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Sample records for address multiple management

  1. Population genetics suggest that multiple invasion processes need to be addressed in the management plan of a plant disease vector

    PubMed Central

    Anderson, Kylie L; Congdon, Bradley C

    2013-01-01

    The use of a multidisciplinary approach is becoming increasingly important when developing management strategies that mitigate the economic and biological costs associated with invasive pests. A framework of simulated dispersal is combined with life-history information and analyses of population genetic structure to investigate the invasion dynamics of a plant disease vector, the island sugarcane planthopper (Eumetopina flavipes), through an archipelago of significant Australian quarantine concern. Analysis of eight microsatellite loci from 648 individuals suggests that frequent, wind-assisted immigration from multiple sources in Papua New Guinea contributes significantly to repeated colonization of far northern islands. However, intermittent wind-assisted immigration better explains patterns of genetic diversity and structure in the southern islands and on the tip of mainland Australia. Significant population structuring associated with the presence of clusters of highly related individuals results from breeding in-situ following colonization, with little postestablishment movement. Results also suggest that less important secondary movements occur between islands; these appear to be human mediated and restricted by quarantine zones. Control of the planthopper may be very difficult on islands close to Papua New Guinea given the apparent propensity for multiple invasion, but may be achievable further south where local populations appear highly independent and isolated. PMID:23789032

  2. Opportunity, risk, and success recognizing, addressing, and balancing multiple factors crucial to the success of a project management system deployed to support multi-lateral decommissioning programs

    SciTech Connect

    Funk, Greg; Longsworth, Paul

    2007-07-01

    This paper addresses the factors involved in effectively implementing a world-class program/project management information system funded by multiple nations. Along with many other benefits, investing in and utilizing such systems improves delivery and drive accountability for major expenditures. However, there are an equally large number of impediments to developing and using such systems. To be successful, the process requires a dynamic combining of elements and strategic sequencing of initiatives. While program/project-management systems involve information technologies, software and hardware, they represent only one element of the overall system.. Technology, process, people and knowledge must all be integrated and working in concert with one another to assure a fully capable system. Major system implementations occur infrequently, and frequently miss established targets in relatively small organizations (with the risk increasing with greater complexity). The European Bank of Reconstruction (EBRD) is midway through just such an implementation. The EBRD is using funds from numerous donor countries to sponsor development of an overarching program management system. The system will provide the Russian Federation with the tools to effectively manage prioritizing, planning, and physically decommissioning assets{sub i}n northwest Russia to mitigate risks associated the Soviet era nuclear submarine program. Project-management delivery using world-class techniques supported by aligned systems has been proven to increase the probability of delivering on-time and on-budget, assuring those funding such programs optimum value for money. However, systems deployed to manage multi-laterally funded projects must be developed with appropriate levels of consideration given to unique aspects such as: accommodation of existing project management methods, consideration for differences is management structures and organizational behaviors, incorporation of unique strengths, and

  3. Marine and Human Systems: Addressing Multiple Scales and Multiple Stressors

    NASA Astrophysics Data System (ADS)

    Hofmann, E. E.; Bundy, A.; Chuenpagdee, R.; Maddison, L.; Svendsen, E.

    2015-12-01

    The Integrated Marine Biogeochemistry and Ecosystem Research (IMBER) project aims to develop a comprehensive understanding of, and predictive capacity of ocean responses to accelerating global change and the consequent effects on the Earth System and human society. Understanding the changing ecology and biogeochemistry of marine ecosystems and their sensitivity and resilience to multiple drivers, pressures and stressors is critical to developing responses that will help reduce the vulnerability of marine-dependent human communities. The cumulative pressure of anthropogenic activities on marine systems is already apparent and is projected to increase in the next decades. Policy- and decision-makers need assessments of the status and trends of marine habitats, species, and ecosystems to promote sustainable human activities in the marine environment, particularly in light of global environmental change and changing social systems and human pressures. The IMBER community recently undertook a synthesis and evaluation of approaches for ecosystem-based marine governance, integrated modeling of marine social-ecological systems, and the social and ecological consequences of changing marine ecosystems. The outcomes of this activity provide assessments of current understanding, indicate approaches needed to predict the effects of multiple stressors, at multiple scales, on marine ecosystems and dependent human populations, and highlight approaches for developing innovative societal responses to changing marine ecosystems.

  4. 46 CFR 67.113 - Managing owner designation; address; requirement to report change of address.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 46 Shipping 2 2010-10-01 2010-10-01 false Managing owner designation; address; requirement to... Required for Vessel Documentation § 67.113 Managing owner designation; address; requirement to report change of address. The owner of each vessel must designate a managing owner on the Application...

  5. 46 CFR 67.113 - Managing owner designation; address; requirement to report change of address.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 46 Shipping 2 2012-10-01 2012-10-01 false Managing owner designation; address; requirement to... Required for Vessel Documentation § 67.113 Managing owner designation; address; requirement to report change of address. The owner of each vessel must designate a managing owner on the Application...

  6. 46 CFR 67.113 - Managing owner designation; address; requirement to report change of address.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 46 Shipping 2 2011-10-01 2011-10-01 false Managing owner designation; address; requirement to... Required for Vessel Documentation § 67.113 Managing owner designation; address; requirement to report change of address. The owner of each vessel must designate a managing owner on the Application...

  7. 46 CFR 67.113 - Managing owner designation; address; requirement to report change of address.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 46 Shipping 2 2014-10-01 2014-10-01 false Managing owner designation; address; requirement to... Required for Vessel Documentation § 67.113 Managing owner designation; address; requirement to report change of address. The owner of each vessel must designate a managing owner on the Application...

  8. 46 CFR 67.113 - Managing owner designation; address; requirement to report change of address.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 46 Shipping 2 2013-10-01 2013-10-01 false Managing owner designation; address; requirement to... Required for Vessel Documentation § 67.113 Managing owner designation; address; requirement to report change of address. The owner of each vessel must designate a managing owner on the Application...

  9. IP address management : augmenting Sandia's capabilities through open source tools.

    SciTech Connect

    Nayar, R. Daniel

    2005-08-01

    Internet Protocol (IP) address management is an increasingly growing concern at Sandia National Laboratories (SNL) and the networking community as a whole. The current state of the available IP addresses indicates that they are nearly exhausted. Currently SNL doesn't have the justification to obtain more IP address space from Internet Assigned Numbers Authority (IANA). There must exist a local entity to manage and allocate IP assignments efficiently. Ongoing efforts at Sandia have been in the form of a multifunctional database application notably known as Network Information System (NWIS). NWIS is a database responsible for a multitude of network administrative services including IP address management. This study will explore the feasibility of augmenting NWIS's IP management capabilities utilizing open source tools. Modifications of existing capabilities to better allocate available IP address space are studied.

  10. Managing Multiple Measures

    ERIC Educational Resources Information Center

    DePascale, Charles A.

    2012-01-01

    Regardless of how one might feel about the recent developments in teacher evaluation systems, No Child Left Behind (NCLB) and adequate yearly progress (AYP), or student assessments for high-stakes promotion decisions, educators overwhelmingly agree that use of multiple measures is better than reliance on a single measure such as a large-scale,…

  11. A single fluorophore to address multiple logic gates.

    PubMed

    Sahu, Saugata; Sil, Timir Baran; Das, Minati; Krishnamoorthy, G

    2015-09-01

    Logic gates with different radixes have been constructed using a biologically active molecule, 2-(4'-N,N-dimethylaminophenyl)imidazo[4,5-b]pyridine (DMAPIP-b). Taking advantage of the multiple binding sites of the fluorophore, a series of different molecular logic gates are developed using fluorescence intensities at different wavelengths. The high emission of the molecule is drastically quenched in the presence of Fe(3+). It is regained by the addition of an equivalent amount of F(-). The fluorescence On-Off nature has been used to construct molecular full subtractor and molecular keypad lock system with Boolean logic. A ternary system is generated by considering three defined fluorescence intensities at particular wavelengths. The smooth dependency of emission intensities with analyte concentration is utilized to construct an infinite-valued fuzzy logic system. The fuzzy logic system is further coupled with a neuro-adaptation method to predict more accurately the dependency of molecular intensity on external inputs. PMID:26215476

  12. 75 FR 41790 - Address Management Services-Elimination of the Manual Card Option for Address Sequencing Services

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-07-19

    ... 111 Address Management Services--Elimination of the Manual Card Option for Address Sequencing Services... Standards of the United States Postal Service, Domestic Mail Manual (DMM ) 507.8 to eliminate the manual... pricing, which requires address sequencing. For the manual option of Address Sequencing service,...

  13. Collaborative socioeconomic tool development to address management and planning needs

    USGS Publications Warehouse

    Richardson, Leslie A.; Huber, Christopher; Cullinane Thomas, Catherine; Donovan, Elizabeth; Koontz, Lynne M.

    2014-01-01

    Public lands and resources managed by the National Park Service (NPS) and other land management agencies provide a wide range of social and economic benefits to both nearby local communities and society as a whole, ranging from job creation, to access to unique recreational opportunities, to subsistence and tribal uses of the land. Over the years, there has been an increased need to identify and analyze the socioeconomic effects of the public’s use of NPS lands and resources, and the wide range of NPS land management decisions. This need stems from laws such as the National Environmental Policy Act (NEPA), increased litigation and appeals on NPS management decisions, as well as an overall need to demonstrate how parks benefit communities and the American public. To address these needs, the U.S. Geological Survey (USGS) and NPS have an ongoing partnership to collaboratively develop socioeconomic tools to support planning needs and resource management. This article discusses two such tools. The first, Assessing Socioeconomic Planning Needs (ASPN), was developed to help NPS planners and managers identify key social and economic issues that can arise as a result of land management actions. The second tool, the Visitor Spending Effects (VSE) model, provides a specific example of a type of analysis that may be recommended by ASPN. The remainder of this article discusses the development, main features, and plans for future versions and applications of both ASPN and the VSE.

  14. Managed care aspects of managing multiple sclerosis.

    PubMed

    Owens, Gary M

    2013-11-01

    Multiple sclerosis (MS) is a chronic disease of the central nervous system usually diagnosed in the second or third decade of life; MS is more common among women than men by a ratio of 3 to 1. With its relatively early age of onset and symptoms that impair patients' quality of life, MS requires lifelong, dynamic treatment, and places a substantial economic burden on individuals, healthcare systems, and society. The costs associated with providing benefits for MS therapy are growing rapidly and the increasing complexity of the MS market is impacting disease management for payers. Employers are also increasingly aware of the costs associated with MS and are asking health plans to advise on the most appropriate and cost-effective ways to manage both pharmacologic and non-pharmacologic therapies for MS. Health plans, by necessity, must therefore balance appropriate access to treatments for MS with the need to manage rising treatment costs. To meet this goal, payers require population-based solutions, guidelines, and treatment algorithms for the management of MS that can be used in clinical and formulary management decision making in the context of an evolving therapeutic landscape. Further, comparative studies are necessary for payers to determine which agents may work best on a population basis. Due to the current lack of appropriate clinical guidance and insufficient head-to-head data on disease-modifying drugs, strategies for health plans and clinical management have been designed using the best available evidence. Undoubtedly, management of this class will continue to evolve with the launch of newer agents. PMID:24494620

  15. Symptomatic management in multiple sclerosis

    PubMed Central

    Shah, Pushkar

    2015-01-01

    Multiple sclerosis (MS) is the commonest cause of disability in young adults. While there is increasing choice and better treatments available for delaying disease progression, there are still, very few, effective symptomatic treatments. For many patients such as those with primary progressive MS (PPMS) and those that inevitably become secondary progressive, symptom management is the only treatment available. MS related symptoms are complex, interrelated, and can be interdependent. It requires good understanding of the condition, a holistic multidisciplinary approach, and above all, patient education and empowerment. PMID:26538847

  16. An Approach for Addressing the Multiple Testing Problem in Social Policy Impact Evaluations

    ERIC Educational Resources Information Center

    Schochet, Peter Z.

    2009-01-01

    In social policy evaluations, the multiple testing problem occurs due to the many hypothesis tests that are typically conducted across multiple outcomes and subgroups, which can lead to spurious impact findings. This article discusses a framework for addressing this problem that balances Types I and II errors. The framework involves specifying…

  17. 46 CFR 67.321 - Requirement to report change of address of managing owner.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 46 Shipping 2 2010-10-01 2010-10-01 false Requirement to report change of address of managing... report change of address of managing owner. Upon the change of address of the managing owner of a documented vessel, the managing owner shall report the change of address to the National Vessel...

  18. 46 CFR 67.321 - Requirement to report change of address of managing owner.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 46 Shipping 2 2014-10-01 2014-10-01 false Requirement to report change of address of managing... report change of address of managing owner. Upon the change of address of the managing owner of a documented vessel, the managing owner shall report the change of address to the National Vessel...

  19. 46 CFR 67.321 - Requirement to report change of address of managing owner.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 46 Shipping 2 2011-10-01 2011-10-01 false Requirement to report change of address of managing... report change of address of managing owner. Upon the change of address of the managing owner of a documented vessel, the managing owner shall report the change of address to the National Vessel...

  20. 46 CFR 67.321 - Requirement to report change of address of managing owner.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 46 Shipping 2 2013-10-01 2013-10-01 false Requirement to report change of address of managing... report change of address of managing owner. Upon the change of address of the managing owner of a documented vessel, the managing owner shall report the change of address to the National Vessel...

  1. 46 CFR 67.321 - Requirement to report change of address of managing owner.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 46 Shipping 2 2012-10-01 2012-10-01 false Requirement to report change of address of managing... report change of address of managing owner. Upon the change of address of the managing owner of a documented vessel, the managing owner shall report the change of address to the National Vessel...

  2. Addressing the Multiple Drivers of Wetland Ecosystems Degradation in Lagos, Nigeria

    NASA Astrophysics Data System (ADS)

    Agboola, J.; Ndimele, P. E.; Odunuga, S.; Akanni, A.; Kosemani, B.; Ahove, M.

    2015-12-01

    Several body of knowledge have noted the importance of wetland ecosystems in climate moderation, resource supply and flood risk reduction amongst others. Relevant as it may, rapidly increasing population and uncontrolled urban development poses a challenge in some regions and require understanding of the ecosystem components and drivers of change over a long period of time. Thus, the main thrust of this paper is to analyse multiple drivers of wetland ecosystems degradation in the last 30 years in the Lagos megacity using field study, desktop review, satellite data and laboratory analysis. Key drivers identified includes: conversion of wetlands to settlements and waste sink, land use planning that neglects wetland conservation and restoration, ineffective legal status for wetlands, over exploitation leading to degradation and fragmentation of wetland ecosystems governance. In stemming further loss of this vital ecosystem, this study adopted and proposed respectively, the Drivers, Pressure, State, Impact and Response (DPSIR) and Integrated Planning Approach (IPA) frameworks in analysing policy and governance issues in wetland development. These analyses figured out amongst others, strict conservation and sustainable use of wetland resources, habitat restoration, climate adaptation measures, legal protection and wetland management institution as major responses to current multiple pressures facing wetland ecosystems in Lagos. For these frameworks to be made meaningful, weak coordination among government agencies and institutional capacity in implementation and law enforcement, unsustainable resource extraction by private/business organization and issues on alternative sources of income on the part of the local communities amongst others needs to be addressed.

  3. Clutter Management for Individuals with Multiple Sclerosis

    PubMed Central

    2014-01-01

    Background: Although there is substantial anecdotal evidence that clutter is common among people with multiple sclerosis (MS), the literature contains no reports of studies on the actual prevalence of the problem or its impact on functional performance in this population. Clutter promotes confusion and places individuals in potentially dangerous situations by increasing their risks of falling, losing medications, and misplacing important documents. In addition, it may negatively affect activities of daily living (ADLs). Many common MS symptoms such as decreased mobility, visual or cognitive changes, fatigue, and depression can exacerbate clutter accumulation, which in turn can have detrimental effects on physical, financial, emotional, cognitive, and social functioning. It is critical for MS clinicians to address clutter management in order to improve patients' overall functional independence and participation. Methods: A clutter reduction protocol was developed and implemented at our institution for individuals with MS. Our group program addresses psychosocial issues preventing organization and offers practical strategies for clutter removal and management to improve performance in ADLs. A clutter questionnaire is administered to individuals before and after their participation in the group program. Results: Anecdotal reports indicate that the intervention helped to reduce clutter, promote a more realistic attitude toward “possessions,” and establish a sense of accomplishment in controlling one's environment. Participants also reported fewer falls, feeling less isolated, increased ease in finding their medications, and a general sense of cognitive clarity in accomplishing ADLs. Outcome assessments are now being developed to objectively measure these effects as well as the prevalence of clutter within the MS population. Conclusions: Clutter management is an important area for MS clinicians to address because it can significantly affect patients' functioning

  4. Addressing drug adherence using an operations management model.

    PubMed

    Nunlee, Martin; Bones, Michelle

    2014-01-01

    OBJECTIVE To provide a model that enables health systems and pharmacy benefit managers to provide medications reliably and test for reliability and validity in the analysis of adherence to drug therapy of chronic disease. SUMMARY The quantifiable model described here can be used in conjunction with behavioral designs of drug adherence assessments. The model identifies variables that can be reproduced and expanded across the management of chronic diseases with drug therapy. By creating a reorder point system for reordering medications, the model uses a methodology commonly seen in operations research. The design includes a safety stock of medication and current supply of medication, which increases the likelihood that patients will have a continuous supply of medications, thereby positively affecting adherence by removing barriers. CONCLUSION This method identifies an adherence model that quantifies variables related to recommendations from health care providers; it can assist health care and service delivery systems in making decisions that influence adherence based on the expected order cycle days and the expected daily quantity of medication administered. This model addresses the possession of medication as a barrier to adherence. PMID:24407742

  5. Accelerating Adaptation of Natural Resource Management to Address Climate Change

    PubMed Central

    Cross, Molly S; McCarthy, Patrick D; Garfin, Gregg; Gori, David; Enquist, Carolyn AF

    2013-01-01

    Abstract Natural resource managers are seeking tools to help them address current and future effects of climate change. We present a model for collaborative planning aimed at identifying ways to adapt management actions to address the effects of climate change in landscapes that cross public and private jurisdictional boundaries. The Southwest Climate Change Initiative (SWCCI) piloted the Adaptation for Conservation Targets (ACT) planning approach at workshops in 4 southwestern U.S. landscapes. This planning approach successfully increased participants’ self-reported capacity to address climate change by providing them with a better understanding of potential effects and guiding the identification of solutions. The workshops fostered cross-jurisdictional and multidisciplinary dialogue on climate change through active participation of scientists and managers in assessing climate change effects, discussing the implications of those effects for determining management goals and activities, and cultivating opportunities for regional coordination on adaptation of management plans. Facilitated application of the ACT framework advanced group discussions beyond assessing effects to devising options to mitigate the effects of climate change on specific species, ecological functions, and ecosystems. Participants addressed uncertainty about future conditions by considering more than one climate-change scenario. They outlined opportunities and identified next steps for implementing several actions, and local partnerships have begun implementing actions and conducting additional planning. Continued investment in adaptation of management plans and actions to address the effects of climate change in the southwestern United States and extension of the approaches used in this project to additional landscapes are needed if biological diversity and ecosystem services are to be maintained in a rapidly changing world. Acelerando la Adaptación del Manejo de Recursos Naturales para

  6. Multiple objective optimization for active sensor management

    NASA Astrophysics Data System (ADS)

    Page, Scott F.; Dolia, Alexander N.; Harris, Chris J.; White, Neil M.

    2005-03-01

    The performance of a multi-sensor data fusion system is inherently constrained by the configuration of the given sensor suite. Intelligent or adaptive control of sensor resources has been shown to offer improved fusion performance in many applications. Common approaches to sensor management select sensor observation tasks that are optimal in terms of a measure of information. However, optimising for information alone is inherently sub-optimal as it does not take account of any other system requirements such as stealth or sensor power conservation. We discuss the issues relating to developing a suite of performance metrics for optimising multi-sensor systems and propose some candidate metrics. In addition it may not always be necessary to maximize information gain, in some cases small increases in information gain may take place at the cost of large sensor resource requirements. Additionally, the problems of sensor tasking and placement are usually treated separately, leading to a lack of coherency between sensor management frameworks. We propose a novel approach based on a high level decentralized information-theoretic sensor management architecture that unifies the processes of sensor tasking and sensor placement into a single framework. Sensors are controlled using a minimax multiple objective optimisation approach in order to address probability of target detection, sensor power consumption, and sensor survivability whilst maintaining a target estimation covariance threshold. We demonstrate the potential of the approach through simulation of a multi-sensor, target tracking scenario and compare the results with a single objective information based approach.

  7. [Multiple trauma and the management structure].

    PubMed

    Sturm, J

    1999-01-01

    The implementation of Quality Management Procedures is necessary in evaluating the treatment of multiple trauma-patients. The development of standards in structures of the trauma management system is the first step to insure quality (appraisal of structure). But the amount of investment in the trauma system structure is limited by 1. The resources available, 2. The efficacy of the applied resources, i.e. the principle of diminishing returns of investment. Centralization of care in Level I Trauma Centers is not realistic in every situation. Transport time can be too long and exceed the critical "golden hour". Review of current data indicates that in approximately 50% of the time, helicopter transport is not possible due to weather, geography, or other limiting factors. This leads to a fragmented transport system, often necessitating extensive transport times, resulting in less than optimal patient outcomes. In order to optimize quality, the following needs to be done: Assessment of process: 1. Realistic algorithms or protocols for primary transport must be developed. 2. Agreements must be reached between designated regional hospitals. 3. Treatment algorithms or protocols which address the different care levels, must be developed by a committee of clinical experts. 4. Quality management procedures must be implemented to monitor the quality of care delivered. Assessments of outcomes: 1. Outcome data must be reviewed on an ongoing basis to determine if changes must be made in the system design or the transportation & clinical algorithms/protocols. 2. Such outcome data should be gathered by means of a Trauma Registry. PMID:10612209

  8. Addressing multiple relationships between clients and therapists in lesbian, gay, bisexual, transgender communities.

    PubMed

    Kessler, Laura E; Waehler, Charles A

    2005-02-01

    Therapists working in lesbian, gay, bisexual, and transgender (LGBT) communities are likely to experience the potential to engage in multiple relationships with their clients. Currently, the American Psychological Association's (2002) ethics code and the related literature base offer minimal direct guidance to therapists practicing in LGBT communities. In this article, the authors review current literature regarding multiple relationships in psychotherapy, considering how this literature addresses issues specific to practitioners working within LGBT communities, present a case study highlighting the negotiation of a multiple relationship between a client and therapist who both identify as lesbian, and offer recommendations for practitioners working within LGBT communities. PMID:17073035

  9. Addressing the Multiplication Makes Bigger and Division Makes Smaller Misconceptions via Prediction and Clickers

    ERIC Educational Resources Information Center

    Lim, Kien H.

    2011-01-01

    This article presents a lesson that uses prediction items, clickers and visuals via PowerPoint slides to help prospective middle-school teachers address two common misconceptions: multiplication makes bigger and division makes smaller (MMB-DMS). Classroom research was conducted to explore the viability of such a lesson. Results show that the…

  10. Managing Multiple Tasks in Complex, Dynamic Environments

    NASA Technical Reports Server (NTRS)

    Freed, Michael; Null, Cynthia H. (Technical Monitor)

    1998-01-01

    Sketchy planners are designed to achieve goals in realistically complex, time-pressured, and uncertain task environments. However, the ability to manage multiple, potentially interacting tasks in such environments requires extensions to the functionality these systems typically provide. This paper identifies a number of factors affecting how interacting tasks should be prioritized, interrupted, and resumed, and then describes a sketchy planner called APEX that takes account of these factors when managing multiple tasks.

