eric Suuberg; John Veranth; Xu Chen; Indrek Kulaots

    2004-02-13

    The overall objective of the present project was to identify and assess strategies and solutions for the management of industry problems related to carbon in ash. Specific issues addressed included: (1) the effect of parent fuel selection on ash properties and adsorptivity, including a first ever examination of the air entrainment behavior of ashes from alternative (non-coal) fuels; (2) the effect of various low-NOx firing modes on ash properties and adsorptivity based on pilot-plant studies; and (3) the kinetics and mechanism of ash ozonation. This laboratory data has provided scientific and engineering support and underpinning for parallel process development activities. The development work on the ash ozonation process has now transitioned into a scale-up and commercialization project involving a multi-industry team and scheduled to begin in 2004. This report describes and documents the laboratory and pilot-scale work in the above three areas done at Brown University and the University of Utah during this three-year project.

  3. Selection of a management strategy for pediatric brainstem tumors

    SciTech Connect

    Halperin, E.C.; Wehn, S.M.; Scott, J.W.; Djang, W.; Oakes, W.J.; Friedman, H.S.

    1989-01-01

    Brainstem tumors arise in portions of the rhombencephalon and mesencephalon. Some authorities include diencephalic tumors in this group. We have reviewed our clinical experience of 69 children (less than 21 years of age) with brainstem tumors evaluated and treated at Duke University Medical Center (DUMC) from 1960 to 1986. There were 19 patients with group 1 tumors (thalamus, third ventricle region, or midbrain) and 50 with group II tumors (pons, medulla oblongata). The common presenting signs and symptoms were ataxia, headache, motor loss, and cranial nerve palsies. The most commonly employed diagnostic imaging studies were air examinations and CT. Preradiotherapy confirmation of malignancy was obtained in five group I patients (astrocytoma, 4; germinoma, 1) and 8 group II patients (astrocytoma, 3; anaplastic astrocytoma, 2; glioblastoma multiforme, 3). All patients received radiotherapy. The 5-year survival rate for the entire population was 40%. The survival rate for group I patients was significantly better than that observed for group II patients. In the 50 group II patients neither patient sex nor age nor presence of cranial nerve palsies nor pretreatment CT scan findings nor field size influenced survival. A long duration of symptoms positively influenced survival. The vast majority of tumor recurrences were within the radiation field. Half of the patients had either stable or improved Karnofsky status 6 months following completion of irradiation. The management strategy for childhood brainstem tumors is discussed.

  4. STRATEGIES AND TECHNOLOGY FOR MANAGING HIGH-CARBON ASH

    SciTech Connect

    Robert Hurt; Eric Suuberg; John Veranth

    2001-12-26

    The overall objective of the present project is to identify and assess strategies and solutions for the management of industry problems related to carbon in ash. Specific research issues to be addressed include: the effect of parent fuel selection on ash properties and adsorptivity, including a first ever examination of the air entrainment behavior of ashes from alternative (non-coal) fuels; the effect of various low-NOx firing modes on ash properties and adsorptivity; and the kinetics and mechanism of ash ozonation. This data will provide scientific and engineering support of the ongoing process development activities. This first project period, experiments were carried out to better understand the fundamental nature of the ozonation effect on ash. Carbon surfaces were characterized by surfactant adsorption, and by X-ray Photoelectron Spectroscopy before and after oxidation, both by air at 440 C and by ozone at room temperature. The results strongly suggest that the beneficial effect of ozonation is in large part due to chemical modification of the carbon surfaces.

  5. Real Time Energy Management Control Strategies for Hybrid Powertrains

    NASA Astrophysics Data System (ADS)

    Zaher, Mohamed Hegazi Mohamed

    In order to improve fuel efficiency and reduce emissions of mobile vehicles, various hybrid power-train concepts have been developed over the years. This thesis focuses on embedded control of hybrid powertrain concepts for mobile vehicle applications. Optimal robust control approach is used to develop a real time energy management strategy for continuous operations. The main idea is to store the normally wasted mechanical regenerative energy in energy storage devices for later usage. The regenerative energy recovery opportunity exists in any condition where the speed of motion is in opposite direction to the applied force or torque. This is the case when the vehicle is braking, decelerating, or the motion is driven by gravitational force, or load driven. There are three main concepts for regernerative energy storing devices in hybrid vehicles: electric, hydraulic, and flywheel. The real time control challenge is to balance the system power demand from the engine and the hybrid storage device, without depleting the energy storage device or stalling the engine in any work cycle, while making optimal use of the energy saving opportunities in a given operational, often repetitive cycle. In the worst case scenario, only engine is used and hybrid system completely disabled. A rule based control is developed and tuned for different work cycles and linked to a gain scheduling algorithm. A gain scheduling algorithm identifies the cycle being performed by the machine and its position via GPS, and maps them to the gains.