  11. Addressing the Need for Management Processes for Higher Education Accreditation.

    ERIC Educational Resources Information Center

    Brennan, Linda L.; Austin, Walter W.

    2003-01-01

    The accreditation standards of the Association to Advance Collegiate Schools of Business (AACSB International) ask business schools to describe consistent processes that provide for operational consistency and continuous improvement in support of the schools' stated missions. This article addresses the identification of requisite quality…

  12. Addressing the multiplication makes bigger and division makes smaller misconceptions via prediction and clickers

    NASA Astrophysics Data System (ADS)

    Lim, Kien H.

    2011-12-01

    This article presents a lesson that uses prediction items, clickers and visuals via PowerPoint slides to help prospective middle-school teachers address two common misconceptions: multiplication makes bigger and division makes smaller (MMB-DMS). Classroom research was conducted to explore the viability of such a lesson. Results show that the lesson was effective in creating awareness that multiplication does not always make bigger and division does not always makes smaller, uncovering students' misconceptions, and providing opportunities for students to learn from mistakes. Students liked the activity for various reasons, such as getting to learn certain mathematical ideas, to think about the problems, to work in groups and to have fun. The lesson was implemented slightly differently in two classes. The class with an additional phase involving prediction and voting via clickers in the PowerPoint lesson showed a gain of 36 points (an effect size of 1.3 standard deviations, SDs) from the pre-test to the exit-test whereas, the comparison class showed a gain of 25 points (an effect size of 0.87 SDs). In terms of students' written responses with regards to addressing the MMB-DMS misconceptions, there was however not much difference between the two classes.

  13. Multiple myeloma: managing a complex blood cancer.

    PubMed

    Dowling, Maura; Kelly, Mary; Meenaghan, Teresa

    2016-09-01

    This article gives a comprehensive overview of multiple myeloma (MM), a complex blood cancer involving overproduction of plasma cells. Although MM remains incurable, patients are living longer as a result of multiple treatment options. However, MM patients are also living with a higher symptom burden. The overall aims in managing MM are therefore to control disease progression, prolong survival and improve quality of life. PMID:27615537

  14. Classroom Management Strategies to Address the Needs of Sudanese Refugee Learners: Advice to Teachers. Support Document

    ERIC Educational Resources Information Center

    Burgoyne, Ursula; Hull, Oksana

    2007-01-01

    "Classroom Management Strategies to Address the Needs of Sudanese Refugee Learners" (ED499673) examined the extent to which English language, literacy and numeracy teachers used classroom management strategies to meet the needs of adult Sudanese refugee learners. The researchers found that while teachers met the needs of these learners insofar as…

  15. Addressable single-spin control in multiple quantum dots coupled in series

    NASA Astrophysics Data System (ADS)

    Nakajima, Takashi

    2015-03-01

    Electron spin in semiconductor quantum dots (QDs) is promising building block of quantum computers for its controllability and potential scalability. Recent experiments on GaAs QDs have demonstrated necessary ingredients of universal quantum gate operations: single-spin rotations by electron spin resonance (ESR) which is virtually free from the effect of nuclear spin fluctuation, and pulsed control of two-spin entanglement. The scalability of this architecture, however, has remained to be demonstrated in the real world. In this talk, we will present our recent results on implementing single-spin-based qubits in triple, quadruple, and quintuple QDs based on a series coupled architecture defined by gate electrodes. Deterministic initialization of individual spin states and spin-state readout were performed by the pulse operation of detuning between two neighboring QDs. The spin state was coherently manipulated by ESR, where each spin in different QDs is addressed by the shift of the resonance frequency due to the inhomogeneous magnetic field induced by the micro magnet deposited on top of the QDs. Control of two-spin entanglement was also demonstrated. We will discuss key issues for implementing quantum algorithms based on three or more qubits, including the effect of a nuclear spin bath, single-shot readout fidelity, and tuning of multiple qubit devices. Our approaches to these issues will be also presented. This research is supported by Funding Program for World-Leading Innovative R&D on Science and Technology (FIRST) from JSPS, IARPA project ``Multi-Qubit Coherent Operations'' through Copenhagen University, and Grant-in-Aid for Scientific Research from JSPS.

  16. Addressing Occupational Fatigue in Nurses: A Risk Management Model for Nurse Executives.

    PubMed

    Steege, Linsey M; Pinekenstein, Barbara

    2016-04-01

    Addressing occupational fatigue in nursing work systems and mitigating associated risks to nurses require strategic management and high-level decision making as well as daily management through operational and tactical actions. Nurse executives are well positioned to lead implementation of a proposed multilevel fatigue risk management system that includes monitoring and decision-support tools to support a culture of safety and nurse well-being. PMID:27011153

  17. Multiple sclerosis in men: management considerations.

    PubMed

    Bove, Riley; McHenry, Allison; Hellwig, Kerstin; Houtchens, Maria; Razaz, Neda; Smyth, Penelope; Tremlett, Helen; Sadovnick, A D; Rintell, D

    2016-07-01

    Multiple sclerosis (MS) is a lifelong disease typically affecting individuals in young to middle adulthood. There are recognized sex differences in MS onset and clinical course. MS affects approximately three times more women than men, thus resulting in less attention to the male experience (i.e. diagnosis, management, societal dimensions). Here, we review current scientific evidence on sex differences in MS risk and course, highlight potential sources of bias, and suggest avenues of further inquiry. We then describe what is known about male experiences with MS diagnosis, treatment, and symptom management (particularly mood and sexual function). Finally, we consider ways in which healthcare providers might engage male patients in the broader aspects of living with MS (e.g. familial and societal relationships) to influence their long-term quality of life (QOL). When possible, we draw from published sources to underscore our collective clinical and scientific experiences. PMID:26725085

  18. Multiple sclerosis medical image analysis and information management.

    PubMed

    Liu, Lifeng; Meier, Dominik; Polgar-Turcsanyi, Mariann; Karkocha, Pawel; Bakshi, Rohit; Guttmann, Charles R G

    2005-01-01

    Magnetic resonance imaging (MRI) has become a central tool for patient management, as well as research, in multiple sclerosis (MS). Measurements of disease burden and activity derived from MRI through quantitative image analysis techniques are increasingly being used. There are many complexities and challenges in building computerized processing pipelines to ensure efficiency, reproducibility, and quality control for MRI scans from MS patients. Such paradigms require advanced image processing and analysis technologies, as well as integrated database management systems to ensure the most utility for clinical and research purposes. This article reviews pipelines available for quantitative clinical MRI research in MS, including image segmentation, registration, time-series analysis, performance validation, visualization techniques, and advanced medical imaging software packages. To address the complex demands of the sequential processes, the authors developed a workflow management system that uses a centralized database and distributed computing system for image processing and analysis. The implementation of their system includes a web-form-based Oracle database application for information management and event dispatching, and multiple modules for image processing and analysis. The seamless integration of processing pipelines with the database makes it more efficient for users to navigate complex, multistep analysis protocols, reduces the user's learning curve, reduces the time needed for combining and activating different computing modules, and allows for close monitoring for quality-control purposes. The authors' system can be extended to general applications in clinical trials and to routine processing for image-based clinical research. PMID:16385023

  19. Use of information visualization methods eliminating cross talk in multiple sensing units investigated for a light-addressable potentiometric sensor.

    PubMed

    Siqueira, José R; Maki, Rafael M; Paulovich, Fernando V; Werner, Carl F; Poghossian, Arshak; de Oliveira, Maria C F; Zucolotto, Valtencir; Oliveira, Osvaldo N; Schöning, Michael J

    2010-01-01

    The integration of nanostructured films containing biomolecules and silicon-based technologies is a promising direction for reaching miniaturized biosensors that exhibit high sensitivity and selectivity. A challenge, however, is to avoid cross talk among sensing units in an array with multiple sensors located on a small area. In this letter, we describe an array of 16 sensing units of a light-addressable potentiometric sensor (LAPS), which was made with layer-by-layer (LbL) films of a poly(amidomine) dendrimer (PAMAM) and single-walled carbon nanotubes (SWNTs), coated with a layer of the enzyme penicillinase. A visual inspection of the data from constant-current measurements with liquid samples containing distinct concentrations of penicillin, glucose, or a buffer indicated a possible cross talk between units that contained penicillinase and those that did not. With the use of multidimensional data projection techniques, normally employed in information visualization methods, we managed to distinguish the results from the modified LAPS, even in cases where the units were adjacent to each other. Furthermore, the plots generated with the interactive document map (IDMAP) projection technique enabled the distinction of the different concentrations of penicillin, from 5 mmol L(-1) down to 0.5 mmol L(-1). Data visualization also confirmed the enhanced performance of the sensing units containing carbon nanotubes, consistent with the analysis of results for LAPS sensors. The use of visual analytics, as with projection methods, may be essential to handle a large amount of data generated in multiple sensor arrays to achieve high performance in miniaturized systems. PMID:20041720

  20. Yoga as a method of symptom management in multiple sclerosis

    PubMed Central

    Frank, Rachael; Larimore, Jennifer

    2015-01-01

    Multiple Sclerosis (MS) is an immune-mediated process in which the body's immune system damages myelin in the central nervous system (CNS). The onset of this disorder typically occurs in young adults, and it is more common among women. Currently, there is no cure and the long-term disease progression makes symptomatic management critical for maintaining quality of life. Several pharmacotherapeutic agents are approved for treatment, but many patients seek complementary and alternative interventions. Reviews have been conducted regarding broad topics such as mindfulness-based interventions for people diagnosed with MS and the impact of yoga on a range of neurological disorders. The objective of the present review is to examine the potential benefits of yoga for individuals with MS and address its use in managing symptoms including pain, mental health, fatigue, spasticity, balance, bladder control, and sexual function. PMID:25983675

  1. Therapeutic Yoga: Symptom Management for Multiple Sclerosis.

    PubMed

    Rogers, Kim A; MacDonald, Megan

    2015-11-01

    Multiple sclerosis (MS) is the most common autoimmune inflammatory demyelinating disease of the central nervous system, affecting over 2.3 million people worldwide. According to the National Institute of Neurological Disorders and Stroke, the age of disease onset is typically between 20 and 40 years, with a higher incidence in women. Individuals with MS experience a wide range of symptoms, including declining physical, emotional, and psychological symptoms (e.g., fatigue, imbalance, spasticity, chronic pain, cognitive impairment, bladder and bowel dysfunction, visual and speech impairments, depression, sensory disturbance, and mobility impairment). To date, both the cause of and cure for MS remain unknown. In recent years, more individuals with MS have been pursuing alternative methods of treatment to manage symptoms of the disease, including mind-body therapies such as yoga, meditation, breathing, and relaxation techniques. It has been suggested that the practice of yoga may be a safe and effective way of managing symptoms of MS. Therefore, the purpose of this paper is to summarize the most relevant literature on exercise and mind-body modalities to treat MS symptoms and, more specifically, the benefits and potential role of yoga as an alternative treatment of symptom management for individuals with MS. The article also discusses future directions for research. PMID:26270955

  2. Adaptation of a Counseling Intervention to Address Multiple Cancer Risk Factors among Overweight/Obese Latino Smokers

    ERIC Educational Resources Information Center

    Castro, Yessenia; Fernández, Maria E.; Strong, Larkin L.; Stewart, Diana W.; Krasny, Sarah; Hernandez Robles, Eden; Heredia, Natalia; Spears, Claire A.; Correa-Fernández, Virmarie; Eakin, Elizabeth; Resnicow, Ken; Basen-Engquist, Karen; Wetter, David W.

    2015-01-01

    More than 60% of cancer-related deaths in the United States are attributable to tobacco use, poor nutrition, and physical inactivity, and these risk factors tend to cluster together. Thus, strategies for cancer risk reduction would benefit from addressing multiple health risk behaviors. We adapted an evidence-based intervention grounded in social…

  3. Addressing Gender-Based Violence at Schools for Learners with Intellectual Disability in Gauteng, South Africa: A Multiple Case Study

    ERIC Educational Resources Information Center

    Phasha, T. N.; Nyokangi, D.

    2012-01-01

    This paper reports part of the findings of the study which investigated sexual violence at two schools catering specifically for learners with mild intellectual disability in Gauteng Province. It looks particularly on participants' suggestions for addressing sexual violence in such school. A multiple case study within the qualitative research…

  4. NEXT Propellant Management System Integration With Multiple Ion Thrusters

    NASA Technical Reports Server (NTRS)

    Sovey, James S.; Soulas, George C.; Herman, Daniel A.

    2011-01-01

    As a critical part of the NEXT test validation process, a multiple-string integration test was performed on the NEXT propellant management system and ion thrusters. The objectives of this test were to verify that the PMS is capable of providing stable flow control to multiple thrusters operating over the NEXT system throttling range and to demonstrate to potential users that the NEXT PMS is ready for transition to flight. A test plan was developed for the sub-system integration test for verification of PMS and thruster system performance and functionality requirements. Propellant management system calibrations were checked during the single and multi-thruster testing. The low pressure assembly total flow rates to the thruster(s) were within 1.4 percent of the calibrated support equipment flow rates. The inlet pressures to the main, cathode, and neutralizer ports of Thruster PM1R were measured as the PMS operated in 1-thruster, 2-thruster, and 3-thruster configurations. It was found that the inlet pressures to Thruster PM1R for 2-thruster and 3-thruster operation as well as single thruster operation with the PMS compare very favorably indicating that flow rates to Thruster PM1R were similar in all cases. Characterizations of discharge losses, accelerator grid current, and neutralizer performance were performed as more operating thrusters were added to the PMS. There were no variations in these parameters as thrusters were throttled and single and multiple thruster operations were conducted. The propellant management system power consumption was at a fixed voltage to the DCIU and a fixed thermal throttle temperature of 75 C. The total power consumed by the PMS was 10.0, 17.9, and 25.2 W, respectively, for single, 2-thruster, and 3-thruster operation with the PMS. These sub-system integration tests of the PMS, the DCIU Simulator, and multiple thrusters addressed, in part, the NEXT PMS and propulsion system performance and functionality requirements.

  5. Interactive actuation of multiple opto-thermocapillary flow-addressed bubble microrobots

    PubMed Central

    Hu, Wenqi; Fan, Qihui; Ohta, Aaron T

    2014-01-01

    Opto-thermocapillary flow-addressed bubble (OFB) microrobots are a potential tool for the efficient transportation of micro-objects. This microrobot system uses light patterns to generate thermal gradients within a liquid medium, creating thermocapillary forces that actuate the bubble microrobots. An interactive control system that includes scanning mirrors and a touchscreen interface was developed to address up to ten OFB microrobots. Using this system, the parallel and cooperative transportation of 20-μm-diameter polystyrene beads was demonstrated. PMID:25678988

  6. Integrated management of multiple reservoir field developments

    SciTech Connect

    Lyons, S.L.; Chan, H.M.; Harper, J.L.; Boyett, B.A.; Dowson, P.R.; Bette, S.

    1995-10-01

    This paper consists of two sections. The authors first describe the coupling of a pipeline network model to a reservoir simulator and then the application of this new simulator to optimize the production strategy of two Mobil field developments. Mobil`s PEGASUS simulator is an integrated all purpose reservoir simulator that handles black-oil, compositional, faulted and naturally fractured reservoirs. The authors have extended the simulator to simultaneously model multiple reservoirs coupled with surface pipeline networks and processes. This allows them to account for the effects of geology, well placement, and surface production facilities on well deliverability in a fully integrated fashion. They have also developed a gas contract allocation system that takes the user-specified constraints, target rates and swing factors and automatically assigns rates to the individual wells of each reservoir. This algorithm calculates the overall deliverability and automatically reduces the user-specified target rates to meet the deliverability constraints. The algorithm and solution technique are described. This enhanced simulator has been applied to model a Mobil field development in the Southern Gas Basin, offshore United Kingdom, which consists of three separate gas reservoirs connected via a pipeline network. The simulator allowed the authors to accurately determine the impact on individual reservoir and total field performance by varying the development timing of these reservoirs. Several development scenarios are shown to illustrate the capabilities of PEGASUS. Another application of this technology is in the field developments in North Sumatra, Indonesia. Here the objective is to economically optimize the development of multiple fields to feed the PT Arun LNG facility. Consideration of a range of gas compositions, well productivity`s, and facilities constraints in an integrated fashion results in improved management of these assets. Model specifics are discussed.

  7. Multiple views to address diversity issues: an initial dialog to advance the chiropractic profession

    PubMed Central

    Johnson, Claire; Killinger, Lisa Zaynab; Christensen, Mark G.; Hyland, John K.; Mrozek, John P.; Zuker, R. Fred; Kizhakkeveettil, Anupama; Perle, Stephen M.; Oyelowo, Tolu

    2012-01-01

    The purpose of this article is to provide expert viewpoints on the topic of diversity in the chiropractic profession, including cultural competency, diversity in the profession, educational and clinical practice strategies for addressing diversity, and workforce issues. Over the next decades, changing demographics in North America will alter how the chiropractic profession functions on many levels. As the population increases in diversity, we will need to prepare our workforce to meet the needs of future patients and society. PMID:23966884

  8. Managing bay and estuarine ecosystems for multiple services

    USGS Publications Warehouse

    Needles, Lisa A.; Lester, Sarah E.; Ambrose, Richard; Andren, Anders; Beyeler, Marc; Connor, Michael S.; Eckman, James E.; Costa-Pierce, Barry A.; Gaines, Steven D.; Lafferty, Kevin D.; Lenihan, Junter S.; Parrish, Julia; Peterson, Mark S.; Scaroni, Amy E.; Weis, Judith S.; Wendt, Dean E.

    2013-01-01

    Managers are moving from a model of managing individual sectors, human activities, or ecosystem services to an ecosystem-based management (EBM) approach which attempts to balance the range of services provided by ecosystems. Applying EBM is often difficult due to inherent tradeoffs in managing for different services. This challenge particularly holds for estuarine systems, which have been heavily altered in most regions and are often subject to intense management interventions. Estuarine managers can often choose among a range of management tactics to enhance a particular service; although some management actions will result in strong tradeoffs, others may enhance multiple services simultaneously. Management of estuarine ecosystems could be improved by distinguishing between optimal management actions for enhancing multiple services and those that have severe tradeoffs. This requires a framework that evaluates tradeoff scenarios and identifies management actions likely to benefit multiple services. We created a management action-services matrix as a first step towards assessing tradeoffs and providing managers with a decision support tool. We found that management actions that restored or enhanced natural vegetation (e.g., salt marsh and mangroves) and some shellfish (particularly oysters and oyster reef habitat) benefited multiple services. In contrast, management actions such as desalination, salt pond creation, sand mining, and large container shipping had large net negative effects on several of the other services considered in the matrix. Our framework provides resource managers a simple way to inform EBM decisions and can also be used as a first step in more sophisticated approaches that model service delivery.

  9. Managing psychological stress in the multiple sclerosis medical visit: Patient perspectives and unmet needs.

    PubMed

    Senders, Angela; Sando, Kelsi; Wahbeh, Helané; Peterson Hiller, Amie; Shinto, Lynne

    2016-08-01

    Psychological stress can negatively impact multiple sclerosis. To further understand how stress is addressed in the multiple sclerosis medical visit, 34 people with multiple sclerosis participated in focus groups. Transcripts were analyzed by inductive thematic analysis. The majority of participants did not discuss stress with their provider, citing barriers to communication such as lack of time, poor coordination between specialties, physician reliance on pharmaceutical prescription, and patient lack of self-advocacy. Participants recommended several ways to better manage psychological well-being in the clinical setting. These findings provide a foundation for future studies aimed at minimizing the detrimental effect of stress in multiple sclerosis. PMID:25527612

  10. Multiple-scattering lidar from both sides of the clouds: Addressing internal structure

    NASA Astrophysics Data System (ADS)

    Davis, A. B.

    2008-07-01

    Multiple-scattering (a.k.a. "off-beam") lidar is an emerging technology in cloud remote sensing. It delivers, as in classic lidar ceilometry, cloud base altitude but also the cloud's physical thickness H as well as its optical depth τ (averaged over horizontal scales on the order of H). The value of τ in fact must lie beyond the range accessible by standard (i.e., single-scattering/on-beam) lidar profiling, namely, up to 3-4. A refined diffusion-theoretical model is presented here for signals from multiple-scattering lidar and applied, on the one hand, to retrieval algorithm development and, on the other hand, signal-to-noise ratio (SNR) estimation. SNRs are computed for LANL's ground-based Wide-Angle Imaging Lidar (WAIL) system and NASA's space-based Lidar-In-space Technology Experiment (LITE). The refinements are threefold and all about internal structure. First, the laser source is modeled as a collimated anisotropic exponentially distributed internal source rather than an isotropic point source at the cloud boundary; this opens the possibility of using δ-Eddington rescaling to capture the forward peaked phase function more effectively within the diffusion framework. Second, stratification of the scattering coefficient is modeled as an increasing function of distance to cloud base; this strongly differentiates the signals when observed from above or from below. Finally, Cairns' rescaling is applied to this conservative scattering problem to account for the systematic effects of random (turbulence-driven) internal variability at scales up to a few mean free paths.

  11. Food-Based Interventions to Modify Diet Quality and Diversity to Address Multiple Micronutrient Deficiency.

    PubMed

    Nair, Madhavan K; Augustine, Little Flower; Konapur, Archana

    2015-01-01

    Global data indicate a high prevalence of hidden hunger among population. Deficiencies of certain micronutrients such as folic acid, iodine, iron, and vitamin A have long lasting effects on growth and development and therefore have been a National priority from many decades. The strategy implemented so far limits to the use of supplemental sources or fortified foods in alleviating the burden of deficiencies. These approaches however undermine the food-based strategies involving dietary diversification as the long-term sustainable strategy. There is lack of understanding on the level of evidence needed to implement such strategies and the level of monitoring required for impact evaluation. Dietary diversity concerns how to ensure access for each individual to a quality and safe diet with adequate macro- and micronutrients. The key to success in using dietary diversity as a strategy to tackle hidden hunger is in integrating it with the principles of bioavailability, translated to efficient food synergies with due emphasis on food accessibility, affordability, and outdoor physical activity/life style modifications. Promoting enabling environment and sustainable agriculture is crucial for practicing dietary diversification with behavior change communication as an integral segment. It can be concluded that food-based strategies require careful understanding of the factors associated with it and moderate it to form an effective strategy for controlling multiple micronutrient deficiencies. PMID:26779472

  12. Food-Based Interventions to Modify Diet Quality and Diversity to Address Multiple Micronutrient Deficiency

    PubMed Central

    Nair, Madhavan K.; Augustine, Little Flower; Konapur, Archana

    2016-01-01

    Global data indicate a high prevalence of hidden hunger among population. Deficiencies of certain micronutrients such as folic acid, iodine, iron, and vitamin A have long lasting effects on growth and development and therefore have been a National priority from many decades. The strategy implemented so far limits to the use of supplemental sources or fortified foods in alleviating the burden of deficiencies. These approaches however undermine the food-based strategies involving dietary diversification as the long-term sustainable strategy. There is lack of understanding on the level of evidence needed to implement such strategies and the level of monitoring required for impact evaluation. Dietary diversity concerns how to ensure access for each individual to a quality and safe diet with adequate macro- and micronutrients. The key to success in using dietary diversity as a strategy to tackle hidden hunger is in integrating it with the principles of bioavailability, translated to efficient food synergies with due emphasis on food accessibility, affordability, and outdoor physical activity/life style modifications. Promoting enabling environment and sustainable agriculture is crucial for practicing dietary diversification with behavior change communication as an integral segment. It can be concluded that food-based strategies require careful understanding of the factors associated with it and moderate it to form an effective strategy for controlling multiple micronutrient deficiencies. PMID:26779472

  13. Managing Multiple Goals in Real Learning Contexts

    ERIC Educational Resources Information Center

    Mansfield, Caroline F.

    2009-01-01

    Understanding students' multiple goals in real learning contexts is an emerging area of importance for educators and researchers investigating student motivation in classrooms. This qualitative study conducted over an academic year investigates the multiple goals articulated by seven 11-year-old students and explores relationships between goals…

  14. Multidisciplinary management of multiple spinal dural arteriovenous fistulae

    PubMed Central

    Ge, Liang; Feng, Rui; Zhang, Xiaolong; Sun, Bing; Gu, Shixin; Xu, Qiwu; Lu, Gang; Huang, Lei

    2013-01-01

    Multiple SDAVFs are quite rare. We present two cases with double synchronous shunts and both were treated during one-stage interventional or surgical procedure. Unique images of the multiple SDAVFs as a PMAVF-like fistula were obtained. These interesting findings suggest the presence of multiple fistulas must be considered in patients being evaluated for SDAVF. A multidisciplinary approach to the management of multiple SDAVFs should depend on the anatomic location and angioarchitecture. PMID:24179577

  15. A roadmap for climate change adaptation in Sweden's forests: addressing wicked problems using adaptive management

    NASA Astrophysics Data System (ADS)

    Rist, L.; Felton, A.; Samuelsson, L.; Marald, E.; Karlsson, B.; Johansson, U.; Rosvall, O.

    2013-12-01

    Climate change is expected to have significant direct and indirect effects on forest ecosystems. Forests will have to adapt not only to changes in mean climate variables but also to increased climatic variability and altered disturbance regimes. Rates of change will likely exceed many forests capabilities to naturally adapt and many of today's trees will be exposed to the climates of 2090. In Sweden the effects are already being seen and more severe impacts are expected in the future. Exacerbating the challenge posed by climate change, a large proportion of Sweden's forests are, as a consequence of dominant production goals, greatly simplified and thus potentially more vulnerable to the uncertainties and risks associated with climate change. This simplification also confers reduced adaptive capacity to respond to potential impacts. Furthermore, many adaptation measures themselves carry uncertainties and risks. Future changes and effects are thus uncertain, yet forest managers, policymakers, scientists and other stakeholders must act. Strategies that build social and ecological resilience in the face of multiple interacting unknowns and surprises are needed. Adaptive management aims to collect and integrate knowledge about how a managed system is likely to respond to alternative management schemes and changing environmental conditions within a continuous decision process. There have been suggestions that adaptive management is not well suited to the large complex uncertainties associated with climate change and associated adaptation measures. However, more recently it has been suggested that adaptive management can handle such wicked problems, given adequate resources and a suitable breakdown of the targeted uncertainties. Here we test this hypothesis by evaluating how an adaptive management process could be used to manage the uncertainties and risks associated with securing resilient, biodiverse and productive forests in Sweden in the face of climate change. We

  16. Experimental demonstration of a single-carrier frequency division multiple address based PON (SCFDMA-PON) architecture.

    PubMed

    Zhang, Cheng; Li, Juhao; Zhang, Fan; He, Yongqi; Wu, Hequan; Chen, Zhangyuan

    2010-11-22

    We introduce a novel architecture for next generation passive optical network (PON) base on the Single-carrier Frequency Division Multiple Address (SC-FDMA) technique. Both downstream and upstream SCFDMA-PON transmissions (5 Gb/s total, 2.5 Gb/s for each user) are experimentally demonstrated over 22.2 km standard single mode fiber and an additional simulated 1:32 optical splitter. We also test the tolerance range of the synchronization error and prove it matches the cyclic prefix period in our scheme, which means the packet transmission accuracy from different optical network units can be relaxed in the upstream. PMID:21164802

  17. Adaptation of a counseling intervention to address multiple cancer risk factors among overweight/obese Latino smokers.

    PubMed

    Castro, Yessenia; Fernández, Maria E; Strong, Larkin L; Stewart, Diana W; Krasny, Sarah; Hernandez Robles, Eden; Heredia, Natalia; Spears, Claire A; Correa-Fernández, Virmarie; Eakin, Elizabeth; Resnicow, Ken; Basen-Engquist, Karen; Wetter, David W

    2015-02-01

    More than 60% of cancer-related deaths in the United States are attributable to tobacco use, poor nutrition, and physical inactivity, and these risk factors tend to cluster together. Thus, strategies for cancer risk reduction would benefit from addressing multiple health risk behaviors. We adapted an evidence-based intervention grounded in social cognitive theory and principles of motivational interviewing originally developed for smoking cessation to also address physical activity and fruit/vegetable consumption among Latinos exhibiting multiple health risk behaviors. Literature reviews, focus groups, expert consultation, pretesting, and pilot testing were used to inform adaptation decisions. We identified common mechanisms underlying change in smoking, physical activity, and diet used as treatment targets; identified practical models of patient-centered cross-cultural service provision; and identified that family preferences and support as particularly strong concerns among the priority population. Adaptations made to the original intervention are described. The current study is a practical example of how an intervention can be adapted to maximize relevance and acceptability and also maintain the core elements of the original evidence-based intervention. The intervention has significant potential to influence cancer prevention efforts among Latinos in the United States and is being evaluated in a sample of 400 Latino overweight/obese smokers. PMID:25527143

  18. Adaptation of a Counseling Intervention to Address Multiple Cancer Risk Factors Among Overweight/Obese Latino Smokers

    PubMed Central

    Castro, Yessenia; Fernández, Maria E.; Strong, Larkin L.; Stewart, Diana W.; Krasny, Sarah; Robles, Eden Hernandez; Heredia, Natalia; Spears, Claire A.; Correa-Fernández, Virmarie; Eakin, Elizabeth; Resnicow, Ken; Basen-Engquist, Karen; Wetter, David W.

    2015-01-01

    More than 60% of cancer-related deaths in the United States are attributable to tobacco use, poor nutrition, and physical inactivity, and these risk factors tend to cluster together. Thus, strategies for cancer risk reduction would benefit from addressing multiple health risk behaviors. We adapted an evidence-based intervention grounded in social cognitive theory and principles of motivational interviewing originally developed for smoking cessation to also address physical activity and fruit/vegetable consumption among Latinos exhibiting multiple health risk behaviors. Literature reviews, focus groups, expert consultation, pretesting, and pilot testing were used to inform adaptation decisions. We identified common mechanisms underlying change in smoking, physical activity, and diet used as treatment targets; identified practical models of patient-centered cross-cultural service provision; and identified that family preferences and support as particularly strong concerns among the priority population. Adaptations made to the original intervention are described. The current study is a practical example of how an intervention can be adapted to maximize relevance and acceptability and also maintain the core elements of the original evidence-based intervention. The intervention has significant potential to influence cancer prevention efforts among Latinos in the United States and is being evaluated in a sample of 400 Latino overweight/obese smokers. PMID:25527143

  19. New approaches to management of multiple myeloma.

    PubMed

    Genadieva-Stavric, Sonja; Cavallo, Federica; Palumbo, Antonio

    2014-06-01

    Multiple myeloma is still an incurable disease with pattern of regression and remission followed by multiple relapses raising from the residual myeloma cells surviving even in the patients who achieve complete clinical response to treatment. New antimyeloma drugs such as thalidomide, lenalidomide, and bortezomib have dramatically changed treatment paradigm leading to both tumor reduction and tumor suppression. Much progress has been made, but still many unsolved questions remain. In the mode of sequencing treatment for patients with multiple myeloma, we are still using old drugs such as the alkylating agent melphalan, which continues to play a central role in the transplantation setting. Newer drugs are now emerging and are being tested: monoclonal antibodies, histone deacetylase (romidespsin), MLN9708 (ixazomib) a new oral proteasome inhibitor, carfilzomib, signal transduction modulator perifosine. Many advances have been made, but there is still a long way to go. PMID:24578203

  20. Enterprise project management is key to success: addressing the people, process and technology dimensions of healthcare.

    PubMed

    Becker, JoAnn; Rhodes, Harry

    2007-01-01

    The world of healthcare professionals is in a constant state of transition, requiring different processes for the organization, and for completing projects and programs. Projects that manage transition are complex undertakings prone to cost and time overruns. An enterprise project management model is proposed to address the people, process and technology dimensions. It includes the five-step PMI project process, vocabulary, processes, soft skills, stakeholder expectation management, portfolio management and talent diversity. Differences in project deliverables and organizational results are discussed, along with a technique to analyze gaps from the current to the new state, which then defines the projects and programs for an organizational initiative. The role and responsibilities of an executive decision team are defined. Learning the model is needed by all members of the organization, regardless of their role or level, for successfully adapting to future changes. Finally, a case is made for healthcare organizations to implement these competencies if they are to be well-performing organizations in this continuous world of change. PMID:19195295

  1. Prioritization of research addressing management strategies for ductal carcinoma in situ.

    PubMed

    Gierisch, Jennifer M; Myers, Evan R; Schmit, Kristine M; Crowley, Matthew J; McCrory, Douglas C; Chatterjee, Ranee; Coeytaux, Remy R; Kendrick, Amy; Sanders, Gillian D

    2014-04-01

    Ductal carcinoma in situ is a common finding in women having mammography screening, and there is considerable uncertainty about the balance of harms and benefits of different management options. This article outlines the process for developing a prioritized research agenda for the Patient-Centered Outcomes Research Institute as informed by a diverse group of stakeholders on the management of ductal carcinoma in situ. Evidence gaps were identified by reviewing existing literature and engaging diverse stakeholders to refine these gaps. Stakeholders ranked evidence gaps by importance from their perspectives using a forced-ranking prioritization method. PubMed was searched for relevant recent studies, and ClinicalTrials.gov was searched for relevant ongoing trials for the 10 highest-ranked evidence gaps. Strengths and limitations of different study designs were assessed to address gaps. Stakeholders prioritized evidence gaps related to incorporation of patient-centered outcomes into future research, development of better methods to predict risk for invasive cancer, evaluation of a strategy of active surveillance, and testing of decision-making tools. The degree to which prioritized evidence gaps may have already been addressed is uncertain because a comprehensive systematic review has not been done. PMID:24567146

  2. Economic burden of multiple sclerosis and the role of managed sare organizations in multiple sclerosis management.

    PubMed

    Owens, Gary M

    2016-06-01

    Multiple sclerosis (MS) is disease that has an early age of onset and may intensify and subside with disease relapses or exacerbations interrupted by periods of stability. Because of this, patients, their families and caregivers, employers, and the entire healthcare system carry substantial clinical and economic burdens associated with the disease over of a period of many years. Although most patients with MS are covered by health insurance, the management landscape has become increasingly complex over the past decade with the introduction and approval of several new disease-modifying therapies that, while remarkably effective and well tolerated, usually come with a very high cost. Whereas the main goal of treating patients with MS is to prevent disease progression and disability, healthcare and benefit providers are faced with an ever-tipping balance point between effectively managing the disease and maximizing the value of high-cost disease-modifying therapies in an already overburdened healthcare system. Treatment of MS should be individualized, and shared decision making between patients and healthcare providers must be preserved. Healthcare providers and payers need to collaborate to ensure that resources are used optimally and not wasted, reducing both the clinical and economic burdens related to this complex chronic disorder. PMID:27356024

  3. Progressive multiple sclerosis: characteristics and management.

    PubMed

    Hawker, Kathleen

    2011-05-01

    Progressive multiple sclerosis (MS) consists of 3 phenotypic subtypes: secondary progressive MS, primary progressive MS, and progressive relapsing MS. There has been a paucity of approved treatments for these subtypes possibly driven by irreversible neurodegeneration within the central nervous system and not amenable to drugs that target inflammation. This article reviews magnetic resonance imaging and clinical data that show that progression may occur early in the course of MS and specific subsets of progressive patients may respond to disease modifying drugs. PMID:21439451

  4. Diagnosis and management of multiple sclerosis.

    PubMed

    Calabresi, Peter A

    2004-11-15

    Multiple sclerosis, an idiopathic inflammatory disease of the central nervous system, is characterized pathologically by demyelination and subsequent axonal degeneration. The disease commonly presents in young adults and affects twice as many women as men. Common presenting symptoms include numbness, weakness, visual impairment, loss of balance, dizziness, urinary bladder urgency, fatigue, and depression. The diagnosis of multiple sclerosis should be made by a physician with experience in identifying the disease. Diagnosis should be based on objective evidence of two or more neurologic signs that are localized to the brain or spinal cord and are disseminated in time and space (i.e., occur in different parts of the central nervous system at least three months apart). Magnetic resonance imaging with gadolinium contrast, especially during or following a first attack, can be helpful in providing evidence of lesions in other parts of the brain and spinal cord. A second magnetic resonance scan may be useful at least three months after the initial attack to identify new lesions and provide evidence of dissemination over time. It is critical to exclude other diseases that can mimic multiple sclerosis, including vascular disease, spinal cord compression, vitamin B12 deficiency, central nervous system infection (e.g., Lyme disease, syphilis), and other inflammatory conditions (e.g., sarcoidosis, systemic lupus erythematosus, Sjögren's syndrome). Symptom-specific drugs can relieve spasticity, bladder dysfunction, depression, and fatigue. Five disease-modifying treatments for multiple sclerosis have been approved by the U.S. Food and Drug Administration. These treatments are partially effective in reducing exacerbations and may slow progression of disability. PMID:15571060

  5. Recognizing and Managing Multiple Organizational Approaches.

    ERIC Educational Resources Information Center

    Giesecke, Joan

    1994-01-01

    Discusses a framework for identifying organizational processes or models within the context of the organization's decision-making processes. Five organizational models appropriate to academic libraries are presented: rational, political bargaining, garbage can, bureaucratic, and participatory. Guidelines for managers include how to distinguish…

  6. MABEL at IPAC: managing address books and email lists at the Infrared Processing and Analysis Center

    NASA Astrophysics Data System (ADS)

    Crane, Megan; Brinkworth, Carolyn; Gelino, Dawn; O'Leary, Ellen

    2012-09-01

    The Infrared Processing and Analysis Center (IPAC), located on the campus of the California Institute of Technology, is NASA's multi-mission data center for infrared astrophysics. Some of IPAC's services include administering data analysis funding awards to the astronomical community, organizing conferences and workshops, and soliciting and selecting fellowship and observing proposals. As most of these services are repeated annually or biannually, it becomes necessary to maintain multiple lists of email contacts associated with each service. MABEL is a PHP/MySQL web database application designed to facilitate this process. It serves as an address book containing up-to-date contact information for thousands of recipients. Recipients may be assigned to any number of email lists categorized by IPAC project and team. Lists may be public (viewable by all project members) or private (viewable only by team members). MABEL can also be used to send HTML or plain-text emails to multiple lists at once and prevents duplicate emails to a single recipient. This work was performed at the California Institute of Technology under contract to the National Aeronautics and Space Administration.

  7. Tool to address green roof widespread implementation effect in flood characteristics for water management planning

    NASA Astrophysics Data System (ADS)

    Tassi, R.; Lorenzini, F.; Allasia, D. G.

    2015-06-01

    In the last decades, new approaches were adopted to manage stormwater as close to its source as possible through technologies and devices that preserve and recreate natural landscape features. Green Roofs (GR) are examples of these devices that are also incentivized by city's stormwater management plans. Several studies show that GR decreases on-site runoff from impervious surfaces, however, the analysis of the effect of widespread implementation of GR in the flood characteristics at the urban basin scale in subtropical areas are little discussed, mainly because of the absence of data. Thereby, this paper shows results related to the monitoring of an extensive modular GR under subtropical weather conditions, the development of a rainfall-runoff model based on the modified Curve Number (CN) and SCS Triangular Unit Hydrograph (TUH) methods and the analysis of large-scale impact of GR by modelling different basins. The model was calibrated against observed data and showed that GR absorbed almost all the smaller storms and reduced runoff even during the most intense rainfall. The overall CN was estimated in 83 (consistent with available literature) with the shape of hydrographs well reproduced. Large-scale modelling (in basins ranging from 0.03 ha to several square kilometers) showed that the widespread use of GRs reduced peak flows (volumes) around 57% (48%) at source and 38% (32%) at the basin scale. Thus, this research validated a tool for the assessment of structural management measures (specifically GR) to address changes in flood characteristics in the city's water management planning. From the application of this model it was concluded that even if the efficiency of GR decreases as the basin scale increase they still provide a good option to cope with urbanization impact.

  8. Managing Neuropsychological Impairment in Multiple Sclerosis

    PubMed Central

    Lau, Stephanie; Penner, Iris; Heesen, Christoph; Moritz, Steffen

    2015-01-01

    Background: Multiple sclerosis (MS) is an inflammatory and neurodegenerative disease of the central nervous system of potential autoimmune origin that is frequently associated with psychological disorders and cognitive deficits, as well as with fatigue, stress, and psychosocial burden. These factors often cause decreased quality of life, social withdrawal, and unemployment. We describe the development of a cognitive-behavioral group intervention based on the concept of metacognition and evaluation of the feasibility and acceptance of the program as a rehabilitation tool. Methods: Metacognitive Training in MS (MaTiMS) consists of six modules, each 90 minutes in duration. We tested acceptance and design of the program in six focus groups (entire sample, n = 27). Framework analysis of transcripts was used to identify key topics and categories. Program modules were revised in accordance with appropriate recommendations of focus group members. We subsequently evaluated MaTiMS in two groups (n = 5, n = 6) in a rehabilitation center. Neuropsychological functioning as well as coping self-efficacy, depression, stress, perceived cognitive deficit, fatigue, and quality of life were assessed. Acceptance of MaTiMS from the patient perspective was also studied. Results: The modules were highly accepted by patients. Pre-post assessments showed significant improvements in the Coping Self Efficacy Scale (P = .007), the Würzburger Fatigue Inventory for MS Score (P = .028), and the Hamburg Quality of Life Questionnaire in Multiple Sclerosis Mood subscale (P = .046). Conclusions: These preliminary results suggest that MaTiMS represents a feasible psychological group training program that may foster improvements in self-efficacy, fatigue, and mood. The next step will be an evaluation of the program in a randomized controlled trial. PMID:26052258

  9. Adapting Semantic Natural Language Processing Technology to Address Information Overload in Influenza Epidemic Management

    PubMed Central

    Keselman, Alla; Rosemblat, Graciela; Kilicoglu, Halil; Fiszman, Marcelo; Jin, Honglan; Shin, Dongwook; Rindflesch, Thomas C.

    2013-01-01

    Explosion of disaster health information results in information overload among response professionals. The objective of this project was to determine the feasibility of applying semantic natural language processing (NLP) technology to addressing this overload. The project characterizes concepts and relationships commonly used in disaster health-related documents on influenza pandemics, as the basis for adapting an existing semantic summarizer to the domain. Methods include human review and semantic NLP analysis of a set of relevant documents. This is followed by a pilot-test in which two information specialists use the adapted application for a realistic information seeking task. According to the results, the ontology of influenza epidemics management can be described via a manageable number of semantic relationships that involve concepts from a limited number of semantic types. Test users demonstrate several ways to engage with the application to obtain useful information. This suggests that existing semantic NLP algorithms can be adapted to support information summarization and visualization in influenza epidemics and other disaster health areas. However, additional research is needed in the areas of terminology development (as many relevant relationships and terms are not part of existing standardized vocabularies), NLP, and user interface design. PMID:24311971

  10. Adapting Semantic Natural Language Processing Technology to Address Information Overload in Influenza Epidemic Management.

    PubMed

    Keselman, Alla; Rosemblat, Graciela; Kilicoglu, Halil; Fiszman, Marcelo; Jin, Honglan; Shin, Dongwook; Rindflesch, Thomas C

    2010-12-01

    Explosion of disaster health information results in information overload among response professionals. The objective of this project was to determine the feasibility of applying semantic natural language processing (NLP) technology to addressing this overload. The project characterizes concepts and relationships commonly used in disaster health-related documents on influenza pandemics, as the basis for adapting an existing semantic summarizer to the domain. Methods include human review and semantic NLP analysis of a set of relevant documents. This is followed by a pilot-test in which two information specialists use the adapted application for a realistic information seeking task. According to the results, the ontology of influenza epidemics management can be described via a manageable number of semantic relationships that involve concepts from a limited number of semantic types. Test users demonstrate several ways to engage with the application to obtain useful information. This suggests that existing semantic NLP algorithms can be adapted to support information summarization and visualization in influenza epidemics and other disaster health areas. However, additional research is needed in the areas of terminology development (as many relevant relationships and terms are not part of existing standardized vocabularies), NLP, and user interface design. PMID:24311971

  11. Sustainable land management (SLM) practices in drylands: how do they address desertification threats?

    PubMed

    Schwilch, G; Liniger, H P; Hurni, H

    2014-11-01

    Managing land sustainably is a huge challenge, especially under harsh climatic conditions such as those found in drylands. The socio-economic situation can also pose challenges, as dryland regions are often characterized by remoteness, marginality, low-productive farming, weak institutions, and even conflict. With threats from climate change, disputes over water, competing claims on land, and migration increasing worldwide, the demands for sustainable land management (SLM) measures will only increase in the future. Within the EU-funded DESIRE project, researchers and stakeholders jointly identified existing SLM technologies and approaches in 17 dryland study sites located in the Mediterranean and around the world. In order to evaluate and share this valuable SLM experience, local researchers documented the SLM technologies and approaches in collaboration with land users, utilizing the internationally recognized WOCAT questionnaires. This article provides an analysis of 30 technologies and 8 approaches, enabling an initial evaluation of how SLM addresses prevalent dryland threats, such as water scarcity, soil degradation, vegetation degradation and low production, climate change, resource use conflicts, and migration. Among the impacts attributed to the documented technologies, those mentioned most were diversified and enhanced production and better management of water and soil degradation, whether through water harvesting, improving soil moisture, or reducing runoff. Favorable local-scale cost-benefit relationships were mainly found when considered over the long term. Nevertheless, SLM was found to improve people's livelihoods and prevent further outmigration. More field research is needed to reinforce expert assessments of SLM impacts and provide the necessary evidence-based rationale for investing in SLM. PMID:23703582

  12. Sustainable Land Management (SLM) Practices in Drylands: How Do They Address Desertification Threats?

    NASA Astrophysics Data System (ADS)

    Schwilch, G.; Liniger, H. P.; Hurni, H.

    2014-11-01

    Managing land sustainably is a huge challenge, especially under harsh climatic conditions such as those found in drylands. The socio-economic situation can also pose challenges, as dryland regions are often characterized by remoteness, marginality, low-productive farming, weak institutions, and even conflict. With threats from climate change, disputes over water, competing claims on land, and migration increasing worldwide, the demands for sustainable land management (SLM) measures will only increase in the future. Within the EU-funded DESIRE project, researchers and stakeholders jointly identified existing SLM technologies and approaches in 17 dryland study sites located in the Mediterranean and around the world. In order to evaluate and share this valuable SLM experience, local researchers documented the SLM technologies and approaches in collaboration with land users, utilizing the internationally recognized WOCAT questionnaires. This article provides an analysis of 30 technologies and 8 approaches, enabling an initial evaluation of how SLM addresses prevalent dryland threats, such as water scarcity, soil degradation, vegetation degradation and low production, climate change, resource use conflicts, and migration. Among the impacts attributed to the documented technologies, those mentioned most were diversified and enhanced production and better management of water and soil degradation, whether through water harvesting, improving soil moisture, or reducing runoff. Favorable local-scale cost-benefit relationships were mainly found when considered over the long term. Nevertheless, SLM was found to improve people's livelihoods and prevent further outmigration. More field research is needed to reinforce expert assessments of SLM impacts and provide the necessary evidence-based rationale for investing in SLM.