  6. Update on prolactinomas. Part 2: Treatment and management strategies.

    PubMed

    Wong, Anni; Eloy, Jean Anderson; Couldwell, William T; Liu, James K

    2015-10-01

    The authors present an update on the various treatment modalities and discuss management strategies for prolactinomas. Prolactinomas are the most common type of functional pituitary tumor. Effective hyperprolactinemia treatment is of great importance, due to its potential deleterious effects including infertility, gonadal dysfunction and osteoporosis. Dopamine agonist therapy is the first line of treatment for prolactinomas because of its effectiveness in normalizing serum prolactin levels and shrinking tumor size. Though withdrawal of dopamine agonist treatment is safe and may be implemented following certain recommendations, recurrence of disease after cessation of the drug occurs in a substantial proportion of patients. Concerns regarding the safety of dopamine agonists have been raised, but its safety profile remains high, allowing its use during pregnancy. Surgery is typically indicated for patients who are resistant to medical therapy or intolerant of its adverse side effects, or are experiencing progressive tumor growth. Surgical resection can also be considered as a primary treatment for those with smaller focal tumors where a biochemical cure can be expected as an alternative to lifelong dopamine agonist treatment. Stereotactic radiosurgery also serves as an option for those refractory to medical and surgical therapy. PMID:26243714

  7. Adolescent prolapsed lumbar intervertebral disc: Management strategies and outcome

    PubMed Central

    Sarma, Pragyan; Thirupathi, Rajan Thanga; Srinivas, Dwarakanath; Somanna, Sampath

    2016-01-01

    Objective: Lumbar intervertebral disc herniation (LIVDH) is rare in children and adolescents when compared to adults. In literature, children generally constitute around 0.5–3% of surgically treated LIVDH. Though much rarer, they are less likely to respond to conservative treatment than adults. In this study, we analyze our experience in the management of adolescent LIVDH (ALIVDH) (age group 12–18 years) including the demographic, clinico-radiological features; surgical management strategies and outcome. Materials and Methods: This retrospective analysis constituted all patients between 12 and 18 years, who underwent surgery for LIVDH at our institute over a period of 15 years from January 1999 to June 2014. The records of these patients were retrieved, and demographic features, clinical picture, radiological features, operative findings, and postoperative events were evaluated. Follow-up data were obtained either through direct clinical evaluation or mailed self-report questionnaire and telephone conversations. The long-term outcome was analyzed by using standardized and condition specific outcome scales in addition to routine clinical follow-up evaluation. The long-term outcome was analyzed by using the short form-36 (SF-36). Results: There were a total of 32 patients (26 males, eight females) with an average age of 15.64 years. Trauma was a significant etiological factor 57.14% (n = 16/28). Vertebral anomalies were present in 35.7% (n = 10/28) cases. Majority had a neurological deficit at presentation (n = 20/28). The most commonly involved level was the L4–L5 level (n = 18/128) in this series. Multiple level disc degeneration was present in eight patients (28.6%). Immediate postoperative relief was achieved in all but one patient. At long-term follow-up twenty patients were pain-free (71.4%). At follow-up, the physical functioning scale of SF-36 was significantly lower in patients with gross motor deficit prior to surgery. Conclusions: Early diagnosis and

  8. Chronic Hepatitis C Virus Infection: A Review of Current Direct-Acting Antiviral Treatment Strategies

    PubMed Central

    Zhang, Johnathan; Nguyen, Douglas; Hu, Ke-Qin

    2016-01-01

    Chronic Hepatitis C virus (HCV) infection carries a significant clinical burden in the United States, affecting more than 4.6 million Americans. Untreated chronic HCV infection can result in cirrhosis, portal hypertension, and hepatocellular carcinoma. Previous interferon based treatment carried low rates of success and significant adverse effects. The advent of new generation oral antiviral therapy has led to major improvements in efficacy and tolerability but has also resulted in an explosion of data with increased treatment choice complexity. Treatment guidelines are constantly evolving due to emerging regimens and real world treatment data. There also still remain subpopulations for whom current treatments are lacking or unclearly defined. Thus, the race for development of HCV treatment regimens still continues. This review of the current literature will discuss the current recommended treatment strategies and briefly overview next generation agents. PMID:27293521

  9. The community resource management area mechanism: a strategy to manage African forest resources for REDD+

    PubMed Central

    Asare, Rebecca A.; Kyei, Andrew; Mason, John J.