  13. Management of Multiple Impacted Teeth: A Case Report and Review

    PubMed Central

    Ajith, Sreedevi D; Shetty, Smitha; Hussain, Huma; Nagaraj, Tejavathy; Srinath, M

    2014-01-01

    Interdisciplinary care for the management of impacted teeth provides a holistic method of treating patients. Careful planning is necessary to reach the desired treatment goals. This article attempts to highlight the importance of diagnosis and adequate treatment planning for successful eruption of impacted teeth. The concept of forced eruption to improve the bone morphology of the impacted teeth has been used to treat a case of multiple impacted teeth. This paper reviews the diagnosis and management of impacted teeth. A case report of multiple impacted maxillary anterior teeth of a 13-year-old female patient has been presented. How to cite the article: Ajith SD, Shetty S, Hussain H, Nagaraj T, Srinath M. Management of multiple impacted teeth: A case report and review. J Int Oral Health 2014;6(3):93-8. PMID:25083041

  14. Classroom Management Strategies to Address the Needs of Sudanese Refugee Learners: Support Document--Methodology and Literature Review

    ERIC Educational Resources Information Center

    Burgoyne, Ursula; Hull, Oksana

    2007-01-01

    This document presents the methodology and literature review for the research report "Classroom Management Strategies to Address the Needs of Sudanese Refugee Learners" (ED499673), which examined the extent to which English language, literacy and numeracy teachers used classroom management strategies to meet the needs of adult Sudanese refugee…

  15. Reducing asthma disparities by addressing environmental inequities: a case study of regional asthma management and prevention's advocacy efforts.

    PubMed

    Lamb, Anne Kelsey; Ervice, Joel; Lorenzen, Kathryn; Prentice, Bob; White, Shannon

    2011-01-01

    Regional Asthma Management and Prevention describes its collaborative approach to address a social determinant of health--air quality--and the associated inequities that have led to asthma disparities impacting African American and Latino communities in the San Francisco Bay Area. The strategies, aimed at decreasing diesel pollution in disproportionately impacted communities, span the levels of the socioecological model, with an emphasis on policy outcomes. Regional Asthma Management and Prevention describes how this work fits within a larger comprehensive approach to address asthma disparities encompassing several components, ranging from clinical management to environmental protection. PMID:21160331

  16. Technical Reference Suite Addressing Challenges of Providing Assurance for Fault Management Architectural Design

    NASA Technical Reports Server (NTRS)

    Fitz, Rhonda; Whitman, Gerek

    2016-01-01

    Research into complexities of software systems Fault Management (FM) and how architectural design decisions affect safety, preservation of assets, and maintenance of desired system functionality has coalesced into a technical reference (TR) suite that advances the provision of safety and mission assurance. The NASA Independent Verification and Validation (IV&V) Program, with Software Assurance Research Program support, extracted FM architectures across the IV&V portfolio to evaluate robustness, assess visibility for validation and test, and define software assurance methods applied to the architectures and designs. This investigation spanned IV&V projects with seven different primary developers, a wide range of sizes and complexities, and encompassed Deep Space Robotic, Human Spaceflight, and Earth Orbiter mission FM architectures. The initiative continues with an expansion of the TR suite to include Launch Vehicles, adding the benefit of investigating differences intrinsic to model-based FM architectures and insight into complexities of FM within an Agile software development environment, in order to improve awareness of how nontraditional processes affect FM architectural design and system health management. The identification of particular FM architectures, visibility, and associated IV&V techniques provides a TR suite that enables greater assurance that critical software systems will adequately protect against faults and respond to adverse conditions. Additionally, the role FM has with regard to strengthened security requirements, with potential to advance overall asset protection of flight software systems, is being addressed with the development of an adverse conditions database encompassing flight software vulnerabilities. Capitalizing on the established framework, this TR suite provides assurance capability for a variety of FM architectures and varied development approaches. Research results are being disseminated across NASA, other agencies, and the

  17. Appalachian residents’ experiences with and management of multiple morbidity

    PubMed Central

    Schoenberg, Nancy E.; Bardach, Shoshana H.; Manchikanti, Kavita N.; Goodenow, Anne C.

    2011-01-01

    Approximately three quarters of middle aged and older adults have at least two simultaneously occurring chronic conditions (“multiple morbidity” or MM), a trend expected to increase dramatically throughout the world. Rural residents, who tend to have fewer personal and health resources, are more likely to experience MM. To improve our understanding of the ways in which vulnerable, rural residents in the U.S. experience and manage MM, we interviewed twenty rural Appalachian residents with MM. We identified the following themes; (a) MM has multifaceted challenges and is viewed as more than the sum of its parts; (b) numerous challenges exist to optimal MM self-management, particularly in a rural, under-resourced context; however, (c) participants described strategic methods of managing multiple chronic conditions, including prioritizing certain conditions and management strategies and drawing heavily on assistance from informal and formal sources. PMID:21263063

  18. An addressable conducting network for autonomic structural health management of composite structures

    NASA Astrophysics Data System (ADS)

    Takahashi, Kosuke; Park, Jong Se; Hahn, H. Thomas

    2010-10-01

    The electrical resistance change method (ERCM) has long been an area of interest as an in-service health monitoring system. To apply the ERCM to existing structures, a new concept, the addressable conducting network (ACN), is proposed for autonomic structural health management of graphite/polymer composites. The ACN consists of two sets of conducting lines normal to each other, where one set resides on the top surface of the laminate and the other on the bottom surface. Damage can be detected by monitoring the resistance change 'through the laminate thickness' between two lines. By using a thermally mendable polymer as the matrix, the same conducting lines can be used to supply the electric current needed for resistive heating, thereby allowing the detected damage to be healed. As shown experimentally, the electrical resistance change method using an ACN distinguishes between laminates made of properly and improperly cured prepreg as well as revealing damage generated during three-point bending tests. Finite element analysis was performed to examine the feasibility of the ACN and indicated that the damage can be easily located from the spatial distribution of resistance changes and that the damaged area can be locally heated by supplying a large amount of current to selected conducting lines.

  19. Empowering marginalized communities in water resources management: addressing inequitable practices in Participatory Model Building.

    PubMed

    Butler, Cameron; Adamowski, Jan

    2015-04-15

    Within the field of water resource management, Group Model Building (GMB) is a growing method used to engage stakeholders in the development of models that describe environmental and socioeconomic systems to create and test policy alternatives. While there is significant focus on improving stakeholder engagement, there is a lack of studies specifically looking at the experiences of marginalized communities and the barriers that prevent their fuller participation in the decision-making process. This paper explores the common issues and presents recommended improved practices, based on anti-oppression, related to the stages of problem framing, stakeholder identification and selection, workshop preparation, and workshop facilitation. For problem defining and stakeholder selection, the major recommendations are to engage diverse stakeholder communities from the earliest stages and give them control over framing the project scope. With regards to planning the model building workshops, it is recommended that the facilitation team work closely with marginalized stakeholders to highlight and address barriers that would prevent their inclusion. With the actual facilitation of the workshops, it is best to employ activities that allow stakeholders to provide knowledge and input in mediums that are most comfortable to them; additionally, the facilitation team needs to be able to challenge problematic interpersonal interactions as they manifest within conversations. This article focuses on building comfortability with political language so that the systemic oppression in which existing participatory processes occur can be understood, thus allowing GMB practitioners to engage in social justice efforts. PMID:25697902

  20. Network management convergence of multiple subnetworks in GSM infrastructure

    NASA Astrophysics Data System (ADS)

    Zong, Baiqing; Su, Jiang; Zhong, Tao; Dong, Hui; Zhong, Shuangli; Zhou, Weiming; Chen, Wansheng

    2001-10-01

    Network convergence, including service, timing and management convergence, is a trend of future telecommunication networks. Because network convergence can provide carriers with cost reduction, highly integrated applications as well as greater flexibility and functionality, new technologies and standards have driven this convergence tide. However, network management convergence, managing disparate networks with a unified platform, has been a challenging task in sophisticated telecommunication network environments. Administrators are faced with the task of managing various devices with several different applications, without an effective tool set to provide visibility across the network. In general, multiple transmission networks such as SDH, PON, HDSL and digital microwave are adopted in GSM infrastructure to transport mobile traffic between BTS and BSC. Traditional method of managing these devices is that GSM network (MSC, BSC and BTS), SDH, PON, HDSL and digital microwave are managed independently. In this paper, a converged network management platform, named OMConvergence, is proposed and demonstrated. The platform aims at managing the whole GSM network covering SDH, PON, HDSL or digital microwave sub-networks within it. The OMConvergence comprises of remote access methods of OAM message, as well as processing of multiple network management protocol such as ECC (Embedded Control Channel), Q3 and simple network management protocol (SNMP). The management and maintenance message of various devices physically converges to E1 timeslots at the sides of BTS, and then convert to unified IP packages before it is terminated at the side of BSC or network administration center. In addition, extended applications of OMConvergence in image monitoring of BTS surroundings are also demonstrated.

  1. Optimization of Landscape Services under Uncoordinated Management by Multiple Landowners

    PubMed Central

    Porto, Miguel; Correia, Otília; Beja, Pedro

    2014-01-01

    Landscapes are often patchworks of private properties, where composition and configuration patterns result from cumulative effects of the actions of multiple landowners. Securing the delivery of services in such multi-ownership landscapes is challenging, because it is difficult to assure tight compliance to spatially explicit management rules at the level of individual properties, which may hinder the conservation of critical landscape features. To deal with these constraints, a multi-objective simulation-optimization procedure was developed to select non-spatial management regimes that best meet landscape-level objectives, while accounting for uncoordinated and uncertain response of individual landowners to management rules. Optimization approximates the non-dominated Pareto frontier, combining a multi-objective genetic algorithm and a simulator that forecasts trends in landscape pattern as a function of management rules implemented annually by individual landowners. The procedure was demonstrated with a case study for the optimum scheduling of fuel treatments in cork oak forest landscapes, involving six objectives related to reducing management costs (1), reducing fire risk (3), and protecting biodiversity associated with mid- and late-successional understories (2). There was a trade-off between cost, fire risk and biodiversity objectives, that could be minimized by selecting management regimes involving ca. 60% of landowners clearing the understory at short intervals (around 5 years), and the remaining managing at long intervals (ca. 75 years) or not managing. The optimal management regimes produces a mosaic landscape dominated by stands with herbaceous and low shrub understories, but also with a satisfactory representation of old understories, that was favorable in terms of both fire risk and biodiversity. The simulation-optimization procedure presented can be extended to incorporate a wide range of landscape dynamic processes, management rules and quantifiable

  2. Diagnosis and Management of Multiple Sclerosis in Children.

    PubMed

    Najafi, Mohammad Reza; Najafi, Mohammad Amin; Nasr, Zahra

    2016-01-01

    Growing evidence indicates the safety and well toleration of treatment by Disease-modifying in children suffering multiple sclerosis (MS). The treatment is not straight forward in a great number of patients, thus patients with pediatric MS must be managed by experienced specialized centers. Common treatments of multiple sclerosis for adults are first-line therapies. These therapies (firstline) are safe for children. Failure in treatment that leads to therapy alteration is almost prevalent in pediatric MS. Toleration against current second-line therapies has been shown in multiple sclerosis children. Oral agents have not been assessed in children MS patients. Although clinical trials in children are insufficient, immunomodulating managed children, experience a side effect similar to the adult MS patients. However, further prospective clinical studies, with large sample size and long follow-up are needed to distinguish the benefits and probable side effects of pediatric MS therapies. PMID:27375751

  3. Thermal management of quantum cascade lasers in an individually addressable monolithic array architecture

    NASA Astrophysics Data System (ADS)

    Missaggia, Leo; Wang, Christine; Connors, Michael; Saar, Brian; Sanchez-Rubio, Antonio; Creedon, Kevin; Turner, George; Herzog, William

    2016-03-01

    There are a number of military and commercial applications for high-power laser systems in the mid-to-long-infrared wavelength range. By virtue of their demonstrated watt-level performance and wavelength diversity, quantum cascade laser (QCL) and amplifier devices are an excellent choice of emitter for those applications. To realize the power levels of interest, beam combining of arrays of these emitters is required and as a result, array technology must be developed. With this in mind, packaging and thermal management strategies were developed to facilitate the demonstration of a monolithic QCL array operating under CW conditions. Thermal models were constructed and simulations performed to determine the effect of parameters such as array-element ridge width and pitch on gain region temperature rise. The results of the simulations were considered in determining an appropriate QCL array configuration. State-of-the-art micro-impingement cooling along with an electrical distribution scheme comprised of AlN multi-layer technology were integrated into the design. The design of the module allows for individual electrical addressability of the array elements, a method of phase control demonstrated previously for coherent beam combining of diode arrays, along with access to both front and rear facets. Hence, both laser and single-pass amplifier arrays can be accommodated. A module was realized containing a 5 mm cavity length monolithic QCL array comprised of 7 elements on 450 m pitch. An output power of 3.16 W was demonstrated under CW conditions at an emission wavelength of 9μm.

  4. Inter-Professional Primary Care Practices Addressing Diabetes Prevention and Management

    ERIC Educational Resources Information Center

    Beagrie, Lesley

    2011-01-01

    Imagine a partnership of university and community which addresses the needs of the community to keep its citizens healthy as long as possible. Through a planning exercise to address the community's needs in primary health care and health promotion, the university has developed key strategic directions to help support the needs of the community it…

  5. Confidentiality Protection of User Data and Adaptive Resource Allocation for Managing Multiple Workflow Performance in Service-Based Systems

    ERIC Educational Resources Information Center

    An, Ho

    2012-01-01

    In this dissertation, two interrelated problems of service-based systems (SBS) are addressed: protecting users' data confidentiality from service providers, and managing performance of multiple workflows in SBS. Current SBSs pose serious limitations to protecting users' data confidentiality. Since users' sensitive data is sent in…

  6. Integrating Collaboration, Adaptive Management, and Scenario-Planning to Address Rapid Change: Experiences at Las Cienegas National Conservation Area

    NASA Astrophysics Data System (ADS)

    Caves, J. K.; Bodner, G.; Simms, K.; Fisher, L.; Robertson, T.

    2012-12-01

    There is growing recognition that public lands cannot be managed as islands; rather, land management must address the ecological, social, and temporal complexity that often spans jurisdictions and traditional planning horizons. Collaborative decision-making and adaptive management (CAM) have been promoted as methods to reconcile competing societal demands and respond to complex ecosystem dynamics. We present the experiences of land managers and stakeholders in using CAM at Las Cienegas National Conservation Area (LCNCA), a highly valued site under the jurisdiction of the Bureau of Land Management (BLM). The CAM process at Las Cienegas is marked by strong stakeholder engagement, with four core elements: 1) shared watershed goals with measurable resource objectives; 2) mechanisms to incorporate new information into decision-making; 3) efforts to make information increasingly relevant and reliable; and 4) shared learning to improve both the process and management actions. The combination of stakeholder engagement and adaptive management has led to agreement on contentious issues, more innovative solutions, and more effective land management. Yet the region is now experiencing rapid changes outside managers' control—including climate change, human population growth, and reduced federal budgets—with large but unpredictable impacts on natural resources. While CAM experience provides a strong foundation for making the difficult and contentious management decisions that such changes are likely to require, neither collaboration nor adaptive management provides a sufficient structure for addressing uncontrollable and unpredictable change. As a result, LCNCA is exploring two specific modifications to CAM that may better address emerging challenges, including: 1) Creating nested resource objectives to distinguish between those objectives which may be crucial from those which may hinder a flexible response to climate change, and 2) Incorporating scenario planning into CAM

  7. Managing Boulder Colorado's Water Supply to Address Risks from Climate Change

    NASA Astrophysics Data System (ADS)

    Smith, J. B.; Strzepek, K.; Rozaklis, L.; Ellinghouse, C.; Hallett, K. C.

    2008-12-01

    Stratus Consulting, the City of Boulder, the University of Colorado and AMEC Consulting (formerly Hydrosphere) studied the impacts of climate change on Boulder, Colorado's water supply. The City of Boulder's Water Resources Coordinator was closely involved in the design of the study and the analysis of results. The work, funded by a grant from the National Oceanographic and Atmospheric Administration to Stratus Consulting, is an example of a successful collaboration between municipal, academic, government, and professional institutes. This study combines the potential impacts of climate change with long-term climate variability to examine their effects on the water supply of one community. The study team examined outputs from general circulation models (GCMs; supplied by the National Center for Atmospheric Research) for grid boxes that include Boulder, Colorado, and selected the wettest model, the driest model, and a middle model. Estimates of climate change for 20-year periods centering on 2030 and 2070 were used. In addition, 437-year (1566- 2002) reconstructions of streamflow in Boulder Creek, South Boulder Creek, and the Colorado River (conducted by Connie Woodhouse) were used. A "nearest neighbor" approach was used to select years in the observed climate record that resemble the paleoclimate reconstructions. Average monthly GCM changes in temperature and precipitation for 2030 and 2070 were combined with multiple recreations of the paleoclimate record to simulate the combined effects of change in climate and paleoclimate variability. Using Boulder's water management model (which incorporates supply and demand for water and water rights) and accounting for population growth in Boulder and changes in demand for crop irrigation, the study found that wet and "middle" scenarios had little effect on the reliability of Boulder's water supply. But reduced precipitation scenarios resulted in violations of some of Boulder's water supply reliability criteria, which give

  8. Smart Energy Management of Multiple Full Cell Powered Applications

    SciTech Connect

    Mohammad S. Alam

    2007-04-23

    In this research project the University of South Alabama research team has been investigating smart energy management and control of multiple fuel cell power sources when subjected to varying demands of electrical and thermal loads together with demands of hydrogen production. This research has focused on finding the optimal schedule of the multiple fuel cell power plants in terms of electric, thermal and hydrogen energy. The optimal schedule is expected to yield the lowest operating cost. Our team is also investigating the possibility of generating hydrogen using photoelectrochemical (PEC) solar cells through finding materials for efficient light harvesting photoanodes. The goal is to develop an efficient and cost effective PEC solar cell system for direct electrolysis of water. In addition, models for hydrogen production, purification, and storage will be developed. The results obtained and the data collected will be then used to develop a smart energy management algorithm whose function is to maximize energy conservation within a managed set of appliances, thereby lowering O/M costs of the Fuel Cell power plant (FCPP), and allowing more hydrogen generation opportunities. The Smart Energy Management and Control (SEMaC) software, developed earlier, controls electrical loads in an individual home to achieve load management objectives such that the total power consumption of a typical residential home remains below the available power generated from a fuel cell. In this project, the research team will leverage the SEMaC algorithm developed earlier to create a neighborhood level control system.

  9. 40 CFR 267.101 - What must I do to address corrective action for solid waste management units?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 40 Protection of Environment 26 2010-07-01 2010-07-01 false What must I do to address corrective action for solid waste management units? 267.101 Section 267.101 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES (CONTINUED) STANDARDS FOR OWNERS AND OPERATORS OF HAZARDOUS WASTE FACILITIES OPERATING UNDER...

  10. Dynamic knowledge management from multiple sources in crowdsourcing environments

    NASA Astrophysics Data System (ADS)

    Kim, Mucheol; Rho, Seungmin

    2015-10-01

    Due to the spread of smart devices and the development of network technology, a large number of people can now easily utilize the web for acquiring information and various services. Further, collective intelligence has emerged as a core player in the evolution of technology in web 2.0 generation. It means that people who are interested in a specific domain of knowledge can not only make use of the information, but they can also participate in the knowledge production processes. Since a large volume of knowledge is produced by multiple contributors, it is important to integrate and manage knowledge efficiently. In this paper, we propose a social tagging-based dynamic knowledge management system in crowdsourcing environments. The approach here is to categorize and package knowledge from multiple sources, in such a way that it easily links to target knowledge.

  11. Management of neurogenic bladder in patients with multiple sclerosis.

    PubMed

    Phé, Véronique; Chartier-Kastler, Emmanuel; Panicker, Jalesh N

    2016-05-01

    Lower urinary tract (LUT) dysfunction is common in patients with multiple sclerosis and is a major negative influence on the quality of life of these patients. The most commonly reported symptoms are those of the storage phase, of which detrusor overactivity is the most frequently reported urodynamic abnormality. The clinical evaluation of patients' LUT symptoms should include a bladder diary, uroflowmetry followed by measurement of post-void residual urine volume, urinalysis, ultrasonography, assessment of renal function, quality-of-life assessments and sometimes urodynamic investigations and/or cystoscopy. The management of these patients requires a multidisciplinary approach. Intermittent self-catheterization is the preferred option for management of incomplete bladder emptying and urinary retention. Antimuscarinics are the first-line treatment for patients with storage symptoms. If antimuscarinics are ineffective, or poorly tolerated, a range of other approaches, such as intradetrusor botulinum toxin A injections, tibial nerve stimulation and sacral neuromodulation are available, with varying levels of evidence in patients with multiple sclerosis. Surgical procedures should be performed only after careful selection of patients. Stress urinary incontinence owing to sphincter deficiency remains a therapeutic challenge, and is only managed surgically if conservative measures have failed. Multiple sclerosis has a progressive course, therefore, patients' LUT symptoms require regular, long-term follow-up monitoring. PMID:27030526

  12. Sustainable use of flatfish resources: Addressing the credibility crisis in mixed fisheries management

    NASA Astrophysics Data System (ADS)

    Rijnsdorp, A. D.; Daan, N.; Dekker, W.; Poos, J. J.; Van Densen, W. L. T.

    2007-02-01

    Many flatfish species are caught in mixed demersal trawl fisheries and managed by Total Allowable Catch (TAC). Despite decades of fisheries management, several major stocks are severely depleted. Using the Common Fisheries Policy (CFP) as an example, the failure of mixed-fisheries management is analysed by focussing on: the management system; the role of science; the role of managers and politicians; the response of fisheries to management. Failure of the CFP management could be ascribed to: incorrect management advice owing to bias in stock assessments; the tendency of politicians to set the TAC well above the recommended level; and non-compliance of the fisheries with the management regulations. We conclude that TAC management, although apparently successful in some single-species fisheries, inevitably leads to unsustainable exploitation of stocks caught in mixed demersal fisheries as it promotes discarding of over-quota catch and misreporting of catches, thereby corrupting the basis of the scientific advice and increasing the risk of stock collapse. This failure in mixed demersal fisheries has resulted in the loss of credibility of both scientists and managers, and has undermined the support of fishermen for management regulations. An approach is developed to convert the TAC system into a system that controls the total allowable effort (TAE). The approach takes account of the differences in catch efficiency between fleets as well as seasonal changes in the distribution of the target species and can also be applied in the recovery plans for rebuilding specific components of the demersal fish community, such as plaice, cod and hake.

  13. Technology requirements to be addressed by the NASA Lewis Research Center Cryogenic Fluid Management Facility program

    NASA Technical Reports Server (NTRS)

    Aydelott, J. C.; Rudland, R. S.

    1985-01-01

    The NASA Lewis Research Center is responsible for the planning and execution of a scientific program which will provide advance in space cryogenic fluid management technology. A number of future space missions were identified that require or could benefit from this technology. These fluid management technology needs were prioritized and a shuttle attached reuseable test bed, the cryogenic fluid management facility (CFMF), is being designed to provide the experimental data necessary for the technology development effort.

  14. The role of information system in multiple sclerosis management.

    PubMed

    Ajami, Sima; Ahmadi, Golchehreh; Etemadifar, Masoud

    2014-12-01

    Multiple sclerosis (MS) is a chronic disease of central nervous system. The multiple sclerosis information system (MSIS), such as other information system (IS), depends on identification, collection and processing of data for producing useful information. Lack of the integrated IS for collecting standard data causes undesirable effects on exchanging, comparing, and managing. The aim of this study was to recognize the role of the IS in the MS management and determine the advantages and barriers in implementing of the MSIS. The present study was a nonsystematized review that was done in order to recognize the role of the IS in the MS management. In this study, electronic scientific resources such as scientific magazines and books and published topics at conferences were used. We used key words (IS, chronic disease management, and multiple sclerosis), their combination or their synonyms in title, key words, abstracts, and text of English articles and published reports from 1980 until 2013, and by using search engines such as Google, Google Scholar and scientific databases and electronic issues such as iPubMed, sufficiently important difference, Scopus, Medlib, and Magiran for gathering information. More than 200 articles and reports were collected and assessed and 139 of them. Findings showed that the MSIS can reduce of disease expenses through continuously collecting correct, accurate, sufficient, and timely patients and disease nature information; recoding; editing; processing; exchanging, and distributing among different health care centers. Although the MSIS has many advantages; but, we cannot ignore cultural, economic, technical, organizational, and managerial barriers. Therefore, it is necessary to do studies for preventing, reducing, and controlling them. One of the ways is to recognize the advantages of the MSIS and usage information technology in optimizing disease management. PMID:25709660

  15. The role of information system in multiple sclerosis management

    PubMed Central

    Ajami, Sima; Ahmadi, Golchehreh; Etemadifar, Masoud

    2014-01-01

    Multiple sclerosis (MS) is a chronic disease of central nervous system. The multiple sclerosis information system (MSIS), such as other information system (IS), depends on identification, collection and processing of data for producing useful information. Lack of the integrated IS for collecting standard data causes undesirable effects on exchanging, comparing, and managing. The aim of this study was to recognize the role of the IS in the MS management and determine the advantages and barriers in implementing of the MSIS. The present study was a nonsystematized review that was done in order to recognize the role of the IS in the MS management. In this study, electronic scientific resources such as scientific magazines and books and published topics at conferences were used. We used key words (IS, chronic disease management, and multiple sclerosis), their combination or their synonyms in title, key words, abstracts, and text of English articles and published reports from 1980 until 2013, and by using search engines such as Google, Google Scholar and scientific databases and electronic issues such as iPubMed, sufficiently important difference, Scopus, Medlib, and Magiran for gathering information. More than 200 articles and reports were collected and assessed and 139 of them. Findings showed that the MSIS can reduce of disease expenses through continuously collecting correct, accurate, sufficient, and timely patients and disease nature information; recoding; editing; processing; exchanging, and distributing among different health care centers. Although the MSIS has many advantages; but, we cannot ignore cultural, economic, technical, organizational, and managerial barriers. Therefore, it is necessary to do studies for preventing, reducing, and controlling them. One of the ways is to recognize the advantages of the MSIS and usage information technology in optimizing disease management. PMID:25709660

  16. Sahra integrated modeling approach to address water resources management in semi-arid river basins

    SciTech Connect

    Springer, E. P.; Gupta, Hoshin V. ,; Brookshire, David S.; Liu, Y.

    2004-01-01

    Water resources decisions in the 21Sf Century that will affect allocation of water for economic and environmental will rely on simulations from integrated models of river basins. These models will not only couple natural systems such as surface and ground waters, but will include economic components that can assist in model assessments of river basins and bring the social dimension to the decision process. The National Science Foundation Science and Technology Center for Sustainability of semi-Arid Hydrology and Riparian Areas (SAHRA) has been developing integrated models to assess impacts of climate variability and land use change on water resources in semi-arid river basins. The objectives of this paper are to describe the SAHRA integrated modeling approach and to describe the linkage between social and natural sciences in these models. Water resources issues that arise from climate variability or land use change may require different resolution models to answer different questions. For example, a question related to streamflow may not need a high-resolution model whereas a question concerning the source and nature of a pollutant will. SAHRA has taken a multiresolution approach to integrated model development because one cannot anticipate the questions in advance, and the computational and data resources may not always be available or needed for the issue to be addressed. The coarsest resolution model is based on dynamic simulation of subwatersheds or river reaches. This model resolution has the advantage of simplicity and social factors are readily incorporated. Users can readily take this model (and they have) and examine the effects of various management strategies such as increased cost of water. The medium resolution model is grid based and uses variable grid cells of 1-12 km. The surface hydrology is more physically based using basic equations for energy and water balance terms, and modules are being incorporated that will simulate engineering components

  17. Using Self-Management Interventions to Address General Education Behavioral Needs: Assessment of Effectiveness and Feasibility

    ERIC Educational Resources Information Center

    Briesch, Amy M.; Daniels, Brian

    2013-01-01

    A comprehensive self-management intervention was utilized to increase the on-task behavior of three African American students within an urban middle-school setting. The intervention was designed to necessitate minimal management on the part of the general education classroom teacher by utilizing an electronic prompting device, as well as a…

  18. Using Dimensional Data to Address Enrollment Management Questions in Higher Education

    ERIC Educational Resources Information Center

    Duniway, Bob; Wiegand, Karl

    2009-01-01

    Enrollment management is central to the success of a college or university. A school must enroll students into courses, completion of a series of which will lead to graduation. While all colleges and universities must manage the enrollment process at least operationally, it is challenging to keep track of all the related data that would allow for…

  19. Insights into the Interactions between Educational Messages: Looking across Multiple Organizations Addressing Water Issues in Maricopa County, Arizona

    ERIC Educational Resources Information Center

    Cutts, Bethany; Saltz, Charlene; Elser, Monica

    2008-01-01

    The public receives environmental information from a variety of sources. Evaluation of a single program or one organization's effort is incomplete. Through surveys and interviews, we evaluate the cumulative impact of outreach by 20 water-related organizations in Maricopa County, Arizona. Household water conservation is a topic addressed by 18…

  20. Summary of technical information and agreements from Nuclear Management and Resources Council industry reports addressing license renewal

    SciTech Connect

    Regan, C.; Lee, S.; Chopra, O.K.; Ma, D.C.; Shack, W.J.

    1996-10-01

    In about 1990, the Nuclear Management and Resources Council (NUMARC) submitted for NRC review ten industry reports (IRs) addressing aging issues associated with specific structures and components of nuclear power plants ad one IR addressing the screening methodology for integrated plant assessment. The NRC staff had been reviewing the ten NUMARC IRs; their comments on each IR and NUMARC responses to the comments have been compiled as public documents. This report provides a brief summary of the technical information and NUMARC/NRC agreements from the ten IRs, except for the Cable License Renewal IR. The technical information and agreements documented herein represent the status of the NRC staffs review when the NRC staff and industry resources were redirected to address rule implementation issues. The NRC staff plans to incorporate appropriate technical information and agreements into the draft standard review plan for license renewal.

  1. Perioperative management of patient with alkaptonuria and associated multiple comorbidities

    PubMed Central

    Pandey, Ravindra; Kumar, Anil; Garg, Rakesh; Khanna, Puneet; Darlong, Vanlal

    2011-01-01

    Alkaptonuria is a rare inherited genetic disorder of tyrosine metabolism characterized by a triad of homogentisic aciduria, ochronosis, and arthritis. The most common clinical manifestations of ochronosis involve the musculoskeletal, respiratory, airway, cardiovascular, genitourinary, cutaneous, and ocular systems. We report the perioperative anesthetic management of a 56-year-old alkaptonuric patient, with multiple comorbidities scheduled, for revision total hip replacement. A review of her medical history revealed alkaptonuria, hypothyroidism, rheumatoid arthritis, hypertension, diabetes mellitus, and Pott's spine with disc prolapse. We want to highlight the need of thorough preoperative evaluation in patients of alkaptonuria, as it is associated with multiple comorbidities. The systemic involvement should determine the anesthetic plan. Caution should be exercised during positioning to prevent injury to the joints and the spine. PMID:21772695

  2. MACSIMS : multiple alignment of complete sequences information management system

    PubMed Central

    Thompson, Julie D; Muller, Arnaud; Waterhouse, Andrew; Procter, Jim; Barton, Geoffrey J; Plewniak, Frédéric; Poch, Olivier

    2006-01-01

    Background In the post-genomic era, systems-level studies are being performed that seek to explain complex biological systems by integrating diverse resources from fields such as genomics, proteomics or transcriptomics. New information management systems are now needed for the collection, validation and analysis of the vast amount of heterogeneous data available. Multiple alignments of complete sequences provide an ideal environment for the integration of this information in the context of the protein family. Results MACSIMS is a multiple alignment-based information management program that combines the advantages of both knowledge-based and ab initio sequence analysis methods. Structural and functional information is retrieved automatically from the public databases. In the multiple alignment, homologous regions are identified and the retrieved data is evaluated and propagated from known to unknown sequences with these reliable regions. In a large-scale evaluation, the specificity of the propagated sequence features is estimated to be >99%, i.e. very few false positive predictions are made. MACSIMS is then used to characterise mutations in a test set of 100 proteins that are known to be involved in human genetic diseases. The number of sequence features associated with these proteins was increased by 60%, compared to the features available in the public databases. An XML format output file allows automatic parsing of the MACSIM results, while a graphical display using the JalView program allows manual analysis. Conclusion MACSIMS is a new information management system that incorporates detailed analyses of protein families at the structural, functional and evolutionary levels. MACSIMS thus provides a unique environment that facilitates knowledge extraction and the presentation of the most pertinent information to the biologist. A web server and the source code are available at . PMID:16792820

  3. Surgical management of complete penile duplication accompanied by multiple anomalies

    PubMed Central

    Karaca, Irfan; Turk, Erdal; Ucan, A. Basak; Yayla, Derya; Itirli, Gulcin; Ercal, Derya

    2014-01-01

    Diphallus (penile duplication) is very rare and seen once every 5.5 million births. It can be isolated, but is usually accompanied by other congenital anomalies. Previous studies have reported many concurrent anomalies, such as bladder extrophy, cloacal extrophy, duplicated bladder, scrotal abnormalities, hypospadias, separated symphysis pubis, intestinal anomalies and imperforate anus; no penile duplication case accompanied by omphalocele has been reported. We present the surgical management of a patient with multiple anomalies, including complete penile duplication, hypo-gastric omphalocele and extrophic rectal duplication. PMID:25408817

  4. Addressing Bullying Problems in Irish Schools and in Cyberspace: A Challenge for School Management

    ERIC Educational Resources Information Center

    Corcoran, Lucie; Mc Guckin, Conor

    2014-01-01

    Background: School management, in Ireland and also internationally, are currently faced with the problem of peer aggression among students both in a traditional school context and in a cyber context. Although Irish school principals are obliged to implement policy and procedures to counter bullying among students, there is a need for guidance that…

  5. "Advances in Coupled Air Quality, Farm Management and Biogeochemistry to address bidirectional ammonia flux"

    EPA Science Inventory

    A cropland farm management modeling system for regional air quality and field-scale applications of bi-directional ammonia exchange was presented at ITM XXI. The goal of this research is to improve estimates of nitrogen deposition to terrestrial and aquatic ecosystems and ambien...

  6. Best Practices in Community Garden Management to Address Participation, Water Access, and Outreach

    ERIC Educational Resources Information Center

    Drake, Luke; Lawson, Laura

    2015-01-01

    As community gardens expand across the U.S., Extension professionals can support them not only in horticultural education but also in planning and organization. Knowledge of community garden management is helpful in this regard. Existing research focuses on outcomes and criteria for successful gardens, but is less clear about how community gardens…

  7. The Gender Mix Policy--Addressing Gender Inequality in Higher Education Management

    ERIC Educational Resources Information Center

    Peterson, Helen

    2011-01-01

    Drawing on quantitative and qualitative data, this article highlights the increasing proportion of women in senior academic management positions in Swedish higher education between 1990 and 2010. The article uncovers some of the factors that account for women's successful entrance into these positions. According to 22 interviewed female senior…

  8. 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

  9. Bone Disease in Multiple Myeloma: Pathophysiology and Management

    PubMed Central

    Hameed, Abdul; Brady, Jennifer J; Dowling, Paul; Clynes, Martin; O’Gorman, Peter

    2014-01-01

    Myeloma bone disease (MBD) is a devastating complication of multiple myeloma (MM). More than 80% of MM patients suffer from destructive bony lesions, leading to pain, fractures, mobility issues, and neurological deficits. MBD is not only a main cause of disability and morbidity in MM patients but also increases the cost of management. Bone destruction and lack of bone formation are main factors in the development of MBD. Some novel factors are found to be involved in the pathogenesis of MBD, eg, receptor activator of nuclear factor kappa-B ligand (RANKL), osteoprotegerin (OPG) system (RANKL/OPG), Wingless (Wnt), dickkopf-1 (Wnt/DKK1) pathway. The addition of novel agents in the treatment of MM, use of bisphosphonates and other supportive modalities such as radiotherapy, vertebroplasty/kyphoplasty, and surgical interventions, all have significant roles in the treatment of MBD. This review provides an overview on the pathophysiology and management of MBD. PMID:25187738

  10. Evolving expectations around early management of multiple sclerosis

    PubMed Central

    Gold, Ralf; Wolinsky, Jerry S.; Amato, Maria Pia; Comi, Giancarlo

    2010-01-01

    Multiple sclerosis is a progressive inflammatory disease of the central nervous system. With prevention or at least delay of disease progression as a key target in the management of multiple sclerosis, current opinion on treatment encourages early intervention with well-tolerated disease-modifying treatments in order to optimize long-term clinical outcomes. Patients presenting with a clinically isolated syndrome (CIS) may progress to clinically definite multiple sclerosis, and clinical trials have demonstrated that early treatment with interferon beta can reduce the conversion rate. Cognitive impairment may already be present in patients with CISs. Today there is evolving evidence that cognitive impairment may be relevant for prognosis and that early treatment with interferon beta may also have a protective effect on the cognitive function. As an accumulation of neuronal loss is now considered to underlie the development of persistent disability in multiple sclerosis, it is crucial that treatment can protect against neuronal damage. In addition to its anti-inflammatory activity, interferon beta may have direct and indirect neuroprotective effects, and several studies have explored the role of interferon beta in regulating neuroprotective factors. With over 15 years of clinical experience as evidence, the long-term safety and efficacy of interferon beta treatment is unquestionable. Results from the CIS studies have demonstrated the high percentage of patients converting to clinically definite multiple sclerosis without treatment and the short- and long-term benefits of an early use of disease-modifying treatments. These findings support starting disease-modifying treatment as soon as the diagnosis of MS is reasonably formulated. PMID:21179596

  11. Managing Responsive Behaviours: A Wicked Problem Addressed through a Grassroots Approach.

    PubMed

    Brémault-Phillips, Suzette; Friesen, Steven; Moulton, Lynne; Germani, Tamara; Miciak, Maxi; Parmar, Jasneet; Rogers, Laura G

    2015-01-01

    Challenging responsive behaviours, such as aggression, wandering and social inappropriateness, exhibited by persons with neurological, mental health or developmental disorders are of increasing concern across Canada. These behaviours can cause distress or catastrophic outcomes for the person, others in care, caregivers and healthcare providers, and result in extensive resource utilization. The objective of this paper is to discuss the role and impact of a unique, grassroots provincial initiative aimed at networking among healthcare providers, decision-makers and caregivers across government ministries and service-provider agencies. This collaboration provides a model for informing service provision and policy development across multiple stakeholders. PMID:26358998

  12. Managing aquatic ecosystems and water resources under multiple stress--an introduction to the MARS project.

    PubMed

    Hering, Daniel; Carvalho, Laurence; Argillier, Christine; Beklioglu, Meryem; Borja, Angel; Cardoso, Ana Cristina; Duel, Harm; Ferreira, Teresa; Globevnik, Lidija; Hanganu, Jenica; Hellsten, Seppo; Jeppesen, Erik; Kodeš, Vit; Solheim, Anne Lyche; Nõges, Tiina; Ormerod, Steve; Panagopoulos, Yiannis; Schmutz, Stefan; Venohr, Markus; Birk, Sebastian

    2015-01-15

    Water resources globally are affected by a complex mixture of stressors resulting from a range of drivers, including urban and agricultural land use, hydropower generation and climate change. Understanding how stressors interfere and impact upon ecological status and ecosystem services is essential for developing effective River Basin Management Plans and shaping future environmental policy. This paper details the nature of these problems for Europe's water resources and the need to find solutions at a range of spatial scales. In terms of the latter, we describe the aims and approaches of the EU-funded project MARS (Managing Aquatic ecosystems and water Resources under multiple Stress) and the conceptual and analytical framework that it is adopting to provide this knowledge, understanding and tools needed to address multiple stressors. MARS is operating at three scales: At the water body scale, the mechanistic understanding of stressor interactions and their impact upon water resources, ecological status and ecosystem services will be examined through multi-factorial experiments and the analysis of long time-series. At the river basin scale, modelling and empirical approaches will be adopted to characterise relationships between multiple stressors and ecological responses, functions, services and water resources. The effects of future land use and mitigation scenarios in 16 European river basins will be assessed. At the European scale, large-scale spatial analysis will be carried out to identify the relationships amongst stress intensity, ecological status and service provision, with a special focus on large transboundary rivers, lakes and fish. The project will support managers and policy makers in the practical implementation of the Water Framework Directive (WFD), of related legislation and of the Blueprint to Safeguard Europe's Water Resources by advising the 3rd River Basin Management Planning cycle, the revision of the WFD and by developing new tools for

  13. DOI Climate Science Centers--Regional science to address management priorities

    USGS Publications Warehouse

    O'Malley, Robin

    2012-01-01

    Our Nation's lands, waters, and ecosystems and the living and cultural resources they contain face myriad challenges from invasive species, the effects of changing land and water use, habitat fragmentation and degradation, and other influences. These challenges are compounded by increasing influences from a changing climate—higher temperatures, increasing droughts, floods, and wildfires, and overall increasing variability in weather and climate. The Department of the Interior (DOI) has established eight regional Climate Science Centers (CSC) (fig. 1) that will provide scientific information and tools to natural and cultural resource managers as they plan for conserving these resources in a changing world. The U.S. Geological Survey (USGS) National Climate Change and Wildlife Science Center (NCCWSC) is managing the CSCs on behalf of the DOI.

  14. Intent, Capability and Opportunity: A Holistic Approach to Addressing Proliferation as a Risk Management Issue

    SciTech Connect

    Amanda Rynes; Trond Bjornard

    2011-07-01

    Currently, proliferation risk assessment models are designed to evaluate only a portion of the overall risk, focusing exclusively on either technological or social factors to determine the extent of a threat. Many of these models are intended to act as a means of predicting proliferation potential rather than assessing the system as a whole, ignoring the ability to enhance mitigating factors and manage, rather just establish the presence of, the threat. While the information garnered through these forms of analysis is necessary, it remains incomplete. By incorporating political, social, economic and technical capabilities as well as human factors such as intent into a single, multi-faceted risk management model, proliferation risk can be evaluated more effectively. Framing this information around how to improve and expand the Regime already in place and establishing where there are gaps in the system allows for a more complete approach to risk management, mitigation and resource allocation. The research conducted here seeks to combine all three elements (intent, capability and opportunity) in a comprehensive evaluation which incorporates an assessment of state-level variables, possible proliferation pathways and technical capability. Each portion of the analysis is carried out independently then combined to illustrate the full scope of a State's nuclear infrastructure while showing areas of weakness in the institutional framework.

  15. "A Group of Me's": Adult Learning through Group Process: The Experiences of Participants in a Teleconference Delivered Multiple Sclerosis Fatigue Management Program

    ERIC Educational Resources Information Center

    Preissner, Katharine L.

    2013-01-01

    Multiple sclerosis (MS) is a chronic, progressive neurological disorder that affects approximately 2.1 million people worldwide. Fatigue is one of the most common and most disabling symptoms of MS. One well-established approach to address fatigue is fatigue management education provided by an occupational therapist. Fatigue management education is…

  16. Improving the Pharmacologic Management of Pain in Older Adults: Identifying the Research Gaps and Methods to Address Them

    PubMed Central

    Reid, M. C.; Bennett, David A.; Chen, Wen G.; Eldadah, Basil A.; Farrar, John T.; Ferrell, Bruce; Gallagher, Rollin M.; Hanlon, Joseph T.; Herr, Keela; Horn, Susan D.; Inturrisi, Charles E.; Lemtouni, Salma; Lin, Yu Woody; Michaud, Kaleb; Morrison, R. Sean; Neogi, Tuhina; Porter, Linda L.; Solomon, Daniel H.; Von Korff, Michael; Weiss, Karen; Witter, James; Zacharoff, Kevin L.

    2011-01-01

    Objective There has been a growing recognition of the need for better pharmacologic management of chronic pain among older adults. To address this need, the National Institutes of Health Pain Consortium sponsored an “Expert Panel Discussion on the Pharmacological Management of Chronic Pain in Older Adults” conference in September, 2010, to identify research gaps and strategies to address them. Specific emphasis was placed on ascertaining gaps regarding use of opioid and non-steroidal anti-inflammatory medications because of continued uncertainties regarding their risks and benefits. Design Eighteen panel members provided oral presentations; each was followed by a multidisciplinary panel discussion. Meeting transcripts and panelists’ slide presentations were reviewed to identify the gaps, and the types of studies and research methods panelists suggested could best address them. Results Fifteen gaps were identified in the areas of treatment(e.g., uncertainty regarding the long-term safety and efficacy of commonly prescribed analgesics), epidemiology (e.g., lack of knowledge regarding the course of common pain syndromes), and implementation(e.g., limited understanding of optimal strategies to translate evidence-based pain treatments into practice). Analyses of data from electronic health care databases, observational cohort studies, and ongoing cohort studies (augmented with pain and other relevant outcomes measures) were felt to be practical methods for building an age-appropriate evidence base to improve the pharmacologic management of pain in later life. Conclusions Addressing the gaps presented in the current report was judged by the panel to have substantial potential to improve the health and well being of older adults with chronic pain. PMID:21834914

  17. Multiple Sclerosis Relapses: Epidemiology, Outcomes and Management. A Systematic Review.

    PubMed

    Kalincik, Tomas

    2015-01-01

    Relapses (episodic exacerbations of neurological signs or symptoms) are a defining feature of relapsing-remitting multiple sclerosis (MS), the most prevalent MS phenotype. While their diagnostic value relates predominantly to the definition of clinically definite MS, their prognostic value is determined by their relatively high associated risk of incomplete remission resulting in residual disability. The mechanisms governing a relapse incidence are unknown, but numerous modifiers of relapse risk have been described, including demographic and clinical characteristics, many of which represent opportunities for improved disease management. Also relapse phenotypes have been associated with patient and disease characteristics and an individual predisposition to certain phenotypic presentations may imply individual neuroanatomical disease patterns. While immunomodulatory therapies and corticosteroids represent the mainstay of relapse prevention and acute management, respectively, their effect has only been partial and further search for more efficient relapse therapies is warranted. Other areas of research include pathophysiology and determinants of relapse incidence, recurrence and phenotypes, including the characteristics of the relapsing and non-relapsing multiple sclerosis variants and their responsiveness to therapies. PMID:25997994

  18. Building non-traditional collaborations to innovatively address climate-related scientific and management needs

    NASA Astrophysics Data System (ADS)

    Bamzai, A.; Mcpherson, R. A.