    2013-01-01

    Climate change poses a significant threat to Africa, and deforestation rates have increased in recent years. Mitigation initiatives such as REDD+ are widely considered as potentially efficient ways to generate emission reductions (or removals), conserve or sustainably manage forests, and bring benefits to communities, but effective implementation models are lacking. This paper presents the case of Ghana's Community Resource Management Area (CREMA) mechanism, an innovative natural resource governance and landscape-level planning tool that authorizes communities to manage their natural resources for economic and livelihood benefits. This paper argues that while the CREMA was originally developed to facilitate community-based wildlife management and habitat protection, it offers a promising community-based structure and process for managing African forest resources for REDD+. At a theoretical level, it conforms to the ecological, socio-cultural and economic factors that drive resource-users’ decision process and practices. And from a practical mitigation standpoint, the CREMA has the potential to help solve many of the key challenges for REDD+ in Africa, including definition of boundaries, smallholder aggregation, free prior and informed consent, ensuring permanence, preventing leakage, clarifying land tenure and carbon rights, as well as enabling equitable benefit-sharing arrangements. Ultimately, CREMA's potential as a forest management and climate change mitigation strategy that generates livelihood benefits for smallholder farmers and forest users will depend upon the willingness of African governments to support the mechanism and give it full legislative backing, and the motivation of communities to adopt the CREMA and integrate democratic decision-making and planning with their traditional values and natural resource management systems. PMID:23878338

  10. The community resource management area mechanism: a strategy to manage African forest resources for REDD+.

    PubMed

    Asare, Rebecca A; Kyei, Andrew; Mason, John J

    2013-01-01

    Climate change poses a significant threat to Africa, and deforestation rates have increased in recent years. Mitigation initiatives such as REDD+ are widely considered as potentially efficient ways to generate emission reductions (or removals), conserve or sustainably manage forests, and bring benefits to communities, but effective implementation models are lacking. This paper presents the case of Ghana's Community Resource Management Area (CREMA) mechanism, an innovative natural resource governance and landscape-level planning tool that authorizes communities to manage their natural resources for economic and livelihood benefits. This paper argues that while the CREMA was originally developed to facilitate community-based wildlife management and habitat protection, it offers a promising community-based structure and process for managing African forest resources for REDD+. At a theoretical level, it conforms to the ecological, socio-cultural and economic factors that drive resource-users' decision process and practices. And from a practical mitigation standpoint, the CREMA has the potential to help solve many of the key challenges for REDD+ in Africa, including definition of boundaries, smallholder aggregation, free prior and informed consent, ensuring permanence, preventing leakage, clarifying land tenure and carbon rights, as well as enabling equitable benefit-sharing arrangements. Ultimately, CREMA's potential as a forest management and climate change mitigation strategy that generates livelihood benefits for smallholder farmers and forest users will depend upon the willingness of African governments to support the mechanism and give it full legislative backing, and the motivation of communities to adopt the CREMA and integrate democratic decision-making and planning with their traditional values and natural resource management systems. PMID:23878338

  11. Needed: A Strategy for Housing Management Training. No. 1.

    ERIC Educational Resources Information Center

    Burgess, Carter L.; Kriegsfield, Irving M.

    The report discusses the need for: housing management; a new doctrine of management; trained people; and incentives. Management recommendations are proposed. (For related document, see AC 014 028.) (Author)

  12. Management of Mesh Complications after SUI and POP Repair: Review and Analysis of the Current Literature

    PubMed Central

    Deng, D. Y.