    2014-12-01

    The South Central Climate Science Center (SC-CSC) is one of eight regional centers formed by the U.S. Department of the Interior in order to provide decision makers with the science, tools, and information they need to address the impacts of climate variability and change on their areas of responsibility. The SC-CSC is operated through the U.S. Geological Survey, in partnership with a consortium led by the University of Oklahoma that also includes Texas Tech University, Oklahoma State University, Louisiana State University, the Chickasaw Nation, the Choctaw Nation of Oklahoma, and NOAA's Geophysical Fluid Dynamics Lab (GFDL). The SC-CSC is distinct from all other CSCs in that we have strategically included non-traditional collaborators directly within our governing consortium. The SC-CSC is the only CSC to include any Tribal nations amongst our consortium (the Chickasaw Nation and the Choctaw Nation of Oklahoma) and to employ a full-time tribal liaison. As a result and in partnership with Tribes, we are able to identify the unique challenges that the almost 70 federally recognized Tribes within our region face. We also can develop culturally sensitive research projects or outreach efforts that bridge western science and traditional knowledge to address their needs. In addition, the SC-CSC is the only CSC to include another federal institution (GFDL) amongst our consortium membership. GFDL is a world-leader in climate modeling and model interpretation. Partnering GFDL's expertise in the evaluation of climate models and downscaling methods with the SC-CSC's stakeholder-driven approach allows for the generation and dissemination of guidance documents and training to accompany the high quality datasets already in development. This presentation will highlight the success stories and co-benefits of the SC-CSC's collaborations with Tribal nations and with GFDL, as well as include information on how other partners can connect to our ongoing efforts.

  19. Addressing information management and dissemination challenges for the next generation analyst

    NASA Astrophysics Data System (ADS)

    Kovach, Jesse; Sadler, Laurel; Suri, Niranjan; Winkler, Robert

    2015-05-01

    Recent technological advances in the areas of sensors, computation, and storage have led to the development of relatively inexpensive sensors that have been deployed on a wide scale and are able to generate large volumes of data. However, tactical networks have not been able to keep pace in terms of their ability to transfer all of the sensor data from the edge to an operations center for analysis. This paper explores multiple techniques to help bridge this gap, by using a three-pronged approach based on value of information-based dissemination, active sensor query capabilities, and anomaly detection mechanisms. These capabilities are being integrated into an open-source sensor platform deployed in a testbed environment for evaluation purposes.

  20. Essential trauma management training: addressing service delivery needs in active conflict zones in eastern Myanmar

    PubMed Central

    Richard, Allison J; Lee, Catherine I; Richard, Matthew G; Oo, Eh Kalu Shwe; Lee, Thomas; Stock, Lawrence

    2009-01-01

    Introduction Access to governmental and international nongovernmental sources of health care within eastern Myanmar's conflict regions is virtually nonexistent. Historically, under these circumstances effective care for the victims of trauma, particularly landmine injuries, has been severely deficient. Recognizing this, community-based organizations (CBOs) providing health care in these regions sought to scale up the capacity of indigenous health workers to provide trauma care. Case description The Trauma Management Program (TMP) was developed by CBOs in cooperation with a United States-based health care NGO. The goal of the TMP is to improve the capacity of local health workers to deliver effective trauma care. From 2000 to the present, international and local health care educators have conducted regular workshops to train indigenous health workers in the management of landmine injuries, penetrating and blunt trauma, shock, wound and infection care, and orthopedics. Health workers have been regularly resupplied with the surgical instruments, supplies and medications needed to provide the care learnt through TMP training workshops. Discussion and Evaluation Since 2000, approximately 300 health workers have received training through the TMP, as part of a CBO-run health system providing care for approximately 250 000 internally displaced persons (IDPs) and war-affected residents. Based on interviews with health workers, trauma registry inputs and photo/video documentation, protocols and procedures taught during training workshops have been implemented effectively in the field. Between June 2005 and June 2007, more than 200 patients were recorded in the trauma patient registry. The majority were victims of weapons-related trauma. Conclusion This report illustrates a method to increase the capacity of indigenous health workers to manage traumatic injuries. These health workers are able to provide trauma care for otherwise inaccessible populations in remote and

  1. Clinical Management of Obesity in Women: Addressing a Lifecycle of Risk.

    PubMed

    Ahmad, Nadia N; Butsch, Winfield Scott; Aidarous, Sabina

    2016-06-01

    The World Health Organization estimates that nearly 2 billion people worldwide are overweight, 600 million of whom are obese. The increasing prevalence of this condition in women is of particular concern given its impact on reproductive health and mortality. Burgeoning data implicating maternal obesity in fetal programming and the metabolic health of future generations further suggest that obesity in women is one of the most pressing public health concerns of the twenty-first century. However, health care professionals are infrequently engaged in obesity management. This article provides a conceptual understanding of obesity and a rational approach to treatment. PMID:27212089

  2. Collaborations, research, and adaptive management to address nonnative Phragmites australis in the Great Lakes Basin

    USGS Publications Warehouse

    Kowalski, Kurt P.

    2016-01-01

    Phragmites australis, also known as common reed, is a native North American wetland grass that has grown in North America for thousands of years. More recently, a nonnative, invasive variety of Phragmites from Eurasia is rapidly invading wetlands across the continental United States and other parts of North America, where it negatively impacts humans and the environment. U.S. Geological Survey scientists, funded by the Great Lakes Restoration Initiative, are leading innovative efforts to improve management of nonnative Phragmites in the Great Lakes Basin.

  3. Addressing astronomy misconceptions and achieving national science standards utilizing aspects of multiple intelligences theory in the classroom and the planetarium

    NASA Astrophysics Data System (ADS)

    Sarrazine, Angela Renee

    The purpose of this study was to incorporate multiple intelligences techniques in both a classroom and planetarium setting to create a significant increase in student learning about the moon and lunar phases. Utilizing a free-response questionnaire and a 25 item multiple choice pre-test/post-test design, this study identified middle school students' misconceptions and measured increases in student learning about the moon and lunar phases. The study spanned two semesters and contained six treatment groups which consisted of both single and multiple interventions. One group only attended the planetarium program. Two groups attended one of two classes a week prior to the planetarium program, and two groups attended one of two classes a week after the planetarium program. The most rigorous treatment group attended a class both a week before and after the planetarium program. Utilizing Rasch analysis techniques and parametric statistical tests, all six groups exhibited statistically significant gains in knowledge at the 0.05 level. There were no significant differences between students who attended only a planetarium program versus a single classroom program. Also, subjects who attended either a pre-planetarium class or a post- planetarium class did not show a statistically significant gain over the planetarium only situation. Equivalent effects on student learning were exhibited by the pre-planetarium class groups and post-planetarium class groups. Therefore, it was determined that the placement of the second intervention does not have a significant impact on student learning. However, a decrease in learning was observed with the addition of a third intervention. Further instruction and testing appeared to hinder student learning. This is perhaps an effect of subject fatigue.

  4. Technical Reference Suite Addressing Challenges of Providing Assurance for Fault Management Architectural Design

    NASA Technical Reports Server (NTRS)

    Fitz, Rhonda; Whitman, Gerek

    2016-01-01

    Research into complexities of software systems Fault Management (FM) and how architectural design decisions affect safety, preservation of assets, and maintenance of desired system functionality has coalesced into a technical reference (TR) suite that advances the provision of safety and mission assurance. The NASA Independent Verification and Validation (IVV) Program, with Software Assurance Research Program support, extracted FM architectures across the IVV portfolio to evaluate robustness, assess visibility for validation and test, and define software assurance methods applied to the architectures and designs. This investigation spanned IVV projects with seven different primary developers, a wide range of sizes and complexities, and encompassed Deep Space Robotic, Human Spaceflight, and Earth Orbiter mission FM architectures. The initiative continues with an expansion of the TR suite to include Launch Vehicles, adding the benefit of investigating differences intrinsic to model-based FM architectures and insight into complexities of FM within an Agile software development environment, in order to improve awareness of how nontraditional processes affect FM architectural design and system health management.

  5. The role of high frequency monitoring in understanding nutrient pollution processes to address catchment management issues

    NASA Astrophysics Data System (ADS)

    Quinn, Paul; Jonczyk, Jennine; Owen, Gareth; Barber, Nick; Adams, Russell; ODonnell, Greg; EdenDTC Team

    2015-04-01

    The process insights afforded to catchment scientists through the availability of high frequency time series of hydrological and nutrient pollution datasets are invaluable. However, the observations reveal both good and bad news for the WFD. Data for flow, N, P and sediment (taken at 30 min intervals) from the River Eden Demonstration Test Catchment and several other detailed UK studies, will be used to discuss nutrient fluxes in catchments between 1km2 and 10km2. Monitoring of the seasonal groundwater status and the forensic analysis of numerous storm events have identified dominant flow pathways and nutrient losses. Nonetheless, many of the management questions demanded by the WFD will not be resolved by collecting these datasets alone. Long term trends are unlikely to be determined from these data and even if trends are found they are unlikely to be accurately apportioned to the activities that have caused them. The impacts of where and when an action takes place will not be detected at the catchment scale and the cost effectiveness of any mitigation method is unlikely to be quantifiable. Even in small well instrumented catchments the natural variability in rainfall, antecedent patterns and the variability in farming practices will mask any identifiable catchment scale signal. This does not mean the cost of the data acquisition has been wasted, it just means that the knowledge and expertise gained from these data should be used in new novel ways. It will always be difficult to quantify the actual losses occurring at the farm or field scale, but the positive benefits of any mitigation may still be approximated. The evidence for the rate of nutrient removal from a local sediment trap, wetland and a pond can be shown with high resolution datasets. However, any quantifiable results are still highly localised and the transfer and upscaling of any findings must be done with care. Modelling these datasets is also possible and the nature of models have evolved in the

  6. Addressing Cultural Contexts in the Management of Stress via Narrative and Mobile Technology.

    PubMed

    Lee, Matthew D; Kang, Xiao; Hanrahan, Nancy

    2014-01-01

    In developing applications for stress management and mental health, developers have largely ignored cultural context in design, opting instead to produce apps for a general audience. However, apps designed without a specific population in mind actually have limited reach. Generally stress trackers and socalled "therapists in your pocket", tend to be lost among a jungle of other generic apps that appeal only to the quantified self population and those already predisposed to help-seeking behavior. To reach a broader audience, designing for a specific population may have appeal. The AppHappy Project's Journey to the West is a mobile app being developed by a multidisciplinary group of students at the University of Pennsylvania. The objective is to promote better stress management and mental health among Asian international college students and facilitate their social integration with the general student population. With a prevalence of depression twice that of domestic college students, a reluctance to engage in help-seeking behavior due to stigma, and the challenge of cultural integration, creating interventions for this population requires a different approach to app-mediated therapy. Journey to the West packages bite-sized pieces of Cognitive Behavioral Therapy techniques within the framework of a role-playing game. Every element of its design-from its characters to its art style, from its narrative to its mechanics to its approach to community features-is rooted in a culturally appropriate context. An avatar serves as a surrogate of self while experiencing externalized stressors. Each quest blends therapeutic elements into gameplay with the goal of building resilience towards stressful events. PMID:24875715

  7. A telemonitoring tool based on serious games addressing money management skills for people with intellectual disability.

    PubMed

    Lopez-Basterretxea, Asier; Mendez-Zorrilla, Amaia; Garcia-Zapirain, Begonya

    2014-03-01

    This article presents a telemonitoring tool based on computer games, aimed at money management skill improvement for people with Intellectual Disabilities (ID). The presented tool is divided into two parts: on one hand, some training activities related to payments and currency discrimination based on Serious Games are proposed to the user using a multitouch device. On the other hand, the psychologists and specialist who work with them, can access to the Serious Games results using an online application in order to evaluate their evolution. The results are measured according to the number of errors they have during the proposed activities, the time they need to complete them and the score. The article show the results of an experiment made with a clinical sample of 12 users with ID between 12 and 15 years, taking into account that all of them are capable of correct oral communication and they do not have severe physical coordination problems. Only two users completed all the games without errors. Males obtained a mean of 28.25 errors, whereas females obtained a mean of 17.75. The results show significant difference between the selection of games 1, 2 or 3, because all of them prefer the game 1 related with "Payments" probably because it permits more interaction using the multitouch device. The authors also made a qualitative evaluation and the results have been very promising and satisfactory. PMID:24573223

  8. A Telemonitoring Tool based on Serious Games Addressing Money Management Skills for People with Intellectual Disability

    PubMed Central

    Lopez-Basterretxea, Asier; Mendez-Zorrilla, Amaia; Garcia-Zapirain, Begonya

    2014-01-01

    This article presents a telemonitoring tool based on computer games, aimed at money management skill improvement for people with Intellectual Disabilities (ID). The presented tool is divided into two parts: on one hand, some training activities related to payments and currency discrimination based on Serious Games are proposed to the user using a multitouch device. On the other hand, the psychologists and specialist who work with them, can access to the Serious Games results using an online application in order to evaluate their evolution. The results are measured according to the number of errors they have during the proposed activities, the time they need to complete them and the score. The article show the results of an experiment made with a clinical sample of 12 users with ID between 12 and 15 years, taking into account that all of them are capable of correct oral communication and they do not have severe physical coordination problems. Only two users completed all the games without errors. Males obtained a mean of 28.25 errors, whereas females obtained a mean of 17.75. The results show significant difference between the selection of games 1, 2 or 3, because all of them prefer the game 1 related with “Payments” probably because it permits more interaction using the multitouch device. The authors also made a qualitative evaluation and the results have been very promising and satisfactory. PMID:24573223

  9. Sativex for the management of multiple sclerosis symptoms.

    PubMed

    Perras C

    2005-09-01

    Sativex (R) is a cannabis-based pharmaceutical product containing delta 9-tetrahydrocannabinol (THC) and cannabidiol (CBD) in a 1:1 ratio, delivered in an oromucosal (mouth) spray. It has been approved as adjunctive treatment for neuropathic pain in patients with multiple sclerosis (MS). It is being investigated for the management of other MS symptoms, such as spasticity. THC:CBD spray is regulated as a narcotic. Five randomized controlled trials (RCTs) compared the benefits and harms of THC:CBD spray with placebo. A total of 368 patients with various neurological conditions (including MS) were recruited. In some trials, THC:CBD spray significantly reduced neuropathic pain, spasticity, muscle spasms and sleep disturbances. The most common adverse events (AEs) reported in trials were dizziness, sleepiness, fatigue, feeling of intoxication and a bad taste. Long-term safety and the potential for dependence, abuse, misuse and diversion are unknown. PMID:16317825

  10. Anaesthetic management in a patient with multiple sclerosis

    PubMed Central

    Kulkarni, Lata M; Sanikop, CS; Shilpa, HL; Vinayan, Anupama

    2011-01-01

    Multiple sclerosis (MS) is a rare autoimmune demyelinating disorder of the central nervous system clinically manifesting as periodic attacks of varied neurologic symptoms, eventually progressing to fixed neurologic deficits and disability. The treatment is symptomatic and directed towards prevention of future progression of the disease involving multiple agents. We present here a case report of a patient with MS who underwent an orthopaedic procedure under general anaesthesia (G.A.) uneventfully. Anaesthetic implications include assessment of neurological deficits with documentation pre- and postoperatively, awareness towards side-effects, potential drug interactions of medications, selection of suitable techniques/anaesthetic agents, neuromuscular monitoring-guided titration of non-depolarizing blocking agents with lowest necessary dose and avoidance of hyperthermia along with temperature, haemodynamic and respiratory monitoring. Lower concentrations of local anaesthetic (LA) should be used for regional blocks keeping in mind the susceptibility of demyelinated neurons, towards LA neurotoxicity. To the best of our knowledge, this is the first report of anaesthetic management of MS in India. PMID:21431057

  11. Advances in the management of multiple sclerosis symptoms: pathophysiology and assessment of spasticity in multiple sclerosis.

    PubMed

    Tintoré, Mar

    2015-01-01

    Spasticity is a prevalent and troublesome symptom for people with multiple sclerosis (MS). Common instruments to measure MS spasticity include the clinician-rated (modified) Ashworth scale and the patient-rated 0-10 spasticity Numerical Rating Scale (NRS). Current opinion is that measurement of MS spasticity should incorporate the patient's perspective. Other instruments to assess spasticity-associated symptoms such as the Penn spasms frequency scale, sleep quality NRS and pain NRS can assist in tracking MS spasticity evolution and inform management choices. Worsening spasticity reduces patient autonomy, impacts negatively on quality of life and increases health resource utilization and costs. Despite the wide range of issues associated with MS spasticity, undertreatment is common and standard treatment options (physiotherapy and classical oral therapies) often fail to provide adequate symptomatic control. PMID:26611266

  12. Nuances in the Management of Older People With Multiple Myeloma.

    PubMed

    Pawlyn, Charlotte; Gay, Francesca; Larocca, Alessandra; Roy, Vivek; Ailawadhi, Sikander

    2016-06-01

    Multiple myeloma is a disease of the elderly, with about a third of patients at diagnosis older than 75 years of age. Yet, the population of elderly patients is heterogeneous: older patients are more likely to have comorbidities and frailties complicating both their initial diagnosis and subsequent management, but these are not consistent across the group. Furthermore, patients with comorbidities and frailty are generally underrepresented in clinical trials. Despite the survival of myeloma patients increasing following the introduction of novel agents, older patients continue to have worse outcomes with increased treatment-related toxicity. Treatment tolerability is not defined by age alone, rather a combination of age, physical function, cognitive function, and comorbidities. These factors all influence patients' tolerability of treatment and therefore treatment efficacy and should also be considered when reviewing the results of clinical trials. It is the nuances of determining how these factors interact that should influence initial treatment and ongoing management decisions and these will be discussed here. PMID:27038805

  13. Stock enhancement to address multiple recreational fisheries objectives: an integrated model applied to red drum Sciaenops ocellatus in Florida.

    PubMed

    Camp, E V; Lorenzen, K; Ahrens, R N M; Allen, M S

    2014-12-01

    An integrated socioecological model was developed to evaluate the potential for stock enhancement with hatchery fishes to achieve socioeconomic and conservation objectives in recreational fisheries. As a case study, this model was applied to the red drum Sciaenops ocellatus recreational fishery in the Tampa Bay estuary, Florida, U.S.A. The results suggest that stocking of juvenile fish larger than the size at which the strongest density dependence in mortality occurs can help increase angler satisfaction and total fishing effort (socioeconomic objectives) but are likely to result in decreases to the abundance of wild fishes (a conservation objective). Stocking of small juveniles that are susceptible to density-dependent mortality after release does not achieve socioeconomic objectives (or only at excessive cost) but still leads to a reduction of wild fish abundance. The intensity and type of socioeconomic gains depended on assumptions of dynamic angler-effort responses and importance of catch-related satisfaction, with greatest gains possible if aggregate effort is responsive to increases in abundance and satisfaction that are greatly related to catch rates. These results emphasize the view of stock enhancement, not as a panacea but rather as a management tool with inherent costs that is best applied to recreational fisheries under certain conditions. PMID:25469950

  14. Addressing the Elephant in the Room: Nurse Manager Recognition of and Response to Nurse-to-Nurse Bullying.

    PubMed

    Gilbert, Rebecca T; Hudson, John S; Strider, David

    2016-01-01

    Health care bullying is a pervasive, underestimated, and underreported problem that results in poor outcomes for staff, patients, and health care organizations. The most common form of health care bullying occurs between nurses. Nurse managers hold an important role in the prevention and elimination of frontline nurse-to-nurse bullying. An anonymous Web-based survey was conducted to uncover what behaviors nurse managers perceive as bullying and how they respond to bullying acts. Respondents who had witnessed or been victimized by bullying were more apt to identify bullying and those who had been victimized or supervised nurses for more than 20 years were more prone to act upon bullying behaviors. There was only a moderate correlation between the identification of and response to bullying behaviors. Finally, overt bullying elicited a stronger response for intervention than covert bullying. Although nurse managers are well positioned to prevent and eliminate nurse-to-nurse bullying, they may not recognize it and often lack the skills and support necessary to address it. Decreases in nurse-to-nurse bullying reduce health care costs, improve nurse and patient satisfaction, and enhance patient outcomes. Therefore, nurse managers at all levels need education and support to ensure proper identification of bullying and, furthermore, to prevent and eliminate the behaviors. PMID:27259133

  15. A Social Media mHealth Solution to Address the Needs of Dengue Prevention and Management in Sri Lanka

    PubMed Central

    Rathnayake, Vajira Sampath; Lim, Gentatsu; Panchapakesan, Chitra; Foo, Schubert; Wijayamuni, Ruwan; Wimalaratne, Prasad; Fernando, Owen Noel Newton

    2016-01-01

    Background Sri Lanka has witnessed a series of dengue epidemics over the past five years, with the western province, home to the political capital of Colombo, bearing more than half of the dengue burden. Existing dengue monitoring prevention programs are exhausted as public health inspectors (PHIs) cope with increasing workloads and paper-based modes of surveillance and education, characterizing a reactive system unable to cope with the enormity of the problem. On the other hand, the unprecedented proliferation and affordability of mobile phones since 2009 and a supportive political climate have thus far remained unexploited for the use of mobile-based interventions for dengue management. Objective To conduct a needs assessment of PHIs in Colombo with respect to their dengue-related tasks and develop a new mobile-based system to address these needs while strengthening existing systems. Methods One-on-one in-depth interviews were conducted with 29 PHIs to a) gain a nuanced, in-depth understanding of the current state of surveillance practices, b) understand the logistical, technological and social challenges they confront, and c) identify opportunities for mobile-based interventions. Quantitative analysis included simple descriptive statistics while qualitative analysis comprised textual analysis of 209 pages of transcripts (or nearly 600 minutes of conversations) using grounded theory approaches. Results Current paper-based data collection practices for dengue surveillance involved a circuitous, time consuming process that could take between 7-10 days to officially report and record a single case. PHIs confronted challenges in terms of unreliable, standalone GIS devices, delays in registering mosquito breeding sites and lack of engagement from communities while delivering dengue education. These findings, in concert with a high motivation to use mobile-based systems, informed the development of Mo-Buzz, a mobile-based system that integrates three components

  16. Building organizational technical capabilities: a new approach to address the office of environmental management cleanup challenges in the 21. century

    SciTech Connect

    Fiore, J.J.; Rizkalla, E.I.

    2007-07-01

    The United States Department of Energy (DOE), Office of Environmental Management (EM) is responsible for the nations nuclear weapons program legacy wastes cleanup. The EM cleanup efforts continue to progress, however the cleanup continues to be technologically complex, heavily regulated, long-term, and a high life cycle cost estimate (LCCE) effort. Over the past few years, the EM program has undergone several changes to accelerate its cleanup efforts with varying degrees of success. Several cleanup projects continued to experience schedule delays and cost growth. The schedule delays and cost growth have been attributed to several factors such as changes in technical scope, regulatory and safety considerations, inadequacy of acquisition approach and project management. This article will briefly review the background and schools of thought on strategic management and organizational change practiced in the United States over the last few decades to improve an organisation's competitive edge and cost performance. The article will briefly review examples such as the change at General Electric, and the recent experience obtained from the nuclear industry, namely the long-term response to the 1986 Chernobyl accident. The long-term response to Chernobyl, though not a case of organizational change, could provide some insight in the strategic management approaches used to address people issues. The article will discuss briefly EM attempts to accelerate cleanup over the past few years, and the subsequent paradigm shift. The paradigm shift targets enhancing and/or creating organizational capabilities to achieve cost savings. To improve its ability to address the 21. century environmental cleanup challenges and achieve cost savings, EM has initiated new corporate changes to develop new and enhance existing capabilities. These new and enhanced organizational capabilities include a renewed emphasis on basics, especially technical capabilities including safety, project management

  17. Italian consensus conference for the outpatient autologous stem cell transplantation management in multiple myeloma.

    PubMed

    Martino, M; Lemoli, R M; Girmenia, C; Castagna, L; Bruno, B; Cavallo, F; Offidani, M; Scortechini, I; Montanari, M; Milone, G; Postacchini, L; Olivieri, A

    2016-08-01

    Multiple myeloma (MM) is the leading indication for autologous stem cell transplantation (ASCT) worldwide. The safety and efficacy of reducing hospital stay for MM patients undergoing ASCT have been widely explored, and different outpatient models have been proposed. However, there is no agreement on the criteria for selecting patients eligible for this strategy as well as the standards for their clinical management. On the basis of this rationale, the Italian Group for Stem Cell Transplantation (GITMO) endorsed a project to develop guidelines for the management of outpatient ASCT in MM, using evidence-based knowledge and consensus-formation techniques. An expert panel convened to discuss the currently available data on the practice of outpatient ASCT management and formulated recommendations according to the supporting evidence. Evidence gaps were filled with consensus-based statements. Three main topics were addressed: (1) the identification of criteria for selecting MM patients eligible for outpatient ASCT management; (2) the definition of standard procedures for performing outpatient ASCT (model, supportive care and monitoring during the aplastic phase); (3) the definition of the standard criteria and procedures for re-hospitalization during the aplastic phase at home. Herein, we report the summary and the results of the discussion and the consensus. PMID:27042841

  18. The design, implementation and acceptability of an integrated intervention to address multiple behavioral and psychosocial risk factors among pregnant African American women

    PubMed Central

    Katz, Kathy S; Blake, Susan M; Milligan, Renee A; Sharps, Phyllis W; White, Davene B; Rodan, Margaret F; Rossi, Maryann; Murray, Kennan B

    2008-01-01

    Background African American women are at increased risk for poor pregnancy outcomes compared to other racial-ethnic groups. Single or multiple psychosocial and behavioral factors may contribute to this risk. Most interventions focus on singular risks. This paper describes the design, implementation, challenges faced, and acceptability of a behavioral counseling intervention for low income, pregnant African American women which integrated multiple targeted risks into a multi-component format. Methods Six academic institutions in Washington, DC collaborated in the development of a community-wide, primary care research study, DC-HOPE, to improve pregnancy outcomes. Cigarette smoking, environmental tobacco smoke exposure, depression and intimate partner violence were the four risks targeted because of their adverse impact on pregnancy. Evidence-based models for addressing each risk were adapted and integrated into a multiple risk behavior intervention format. Pregnant women attending six urban prenatal clinics were screened for eligibility and risks and randomized to intervention or usual care. The 10-session intervention was delivered in conjunction with prenatal and postpartum care visits. Descriptive statistics on risk factor distributions, intervention attendance and length (i.e., with < 4 sessions considered minimal adherence) for all enrolled women (n = 1,044), and perceptions of study participation from a sub-sample of those enrolled (n = 152) are reported. Results Forty-eight percent of women screened were eligible based on presence of targeted risks, 76% of those eligible were enrolled, and 79% of those enrolled were retained postpartum. Most women reported a single risk factor (61%); 39% had multiple risks. Eighty-four percent of intervention women attended at least one session (60% attended ≥ 4 sessions) without disruption of clinic scheduling. Specific risk factor content was delivered as prescribed in 80% or more of the sessions; 78% of sessions were

  19. Pathophysiology, assessment and management of multiple sclerosis spasticity: an update.

    PubMed

    Haas, Judith

    2011-04-01

    Spasticity is one of the most common and disabling symptoms associated with multiple sclerosis (MS). MS spasticity occurs through both myelin and nerve fiber (axonal) degradation, which commence in the early stages of the disease. More than 80% of MS patients experienced spasticity in a large UK survey, with more than 50% of patients reporting their spasticity to be `moderate' or `severe'. Data from a large US registry show that patients with moderate-to-severe MS spasticity experience levels of disability that correlate closely with being wheelchair-bound and/or bedridden. The Ashworth scale is the most commonly used scale for assessing the degree of MS spasticity. However, the validity, reliability and sensitivity of this scale have been challenged and it is not considered an ideal scale for assessing the severity of MS spasticity. The numerical rating scale, a well-established standard pain assessment tool, provides a reliable, valid and simplified scale for patient self-rated assessment of the mean level of spasticity over the previous 24 h (0 = no spasticity, 10 = worst possible spasticity). According to data from the German MS Register, almost a third of MS patients with spasticity were untreated. Despite the availability of oral agents for generalized spasticity (often used in conjunction with physical/rehabilitation management strategies), including baclofen, tizanidine, dantrolene and gabapentin, there is limited clinical evidence to support their use and there is a need for improved and better tolerated pharmacological therapies for MS spasticity. The endocannabinoid system modulator, Sativex(®) (nabiximols, USAN name), provides an alternative therapeutic approach in the management of MS spasticity. PMID:21449853

  20. Operation Castle Cascade: managing multiple casualties from a simulated chemical weapons attack.

    PubMed

    Siegel, David; Younggren, Bradley N; Ness, Brian; Kvool, Valerie

    2003-05-01

    In the wake of the recent terrorist attack on the United States, there is an ever-increasing need for the defense against weapons of mass destruction. The use of explosive devices in combination with chemical agents could result in a community disaster with multiple traumatic and medical injuries. Military medical personnel may be the first called upon due to their unique training and equipment. Operation Castle Cascade was a large-scale exercise on a military instillation involving the apprehension of hostages and detonation of an explosive device containing dimethyl sulfate. We will provide details on the medical management of 50 patients with simulated chemical and traumatic injuries. Issues relating to on-site chemical identification, triage, decontamination, treatment, casualty collection, and transportation of casualties are addressed in this article. PMID:12775167

  1. Advances in the management of multiple sclerosis spasticity: multiple sclerosis spasticity guidelines.

    PubMed

    Gold, Ralf; Oreja-Guevara, Celia

    2013-12-01

    Symptomatic therapy of multiple sclerosis (MS) is an important part of a comprehensive treatment plan that aims to improve patients' quality of life. In the current era of medical progress, several factors have led to the development of guidelines for MS management. There is continued need for an evidence-based approach supported by high-quality data from controlled clinical trials. Most healthcare systems require this approach and include it in the reimbursement process. Guidelines are usually committed by national or continental neurological societies. The Spanish Society of Neurology demyelinating diseases working group has developed a consensus document on spasticity in patients with MS. MS experts from the group used the metaplan method to sum up the most important recommendations about spasticity for inclusion in the guidance. Recommendations were classified according to the Scottish Intercollegiate Guidelines Network system and approved by all members of the group. In Germany, the guideline panel of the German Neurological Society endorsed the national competence network for multiple sclerosis (Krankheitsbezogenes Kompetenznetz Multiple Sklerose) to update the existing recommendations. The most recent fifth edition of the guidelines (dated April 2012) now also includes recommendations for treatment of key symptoms such as spasticity. More than 30 MS neurologists contributed to the new edition reflecting the need for broad expertise. After a first round in which key topics were defined, a web-based decision process was undertaken to further develop individual topics such as symptomatic therapy. The draft manuscript was reviewed once again by the group prior to submission to the official review process. The aims of spasticity treatment are to improve mobility and dexterity, achieve physiological movement patterns, reduce pain, facilitate nursing measures and avoid complications such as contractures. Representative antispasticity medications include baclofen

  2. Secure and efficient health data management through multiple watermarking on medical images.

    PubMed

    Giakoumaki, A; Pavlopoulos, S; Koutsouris, D

    2006-08-01

    The landscape of healthcare delivery and medical data management has significantly changed over the last years, as a result of the significant advancements in information and communication technologies. Complementary and/or alternative solutions are needed to meet the new challenges, especially regarding security of the widely distributed sensitive medical information. Digital watermarking is a recently established research area with many applications; nevertheless, the potential of this technology to contribute value-added services to medical information management systems has only recently started to be realized by the research community. The paper presents a review of research efforts in the area of medical-oriented watermarking and proposes a wavelet-based multiple watermarking scheme; this scheme aims to address critical health information management issues, including origin and data authentication, protection of sensitive data, and image archiving and retrieval. In accordance with the strict limitations applying to medical images, the scheme allows the definition of a region of interest (ROI) whose diagnostic value is protected, since the only additional information embedded therein aims at integrity control. The robustness of the method is enhanced through a form of hybrid coding, which includes repetitive embedding of BCH encoded watermarks. The experimental results on different medical imaging modalities demonstrate the efficiency and transparency of the watermarking scheme. PMID:16937204

  3. A multiple metrics approach to prioritizing strategies for measuring and managing reactive nitrogen in the San Joaquin Valley of California

    NASA Astrophysics Data System (ADS)

    Horowitz, Ariel I.; Moomaw, William R.; Liptzin, Daniel; Gramig, Benjamin M.; Reeling, Carson; Meyer, Johanna; Hurley, Kathleen

    2016-06-01

    Human alteration of the nitrogen cycle exceeds the safe planetary boundary for the use of reactive nitrogen (Nr). We complement global analysis by analyzing regional mass flows and the relative consequences of multiple chemical forms of Nr as they ‘cascade’ through multiple environmental media. The goals of this paper are (1) to identify the amounts of Nr that flow through a specific nitrogen rich region, (2) develop multiple metrics to characterize and compare multiple forms of Nr and the different damages that they cause, and (3) to use these metrics to assess the most societally acceptable and cost effective means for addressing the many dimensions of Nr damage. This paper uses a multiple metrics approach that in addition to mass flows considers economic damage, health and mitigation costs and qualitative damages to evaluate options for mitigating Nr flows in California’s San Joaquin Valley (SJV). Most analysis focuses attention on agricultural Nr because it is the largest flow in terms of mass. In contrast, the multiple metrics approach identifies mobile source Nr emissions as creating the most economic and health damage in the SJV. Emissions of Nr from mobile sources are smaller than those from crop agriculture and dairy in the SJV, but the benefits of abatement are greater because of reduced health impacts from air pollution, and abatement costs are lower. Our findings illustrate the benefit of a comprehensive multiple metrics approach to Nr management.

  4. Forest management under uncertainty for multiple bird population objectives

    USGS Publications Warehouse

    Moore, C.T.; Plummer, W.T.; Conroy, M.J.

    2005-01-01

    We advocate adaptive programs of decision making and monitoring for the management of forest birds when responses by populations to management, and particularly management trade-offs among populations, are uncertain. Models are necessary components of adaptive management. Under this approach, uncertainty about the behavior of a managed system is explicitly captured in a set of alternative models. The models generate testable predictions about the response of populations to management, and monitoring data provide the basis for assessing these predictions and informing future management decisions. To illustrate these principles, we examine forest management at the Piedmont National Wildlife Refuge, where management attention is focused on the recovery of the Red-cockaded Woodpecker (Picoides borealis) population. However, managers are also sensitive to the habitat needs of many non-target organisms, including Wood Thrushes (Hylocichla mustelina) and other forest interior Neotropical migratory birds. By simulating several management policies on a set of-alternative forest and bird models, we found a decision policy that maximized a composite response by woodpeckers and Wood Thrushes despite our complete uncertainty regarding system behavior. Furthermore, we used monitoring data to update our measure of belief in each alternative model following one cycle of forest management. This reduction of uncertainty translates into a reallocation of model influence on the choice of optimal decision action at the next decision opportunity.

  5. Multiple sclerosis: patients’ information sources and needs on disease symptoms and management

    PubMed Central

    Matti, Albert I; McCarl, Helen; Klaer, Pamela; Keane, Miriam C; Chen, Celia S

    2010-01-01

    Objective: To investigate the current information sources of patients with multiple sclerosis (MS) in the early stages of their disease and to identify patients’ preferred source of information. The relative amounts of information from the different sources were also compared. Methods: Participants at a newly diagnosed information session organized by the Multiple Sclerosis Society of South Australia were invited to complete a questionnaire. Participants were asked to rate on a visual analog scale how much information they had received about MS and optic neuritis from different information sources and how much information they would like to receive from each of the sources. Results: A close to ideal amount of information is being provided by the MS society and MS specialist nurses. There is a clear deficit between what information patients are currently receiving and the amount of information they actually want from various sources. Patients wish to receive significantly more information from treating general practitioners, eye specialists, neurologists, and education sessions. Patients have identified less than adequate information received on optic neuritis from all sources. Conclusion: This study noted a clear information deficit regarding MS from all sources. This information deficit is more pronounced in relation to optic neuritis and needs to be addressed in the future. Practice implications: More patient information and counselling needs to be provided to MS patients even at early stages of their disease, especially in relation to management of disease relapse. PMID:20622916

  6. Management of Complicated Aortic Aneurysms Using Multiple Overlapping Uncovered Stents

    PubMed Central

    Zhang, Yongxue; Teng, Zhongzhao; Lu, Qingsheng; Zhao, Zhiqing; Bao, Junmin; Feng, Xiang; Feng, Rui; Chen, Zengsheng; Huang, Yuan; Sadat, Umar; Gillard, Jonathan H; Jing, Zaiping

    2014-01-01

    Abstract This study sought to report the mid-term outcome of a modified flow-diverting strategy in the treatment of complicated aortic aneurysms of different morphology. Historical data suggested aortic aneurysm expansion and rupture after endovascular treatment with current commercial flow-diverters, indicating the essentiality of further investigation of this technique prior to its large-scale clinical application. An alternative flow-diverting strategy using layer-by-layer assembled multiple overlapping uncovered stents was employed in this study. The treatment outcome in aneurysms of different morphology (saccular, fusiform, and dissecting) was assessed during a mid-term follow-up period. Of 42 patients enrolled in this study (30 male, mean age: 63.3 years), technical success was achieved in 40 cases. During an average follow-up period of 20.9 months, mean aneurysm diameter shrunk from 53.4 ± 13.6 mm to 48.8 ± 13.9 mm (P < 0.001), while stent-induced sac thrombosis ratio increased significantly (18.1 ± 14.9% to 93.6 ± 9.5%, P < 0.001). The majority of side branches (74/76 major visceral branches, 237/244 minor segmental arteries), covered by 3.3 stents on average, maintained their patency after stenting. Saccular aneurysms manifested the highest thrombus deposition speed (18/20 were totally thrombosed within 12 months) and most significant shrinkage (51.4 ± 13.3 mm pre-operatively vs 43.5 ± 10.2 mm during follow-up, P < 0.001) compared with fusiform and dissecting aneurysms. This modified flow-diverting strategy could be a feasible alternative in the management of complicated aortic aneurysms where vital branches need to be preserved. The treatment outcome may depend on the aneurysm type. Further studies with larger patient cohort and longer follow-up are required to substantiate these results. PMID:25501077

  7. Multiple methods, maps, and management applications: Purpose made seafloor maps in support of ocean management

    NASA Astrophysics Data System (ADS)

    Brown, Craig J.; Sameoto, Jessica A.; Smith, Stephen J.

    2012-08-01

    The establishment of multibeam echosounders (MBES) as a mainstream tool in ocean mapping has facilitated integrative approaches toward nautical charting, benthic habitat mapping, and seafloor geotechnical surveys. The inherent bathymetric and backscatter information generated by MBES enables marine scientists to present highly accurate bathymetric data with a spatial resolution closely matching that of terrestrial mapping. Furthermore, developments in data collection and processing of MBES backscatter, combined with the quality of the co-registered depth information, have resulted in the increasing preferential use of multibeam technology over conventional sidescan sonar for the production of benthic habitat maps. A range of post-processing approaches can generate customized map products to meet multiple ocean management needs, thus extracting maximum value from a single survey data set. Based on recent studies over German Bank off SW Nova Scotia, Canada, we show how primary MBES bathymetric and backscatter data, along with supplementary data (i.e. in situ video and stills), were processed using a variety of methods to generate a series of maps. Methods conventionally used for classification of multi-spectral data were tested for classification of the MBES data set to produce a map summarizing broad bio-physical characteristics of the seafloor (i.e. a benthoscape map), which is of value for use in many aspects of marine spatial planning. A species-specific habitat map for the sea scallop Placopecten magellanicus was also generated from the MBES data by applying a Species Distribution Modeling (SDM) method to spatially predict habitat suitability, which offers tremendous promise for use in fisheries management. In addition, we explore the challenges of incorporating benthic community data into maps based on species information derived from a large number of seafloor photographs. Through the process of applying multiple methods to generate multiple maps for

  8. Overview of US AID-World Bank-NASA Collaboration to Address Water Management Issues in the MENA Region

    NASA Technical Reports Server (NTRS)

    Habib, Shahid

    2012-01-01

    The World Bank, USAID and NASA have recently established a joint project to study multiple issues pertaining to water related applications in the Middle East North Africa (MENA) region. The main concentration of the project is on utilization of remote sensing data and hydrological models to address crop irrigation and mapping, flood mapping and forecasting, evapotranspiration and drought problems prevalent in this large geographic area. Additional emphases are placed on understanding the climate impact on these areas as well. Per IPCC 2007 report, by the end of this century MENA region is projected to experience an increase of 3 C to 5 C rise in mean temperatures and a 20% decline in precipitation. This poses a serious problem for this geographic zone especially when majority of the hydrological consumption is for the agriculture sector and the remaining amount is for domestic consumption. The remote sensing data from space is one of the best ways to study such complex issues and further feed into the decision support systems. NASA's fleet of Earth Observing satellites offer a great vantage point from space to look at the globe and provide vital signs necessary to maintain healthy and sustainable ecosystem. These observations generate multiple products such as soil moisture, global precipitation, aerosols, cloud cover, normalized difference vegetation index, land cover/use, ocean altimetry, ocean salinity, sea surface winds, sea surface temperature, ozone and atmospheric gases, ice and snow measurements, and many more. All of the data products, models and research results are distributed-via the Internet freely through out the world. This project will utilize several NASA models such as global Land Data Assimilation System (LDAS) to generate hydrological states and fluxes in near real time. These LDAS products will then be further compared with other NASA satellite observations (MODIS, VIIRS, TRMM, etc.) and other discrete models to compare and optimize

  9. Optimising the application of multiple-capture traps for invasive species management using spatial simulation.

    PubMed

    Warburton, Bruce; Gormley, Andrew M

    2015-01-01

    Internationally, invasive vertebrate species pose a significant threat to biodiversity, agricultural production and human health. To manage these species a wide range of tools, including traps, are used. In New Zealand, brushtail possums (Trichosurus vulpecula), stoats (Mustela ermine), and ship rats (Rattus rattus) are invasive and there is an ongoing demand for cost-effective non-toxic methods for controlling these pests. Recently, traps with multiple-capture capability have been developed which, because they do not require regular operator-checking, are purported to be more cost-effective than traditional single-capture traps. However, when pest populations are being maintained at low densities (as is typical of orchestrated pest management programmes) it remains uncertain if it is more cost-effective to use fewer multiple-capture traps or more single-capture traps. To address this uncertainty, we used an individual-based spatially explicit modelling approach to determine the likely maximum animal-captures per trap, given stated pest densities and defined times traps are left between checks. In the simulation, single- or multiple-capture traps were spaced according to best practice pest-control guidelines. For possums with maintenance densities set at the lowest level (i.e. 0.5/ha), 98% of all simulated possums were captured with only a single capacity trap set at each site. When possum density was increased to moderate levels of 3/ha, having a capacity of three captures per trap caught 97% of all simulated possums. Results were similar for stoats, although only two potential captures per site were sufficient to capture 99% of simulated stoats. For rats, which were simulated at their typically higher densities, even a six-capture capacity per trap site only resulted in 80% kill. Depending on target species, prevailing density and extent of immigration, the most cost-effective strategy for pest control in New Zealand might be to deploy several single

  10. Optimising the Application of Multiple-Capture Traps for Invasive Species Management Using Spatial Simulation

    PubMed Central

    Warburton, Bruce; Gormley, Andrew M.

    2015-01-01

    Internationally, invasive vertebrate species pose a significant threat to biodiversity, agricultural production and human health. To manage these species a wide range of tools, including traps, are used. In New Zealand, brushtail possums (Trichosurus vulpecula), stoats (Mustela ermine), and ship rats (Rattus rattus) are invasive and there is an ongoing demand for cost-effective non-toxic methods for controlling these pests. Recently, traps with multiple-capture capability have been developed which, because they do not require regular operator-checking, are purported to be more cost-effective than traditional single-capture traps. However, when pest populations are being maintained at low densities (as is typical of orchestrated pest management programmes) it remains uncertain if it is more cost-effective to use fewer multiple-capture traps or more single-capture traps. To address this uncertainty, we used an individual-based spatially explicit modelling approach to determine the likely maximum animal-captures per trap, given stated pest densities and defined times traps are left between checks. In the simulation, single- or multiple-capture traps were spaced according to best practice pest-control guidelines. For possums with maintenance densities set at the lowest level (i.e. 0.5/ha), 98% of all simulated possums were captured with only a single capacity trap set at each site. When possum density was increased to moderate levels of 3/ha, having a capacity of three captures per trap caught 97% of all simulated possums. Results were similar for stoats, although only two potential captures per site were sufficient to capture 99% of simulated stoats. For rats, which were simulated at their typically higher densities, even a six-capture capacity per trap site only resulted in 80% kill. Depending on target species, prevailing density and extent of immigration, the most cost-effective strategy for pest control in New Zealand might be to deploy several single

  11. Assessment of multiple management systems in the Upper Midwest

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Reduced tillage, multi-crop rotations and use of organic fertilizers are characteristically expected to improve soil quality. As measures of soil quality, microbial and soluble C and N were evaluated in an nine-year assessment of management practices alternative to a conventionally managed two-year ...

  12. Managing and learning with multiple models: Objectives and optimization algorithms

    USGS Publications Warehouse

    Probert, William J. M.; Hauser, C.E.; McDonald-Madden, E.; Runge, M.C.; Baxter, P.W.J.; Possingham, H.P.

    2011-01-01

    The quality of environmental decisions should be gauged according to managers' objectives. Management objectives generally seek to maximize quantifiable measures of system benefit, for instance population growth rate. Reaching these goals often requires a certain degree of learning about the system. Learning can occur by using management action in combination with a monitoring system. Furthermore, actions can be chosen strategically to obtain specific kinds of information. Formal decision making tools can choose actions to favor such learning in two ways: implicitly via the optimization algorithm that is used when there is a management objective (for instance, when using adaptive management), or explicitly by quantifying knowledge and using it as the fundamental project objective, an approach new to conservation.This paper outlines three conservation project objectives - a pure management objective, a pure learning objective, and an objective that is a weighted mixture of these two. We use eight optimization algorithms to choose actions that meet project objectives and illustrate them in a simulated conservation project. The algorithms provide a taxonomy of decision making tools in conservation management when there is uncertainty surrounding competing models of system function. The algorithms build upon each other such that their differences are highlighted and practitioners may see where their decision making tools can be improved. ?? 2010 Elsevier Ltd.

  13. An Internet-based exercise as a component of an overall training program addressing medical aspects of radiation emergency management.