    2015-01-01

    Purpose. To evaluate the surgical treatment concepts for the complications related to the implantation of mesh material for urogynecological indications. Materials and Methods. A review of the current literature on PubMed was performed. Results. Only retrospective studies were detected. The rate of mesh-related complications is about 15–25% and mesh erosion is up to 10% for POP and SUI repair. Mesh explantation is necessary in about 1-2% of patients due to complications. The initial approach appears to be an early surgical treatment with partial or complete mesh resection. Vaginal and endoscopic access for mesh resection is favored. Prior to recurrent surgeries, a careful examination and planning for the operation strategy are crucial. Conclusions. The data on the management of mesh complication is scarce. Revisions should be performed by an experienced surgeon and a proper follow-up with prospective documentation is essential for a good outcome. PMID:25973425

  13. Targeted therapies with companion diagnostics in the management of breast cancer: current perspectives.

    PubMed

    Myers, Meagan B

    2016-01-01

    Breast cancer is a multifaceted disease exhibiting both intertumoral and intratumoral heterogeneity as well as variable disease course. Over 2 decades of research has advanced the understanding of the molecular substructure of breast cancer, directing the development of new therapeutic strategies against these actionable targets. In vitro diagnostics, and specifically companion diagnostics, have been integral in the successful development and implementation of these targeted therapies, such as those directed against the human epidermal growth factor receptor 2. Lately, there has been a surge in the development, commercialization, and marketing of diagnostic assays to assist in breast cancer patient care. More recently, multigene signature assays, such as Oncotype DX, MammaPrint, and Prosigna, have been integrated in the clinical setting in order to tailor decisions on adjuvant endocrine and chemotherapy treatment. This review provides an overview of the current state of breast cancer management and the use of companion diagnostics to direct personalized approaches in the treatment of breast cancer. PMID:26858530

  14. A Review of Current Management of Vitreomacular Traction and Macular Hole

    PubMed Central

    García-Layana, Alfredo; García-Arumí, José; Ruiz-Moreno, José M.; Arias-Barquet, Lluís; Cabrera-López, Francisco; Figueroa, Marta S.

    2015-01-01

    The paper presents a review of the sequence of events of posterior vitreous detachment (PVD), vitreomacular adhesion (VMA), vitreomacular traction (VMT), and macular hole (MH) from their pathophysiological aspects, clinical features, diagnostic implications, and current management strategies. A treatment algorithm to be used in clinical practice in patients with VMA, VMT, and MH based on the presence of symptoms, visual acuity, associated epiretinal membrane, and width of the vitreous attachment is presented. Observation, pharmacologic vitreolysis with ocriplasmin, and surgical treatment are positioned as treatment options in the different steps of the therapeutic algorithm, with clear indications of the paths to be followed according to the initial presenting manifestations and the patient's clinical course. PMID:25821592

  15. Targeted therapies with companion diagnostics in the management of breast cancer: current perspectives

    PubMed Central

    Myers, Meagan B

    2016-01-01

    Breast cancer is a multifaceted disease exhibiting both intertumoral and intratumoral heterogeneity as well as variable disease course. Over 2 decades of research has advanced the understanding of the molecular substructure of breast cancer, directing the development of new therapeutic strategies against these actionable targets. In vitro diagnostics, and specifically companion diagnostics, have been integral in the successful development and implementation of these targeted therapies, such as those directed against the human epidermal growth factor receptor 2. Lately, there has been a surge in the development, commercialization, and marketing of diagnostic assays to assist in breast cancer patient care. More recently, multigene signature assays, such as Oncotype DX, MammaPrint, and Prosigna, have been integrated in the clinical setting in order to tailor decisions on adjuvant endocrine and chemotherapy treatment. This review provides an overview of the current state of breast cancer management and the use of companion diagnostics to direct personalized approaches in the treatment of breast cancer. PMID:26858530

  16. Improving outcomes of refractory celiac disease – current and emerging treatment strategies

    PubMed Central

    Woodward, Jeremy

    2016-01-01

    Intestinal inflammation and symptoms of celiac disease (CD) usually respond well to gluten withdrawal, but rare cases are refractory to diet. Two types of refractory CD are discriminated on the basis of the presence or absence of an atypical population of mucosal lymphocytes that may progress to enteropathy-associated T-cell lymphoma. Challenges remain in the secure diagnosis of both types of refractory disease, and evidence on which to base treatment recommendations is flawed by the small numbers of reported patients and the use of different diagnostic strategies. Recent advances in our understanding of the mechanisms of the condition in conjunction with the development of immunomodulatory agents for managing other inflammatory diseases are helping to shape future approaches to targeted therapy. Progression will depend on collaboration and recruitment to trials. In the meantime, there is evidence to suggest that earlier diagnosis and better follow-up and management of CD may prevent the development of refractoriness. PMID:27536154

  17. Improving outcomes of refractory celiac disease - current and emerging treatment strategies.

    PubMed

    Woodward, Jeremy

    2016-01-01

    Intestinal inflammation and symptoms of celiac disease (CD) usually respond well to gluten withdrawal, but rare cases are refractory to diet. Two types of refractory CD are discriminated on the basis of the presence or absence of an atypical population of mucosal lymphocytes that may progress to enteropathy-associated T-cell lymphoma. Challenges remain in the secure diagnosis of both types of refractory disease, and evidence on which to base treatment recommendations is flawed by the small numbers of reported patients and the use of different diagnostic strategies. Recent advances in our understanding of the mechanisms of the condition in conjunction with the development of immunomodulatory agents for managing other inflammatory diseases are helping to shape future approaches to targeted therapy. Progression will depend on collaboration and recruitment to trials. In the meantime, there is evidence to suggest that earlier diagnosis and better follow-up and management of CD may prevent the development of refractoriness. PMID:27536154

  18. Strategies to reduce indoor tanning: current research gaps and future opportunities for prevention.

    PubMed

    Holman, Dawn M; Fox, Kathleen A; Glenn, Jeffrey D; Guy, Gery P; Watson, Meg; Baker, Katie; Cokkinides, Vilma; Gottlieb, Mark; Lazovich, DeAnn; Perna, Frank M; Sampson, Blake P; Seidenberg, Andrew B; Sinclair, Craig; Geller, Alan C

    2013-06-01

    Exposure to ultraviolet radiation from indoor tanning device use is associated with an increased risk of skin cancer, including risk of malignant melanoma, and is an urgent public health problem. By reducing indoor tanning, future cases of skin cancer could be prevented, along with the associated morbidity, mortality, and healthcare costs. On August 20, 2012, the CDC hosted a meeting to discuss the current body of evidence on strategies to reduce indoor tanning as well as research gaps. Using the Action Model to Achieve Healthy People 2020 Overarching Goals as a framework, the current paper provides highlights on the topics that were discussed, including (1) the state of the evidence on strategies to reduce indoor tanning; (2) the tools necessary to effectively assess, monitor, and evaluate the short- and long-term impact of interventions designed to reduce indoor tanning; and (3) strategies to align efforts at the national, state, and local levels through transdisciplinary collaboration and coordination across multiple sectors. Although many challenges and barriers exist, a coordinated, multilevel, transdisciplinary approach has the potential to reduce indoor tanning and prevent future cases of skin cancer. PMID:23683986

  19. Learning in the Panic Zone: Strategies for Managing Learner Anxiety

    ERIC Educational Resources Information Center

    Palethorpe, Rob; Wilson, John P.

    2011-01-01

    Purpose: This study aims to highlight the value of stressful and challenging environments as a strategy to enhance learning and to provide an inventory of strategies for use in cases where participants experience anxiety-related blockages to learning. Design/methodology/approach: This article adopted a qualitative research strategy which consisted…

  20. An integrated crop- and soil-based strategy for variable-rate nitrogen management in corn

    NASA Astrophysics Data System (ADS)

    Roberts, Darrin F.

    Nitrogen (N) management in cereal crops has been the subject of considerable research and debate for several decades. Historic N management practices have contributed to low nitrogen use efficiency (NUE). Low NUE can be caused by such things as poor synchronization between soil N supply and crop demand, uniform application rates of fertilizer N to spatially variable landscapes, and failure to account for temporally variable influences on soil N supply and crop N need. Active canopy reflectance sensors and management zones (MZ) have been studied separately as possible plant- and soil-based N management tools to increase NUE. Recently, some have suggested that the integration of these two approaches would provide a more robust N management strategy that could more effectively account for soil and plant effects on crop N need. For this reason, the goal of this research was to develop an N application strategy that would account for spatial variability in soil properties and use active canopy reflectance sensors to determine in-season, on-the-go N fertilizer rates, thereby increasing NUE and economic return for producers over current N management practices. To address this overall goal, a series of studies were conducted to better understand active canopy sensor use and explore the possibility of integrating spatial soil data with active canopy sensors. Sensor placement to assess crop N status was first examined. It was found that the greatest reduction in error over sensing each individual row for a hypothetical 24-row applicator was obtained with 2-3 sensors estimating an average chlorophyll index for the entire boom width. Next, use of active sensor-based soil organic matter (OM) estimation was compared to more conventional aerial image-based soil OM estimation. By adjusting regression intercept values for each field, OM could be predicted using either a single sensor or image data layer. The final study consisted of validation of the active sensor algorithm