    PubMed

    Levy, K; Aghababian, R V; Hirsch, E F; Screnci, D; Boshyan, A; Ricks, R C; Samiei, M

    2000-01-01

    The use of ionizing radiation and radioactive materials continues to increase worldwide in industry, medicine, agriculture, research, electrical power generation, and nuclear weaponry. The risk of terrorism using weapons of mass destruction or simple radiological devices also has increased, leading to heightened concerns. Radiation accidents occur as a consequence of errors in transportation of radionuclides, use of radiation in medical diagnosis and therapy, industrial monitoring and sterilization procedures, and rarely, nuclear power generation. Compared to other industries, a small number of serious radiation accidents have occurred over the last six decades with recent cases in the Republic of Georgia, Peru, Japan, and Thailand. The medical, psychological, and political consequences of such accidents can be considerable. A number of programs designed to train medical responders in the techniques of radiation accident management have been developed and delivered in many countries. The low frequency of serious radiation accidents requires constant re-training, as skills are lost and medical staff turnover occurs. Not all of the training involves drills or exercises in which responders demonstrate learning or communication over the broad spectrum of medical response capabilities. Medical preparedness within the context of a total emergency response program is lacking in many parts of the world, particularly in Central and Eastern Europe and the Newly Independent States. This paper describes an effort to enhance medical preparedness in the context of a total program of international cooperation and conventions facilitated by the International Atomic Energy Agency. The paper concludes that novel application of telecommunications technology as part of a training activity in radiation accident preparedness can help address gaps in training in this field in which preparedness is essential but experience and practical field exercises are lacking. PMID:11183457

  14. An integrated modeling approach to support management decisions of coupled groundwater-agricultural systems under multiple uncertainties

    NASA Astrophysics Data System (ADS)

    Hagos Subagadis, Yohannes; Schütze, Niels; Grundmann, Jens

    2015-04-01

    The planning and implementation of effective water resources management strategies need an assessment of multiple (physical, environmental, and socio-economic) issues, and often requires new research in which knowledge of diverse disciplines are combined in a unified methodological and operational frameworks. Such integrative research to link different knowledge domains faces several practical challenges. Such complexities are further compounded by multiple actors frequently with conflicting interests and multiple uncertainties about the consequences of potential management decisions. A fuzzy-stochastic multiple criteria decision analysis tool was developed in this study to systematically quantify both probabilistic and fuzzy uncertainties associated with complex hydrosystems management. It integrated physical process-based models, fuzzy logic, expert involvement and stochastic simulation within a general framework. Subsequently, the proposed new approach is applied to a water-scarce coastal arid region water management problem in northern Oman, where saltwater intrusion into a coastal aquifer due to excessive groundwater extraction for irrigated agriculture has affected the aquifer sustainability, endangering associated socio-economic conditions as well as traditional social structure. Results from the developed method have provided key decision alternatives which can serve as a platform for negotiation and further exploration. In addition, this approach has enabled to systematically quantify both probabilistic and fuzzy uncertainties associated with the decision problem. Sensitivity analysis applied within the developed tool has shown that the decision makers' risk aversion and risk taking attitude may yield in different ranking of decision alternatives. The developed approach can be applied to address the complexities and uncertainties inherent in water resources systems to support management decisions, while serving as a platform for stakeholder participation.

  15. Orthodontic management of non-syndromic multiple supernumerary teeth

    PubMed Central

    Singhvi, Vijay; Nambiar, Supriya; Shetty, Siddarth

    2013-01-01

    Hyperdontia amounts to an odontostomatologic anomaly wherein, there is an increase in tooth number irrespective of the location. This case report represents a form of hyperdontia characterized by bilateral multiple supernumerary teeth in both the jaws without any evident familial history. PMID:24403806

  16. [MATCHE: Management Approach to Teaching Consumer and Homemaking Education.] Consumer Approach Strand: Management. Module I-F-6: Management View of the Multiple Role.

    ERIC Educational Resources Information Center

    Smith, Sharman

    This competency-based preservice home economics teacher education module on management view of the multiple role is the sixth in a set of seven modules on consumer education related to management. (This set is part of a larger series of sixty-seven modules on the Management Approach to Teaching Consumer and Homemaking Education [MATCHE]--see CE…

  17. Recognizing Multiple Decision-Making Models: A Guide for Managers.

    ERIC Educational Resources Information Center

    Giesecke, Joan

    1993-01-01

    Provides a theoretical overview of decision-making models which are applicable to libraries; presents a framework for comparing the rational, political bargaining, and garbage can models; describes a case study that applied the models to a decision regarding an academic library governance system; and discusses strategies for library managers for…

  18. Failure management of multiple gimbal inertial systems for space shuttle

    NASA Technical Reports Server (NTRS)

    Dove, D. W.; Mckern, R. A.

    1973-01-01

    A failure detection and isolation technique for use with four gimbaled inertial measurement units (IMU) is presented. By using simulated boost and entry shuttle trajectories with specific gimbaled IMU models, failure detection thresholds are developed based on red-line life dependent requirements and warning thresholds within the red-line thresholds based on expected worst case IMU performance. Using these trajectories, established trajectory threshold, and multiple IMU models, various failure detection and isolation techniques are evaluated for application in both powered and unpowered flight phases. The adequacy of the systems for both attitude and velocity detection methods is evaluated and recommendations for space shuttle applications are made.

  19. Impact of a nurse managed clinic in multiple sclerosis.

    PubMed

    Wahlquist, G I

    1984-08-01

    This article indicates the importance of evaluation in the practice of professional nursing. In the chronically ill neurological population both process (what the nurse actually does) and outcome measures need to be considered when formulating the objectives and scope of service to be provided by the clinical nurse specialist. For this population, morbidity was a natural evaluative measure for the nurse to employ as an index of intervention effectiveness. This does not mean to imply that nurses are the sole persons who can manage this type of outpatient clinic, but rather that nursing can play a pivotal part in the promotion of health for this particular group of neurologically disabled individuals. For this population, a consistent caregiver is important in implementing a rehabilitative approach to manage the interdisciplinary effort needed to help these individuals and their families maintain or improve health. PMID:6565749

  20. Using State-Wide Multiple Measures for School Leadership and Management: Costs Incurred vs. Benefits Gained

    ERIC Educational Resources Information Center

    Hentschke, Guilbert; Wohlstetter, Priscilla; Hirman, Jennifer; Zeehandelaar, Dara

    2011-01-01

    In this article, we examine the utility and value of multiple measures of school performance for school leaders and managers. The research was conducted within the context of the state of California through an investigation of how operators, managers and authorisers of autonomous "charter" (publicly financed but privately operated) schools use…

  1. Risk management for sulfur dioxide abatement under multiple uncertainties

    NASA Astrophysics Data System (ADS)

    Dai, C.; Sun, W.; Tan, Q.; Liu, Y.; Lu, W. T.; Guo, H. C.

    2016-03-01

    In this study, interval-parameter programming, two-stage stochastic programming (TSP), and conditional value-at-risk (CVaR) were incorporated into a general optimization framework, leading to an interval-parameter CVaR-based two-stage programming (ICTP) method. The ICTP method had several advantages: (i) its objective function simultaneously took expected cost and risk cost into consideration, and also used discrete random variables and discrete intervals to reflect uncertain properties; (ii) it quantitatively evaluated the right tail of distributions of random variables which could better calculate the risk of violated environmental standards; (iii) it was useful for helping decision makers to analyze the trade-offs between cost and risk; and (iv) it was effective to penalize the second-stage costs, as well as to capture the notion of risk in stochastic programming. The developed model was applied to sulfur dioxide abatement in an air quality management system. The results indicated that the ICTP method could be used for generating a series of air quality management schemes under different risk-aversion levels, for identifying desired air quality management strategies for decision makers, and for considering a proper balance between system economy and environmental quality.

  2. Managing multiple image stacks from confocal laser scanning microscopy

    NASA Astrophysics Data System (ADS)

    Zerbe, Joerg; Goetze, Christian H.; Zuschratter, Werner

    1999-05-01

    A major goal in neuroanatomy is to obtain precise information about the functional organization of neuronal assemblies and their interconnections. Therefore, the analysis of histological sections frequently requires high resolution images in combination with an overview about the structure. To overcome this conflict we have previously introduced a software for the automatic acquisition of multiple image stacks (3D-MISA) in confocal laser scanning microscopy. Here, we describe a Windows NT based software for fast and easy navigation through the multiple images stacks (MIS-browser), the visualization of individual channels and layers and the selection of user defined subregions. In addition, the MIS browser provides useful tools for the visualization and evaluation of the datavolume, as for instance brightness and contrast corrections of individual layers and channels. Moreover, it includes a maximum intensity projection, panning and zoom in/out functions within selected channels or focal planes (x/y) and tracking along the z-axis. The import module accepts any tiff-format and reconstructs the original image arrangement after the user has defined the sequence of images in x/y and z and the number of channels. The implemented export module allows storage of user defined subregions (new single image stacks) for further 3D-reconstruction and evaluation.

  3. Development of a Watershed Management Model for the Chesapeake Using Multiple Model

    NASA Astrophysics Data System (ADS)

    Bhatt, G.; Shenk, G.

    2014-12-01

    Calibrated watershed models are widely used as tools for estimating the outcomes of management scenarios. Multiple models are often recommended for well-informed decision making to gain an estimate of uncertainty, to allow for multiple representations of the physical-chemical-biological system, and to provide confidence in the model predictions. Implementing and maintaining multiple watershed models, particularly of a large-scale watershed, poses significant financial and logistical challenges associated with model calibrations, computation requirements, and differences in data formats. Moreover, analysis of results from multiple models adds additional complexity in decision-making. We propose and demonstrate a framework to simulate management scenarios using a 'sensitivity' approach that incorporates the findings of multiple models into a single simulation framework. This simple and easily-understood modeling framework provides the ability to explicitly incorporate the best available science-based understanding of watershed responses to changes in nutrient balances. Generalized watershed nutrient response are derived from the synthesis of multiple lines of evidence, which include studies involving multiple physically-based models of watersheds at catchment to regional scales, along with experimental studies and watershed observatories. The framework provides simplified accounting for planning, implementation, and tracking of management scenarios while providing capabilities to incorporate complex watershed phenomenon such as lag-times in nutrient response. The framework is being developed by the Chesapeake Bay Partnership for an assessment of a Total Maximum Daily Load (TMDL) in 2017 and to develop management plans to meet water quality standards in the Bay waters.

  4. The role of Social Support in Multiple Morbidity: Self-Management among rural residents

    PubMed Central

    Bardach, Shoshana H.; Tarasenko, Yelena N.; Schoenberg, Nancy E.

    2013-01-01

    Social support generally is considered a valuable asset that may compensate for health service deficiencies among rural populations. Employing a mixed methods approach, we explored how vulnerable rural residents described social support in the context of self-management for multiple chronic conditions. Participants generally felt support was available, though emotional/informational support was perceived as less available than other types of support. Participants did not rely heavily on informal support to help them manage their multiple morbidities, preferring to call on their doctor and their own resources. We discuss implications of these findings for meeting this vulnerable population’s self-management needs. PMID:21841277

  5. Redundancy management of multiple inertial systems for Space Shuttle.

    NASA Technical Reports Server (NTRS)

    Dove, D. W.; Mckern, R. A.

    1972-01-01

    Failure detection and isolation techniques are developed for application to off-the-shelf type four-gimbaled inertial measurement units such as the KT-70 or Carousel IV. By using simulated boost and entry shuttle trajectories with specific gimbaled IMU models, failure detection thresholds are developed based upon red-line life dependent requirements and warning thresholds are given within the red-line thresholds based upon expected worst case IMU performance. Using these trajectories, established trajectory thresholds, and multiple IMU models, various failure detection and isolation techniques are evaluated for application in both powered and unpowered flight phases. The adequacy of off-the-shelf systems for both attitude and velocity detection methods is evaluated and recommendations for shuttle application are made.

  6. Multiple Friends with Benefits: An Optimal Mutualist Management Strategy?

    PubMed

    Moeller, Holly V; Neubert, Michael G

    2016-01-01

    Most mutualisms in nature involve interactions between multispecies mutualist guilds and multiple partner species. While mechanisms such as niche partitioning can explain part of this diversity, the presence of low-quality partners, which produce relatively low returns on investment compared with other guild members, is not well understood. Here, we consider a novel explanation for this persistence: that low-quality partners are actively maintained by their hosts as part of a growth-maximizing strategy, even in the presence of higher-quality alternatives. We use a model inspired by the interaction between host trees and ectomycorrhizal fungi to demonstrate that when the environment is variable, trees maintain low-quality fungal partners that they would not otherwise maintain in constant environments. This active investment, which emerges as a response to saturating returns on investment in higher-quality partners, could contribute to the maintenance of diversity in multispecies mutualisms. PMID:27277412

  7. Exercise in multiple sclerosis -- an integral component of disease management

    PubMed Central

    2012-01-01

    Multiple sclerosis (MS) is the most common chronic inflammatory disorder of the central nervous system (CNS) in young adults. The disease causes a wide range of symptoms depending on the localization and characteristics of the CNS pathology. In addition to drug-based immunomodulatory treatment, both drug-based and non-drug approaches are established as complementary strategies to alleviate existing symptoms and to prevent secondary diseases. In particular, physical therapy like exercise and physiotherapy can be customized to the individual patient's needs and has the potential to improve the individual outcome. However, high quality systematic data on physical therapy in MS are rare. This article summarizes the current knowledge on the influence of physical activity and exercise on disease-related symptoms and physical restrictions in MS patients. Other treatment strategies such as drug treatments or cognitive training were deliberately excluded for the purposes of this article. PMID:22738091

  8. 40 CFR 267.101 - What must I do to address corrective action for solid waste management units?

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... action for solid waste management units? 267.101 Section 267.101 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES (CONTINUED) STANDARDS FOR OWNERS AND OPERATORS OF HAZARDOUS WASTE FACILITIES OPERATING UNDER A STANDARDIZED PERMIT Releases from Solid Waste Management Units § 267.101...

  9. An Evaluation of Multiple Perceptions of Digital Rights Management

    NASA Astrophysics Data System (ADS)

    Stott, Allyn D.; Taneja, Aakash

    Digital Rights Management (DRM) solutions have generated much interest because of their influence on the expectations and responsibilities of customers and related organizations. It was created to restrict piracy and enhance digital media sales, however, it is found to be unable to fulfill its objectives. We find the protections by DRM lack an understanding of the end user and the evolving nature of copyright and fair use. The potential motives for pirating appear to increase as DRM becomes more intrusive causing a conflict in the objectives of DRM. Thus, adjustments must be made to the current DRM model in order for it to become beneficial for both the producer and the consumer. Our research identifies the needs, desires, and responsibilities of the various DRM stakeholders so that a successful use of DRM technologies can be modeled: a challenge faced by the media industry.

  10. Perioperative Management of Multiple Noncardiac Implantable Electronic Devices.

    PubMed

    Ramos, Juan A; Brull, Sorin J

    2015-12-01

    The number of patients with noncardiac implantable electronic devices is increasing, and the absence of perioperative management standards, guidelines, practice parameters, or expert consensus statements presents clinical challenges. A 69-year-old woman presented for latissimus dorsi breast reconstruction. The patient had previously undergone implantation of a spinal cord stimulator, a gastric pacemaker, a sacral nerve stimulator, and an intrathecal morphine pump. After consultation with device manufacturers, the devices with patient programmability were switched off. Bipolar cautery was used intraoperatively. Postoperatively, all devices were interrogated to ensure appropriate functioning before home discharge. Perioperative goals include complete preoperative radiologic documentation of device component location, minimizing electromagnetic interference, and avoiding mechanical damage to implanted device components. PMID:26588030

  11. Management of spastic cerebral palsy through multiple Ayurveda treatment modalities

    PubMed Central

    Bhinde, Sagar M.; Patel, Kalpana S.; Kori, Virendra Kumar; Rajagopala, S.

    2014-01-01

    Background: Cerebral palsy (CP) is a leading cause of childhood disability affecting function and development. The global incidence of CP is 2:1000. It has been reported that children with CP and their caretaker have impaired health-related quality of life (QOL). Of the many types and subtypes of CP, none has any known cure. For a detailed description of the disease CP, though, there is no one to one correlation in Ayurvedic classics; it can be taken as Vata Vyadhi as far as its etiology and symptomatology are concerned. Aim: To assess the effect of certain Panchakarma procedures in the management of CP. Materials and Methods: Total 8 patients were registered and treated with 5 days of Udvartana, 5 days of Abhyanga followed by Sarvanga Swedana and then 8 days of Yoga Basti. The same course of treatment has been repeated for 3 times with an interval of 14 days. Ashtanga Ghrita was given during whole procedures as internal medication. Results of treatment were assessed with anthropometrical measurement, developmental milestone, Modified Ashworth Scale, spasm scale, reflex scale, and muscle power grading. Result: This Ayurvedic management shows good result in CP patients, especially by improving growth (height, weight, chest circumference) and development (head holding and sitting), reducing spasticity of left upper limb and muscle spasm. Conclusion: Multisystem approach is needed to improve the condition of the patient. Panchakarma along with internal medication should be given to improve all the facets of spastic CP. Yoga Basti acts by their own mode of action and can be used freely for such disease conditions. PMID:26195914

  12. Developing objectives with multiple stakeholders: adaptive management of horseshoe crabs and Red Knots in the Delaware Bay.

    PubMed

    McGowan, Conor P; Lyons, James E; Smith, David R

    2015-04-01

    Structured decision making (SDM) is an increasingly utilized approach and set of tools for addressing complex decisions in environmental management. SDM is a value-focused thinking approach that places paramount importance on first establishing clear management objectives that reflect core values of stakeholders. To be useful for management, objectives must be transparently stated in unambiguous and measurable terms. We used these concepts to develop consensus objectives for the multiple stakeholders of horseshoe crab harvest in Delaware Bay. Participating stakeholders first agreed on a qualitative statement of fundamental objectives, and then worked to convert those objectives to specific and measurable quantities, so that management decisions could be assessed. We used a constraint-based approach where the conservation objectives for Red Knots, a species of migratory shorebird that relies on horseshoe crab eggs as a food resource during migration, constrained the utility of crab harvest. Developing utility functions to effectively reflect the management objectives allowed us to incorporate stakeholder risk aversion even though different stakeholder groups were averse to different or competing risks. While measurable objectives and quantitative utility functions seem scientific, developing these objectives was fundamentally driven by the values of the participating stakeholders. PMID:25537153

  13. Developing Objectives with Multiple Stakeholders: Adaptive Management of Horseshoe Crabs and Red Knots in the Delaware Bay

    NASA Astrophysics Data System (ADS)

    McGowan, Conor P.; Lyons, James E.; Smith, David R.

    2015-04-01

    Structured decision making (SDM) is an increasingly utilized approach and set of tools for addressing complex decisions in environmental management. SDM is a value-focused thinking approach that places paramount importance on first establishing clear management objectives that reflect core values of stakeholders. To be useful for management, objectives must be transparently stated in unambiguous and measurable terms. We used these concepts to develop consensus objectives for the multiple stakeholders of horseshoe crab harvest in Delaware Bay. Participating stakeholders first agreed on a qualitative statement of fundamental objectives, and then worked to convert those objectives to specific and measurable quantities, so that management decisions could be assessed. We used a constraint-based approach where the conservation objectives for Red Knots, a species of migratory shorebird that relies on horseshoe crab eggs as a food resource during migration, constrained the utility of crab harvest. Developing utility functions to effectively reflect the management objectives allowed us to incorporate stakeholder risk aversion even though different stakeholder groups were averse to different or competing risks. While measurable objectives and quantitative utility functions seem scientific, developing these objectives was fundamentally driven by the values of the participating stakeholders.

  14. Developing objectives with multiple stakeholders: adaptive management of horseshoe crabs and Red Knots in the Delaware Bay

    USGS Publications Warehouse

    McGowan, Conor P.; Lyons, James E.; Smith, David

    2015-01-01

    Structured decision making (SDM) is an increasingly utilized approach and set of tools for addressing complex decisions in environmental management. SDM is a value-focused thinking approach that places paramount importance on first establishing clear management objectives that reflect core values of stakeholders. To be useful for management, objectives must be transparently stated in unambiguous and measurable terms. We used these concepts to develop consensus objectives for the multiple stakeholders of horseshoe crab harvest in Delaware Bay. Participating stakeholders first agreed on a qualitative statement of fundamental objectives, and then worked to convert those objectives to specific and measurable quantities, so that management decisions could be assessed. We used a constraint-based approach where the conservation objectives for Red Knots, a species of migratory shorebird that relies on horseshoe crab eggs as a food resource during migration, constrained the utility of crab harvest. Developing utility functions to effectively reflect the management objectives allowed us to incorporate stakeholder risk aversion even though different stakeholder groups were averse to different or competing risks. While measurable objectives and quantitative utility functions seem scientific, developing these objectives was fundamentally driven by the values of the participating stakeholders.

  15. Nominal Address and Rapport Management in Informal Interactions among University Students in Quito (Ecuador), Santiago (Chile) and Seville (Spain)

    ERIC Educational Resources Information Center

    Placencia, María Elena; Fuentes Rodríguez, Catalina; Palma-Fahey, María

    2015-01-01

    Nominal and pronominal address forms, which play a central role in the construction of interpersonal relations (cf. Bargiela et al. 2002; Clyne et al. 2009), have been the focus of attention in different linguistics subfields for several decades now. Less attention, however, has been paid to these forms from a variational pragmatics (Schneider and…

  16. New approaches in the management of multiple sclerosis

    PubMed Central

    Barten, Laurie J; Allington, Douglas R; Procacci, Kendra A; Rivey, Michael P

    2010-01-01

    Multiple sclerosis (MS) is a central nervous system chronic inflammatory disease that is characterized by an extensive and complex immune response. Scientific advances have occurred in immunology, pathophysiology, and diagnostic and clinical assessment tools, and recent discovery of unique therapeutic targets has spurred numerous Phase II and Phase III clinical trials. Reductions in MS relapse rates and improvements in T2 or gadolinium-enhancing lesion burdens have been reported from Phase III trials that include fingolimod, alemtuzumab, cladribine, and rituximab. Promising Phase II trial data exist for teriflunomide, daclizumab, laquinimod, and fumarate. The optimism created by these favorable findings must be tempered with evaluation of the adverse effect profile produced by these new agents. Given the discovery of progressive multifocal leukoencephalopathy with the use of natalizumab, ongoing vigilance for rare and life-threatening reactions due to new agents should be paramount. Patients with MS often experience difficulty with ambulation, spasticity, and cognition. Recent clinical trial data from two Phase III dalfampridine-SR trials indicate certain patients receive benefits in ambulation. This article provides an overview of data from clinical trials of newer agents of potential benefit in MS. PMID:21151622

  17. Management of Multiple Sclerosis in the Breastfeeding Mother

    PubMed Central

    Almas, Saneea; Vance, Jesse; Baker, Teresa; Hale, Thomas

    2016-01-01

    Multiple Sclerosis (MS) is an autoimmune neurological disease characterized by inflammation of the brain and spinal cord. Relapsing-Remitting MS is characterized by acute attacks followed by remission. Treatment is aimed at halting these attacks; therapy may last for months to years. Because MS disproportionately affects females and commonly begins during the childbearing years, clinicians treat pregnant or nursing MS patients. The intent of this review is to perform an in-depth analysis into the safety of drugs used in breastfeeding women with MS. This paper is composed of several drugs used in the treatment of MS and current research regarding their safety in breastfeeding including immunomodulators, immunosuppressants, monoclonal antibodies, corticosteroids, and drugs used for symptomatic treatment. Typically, some medications are large polar molecules which often do not pass into the milk in clinically relevant amounts. For this reason, interferon beta is likely safe for the infant when given to a breastfeeding mother. However, other drugs with particularly dangerous side effects may not be recommended. While treatment options are available and some data from clinical studies does exist, there continues to be a need for investigation and ongoing review of the medications used in breastfeeding mothers. PMID:26966579

  18. Multiple benefits arising from novel management of agricultural ditches

    NASA Astrophysics Data System (ADS)

    Jonczyk, Jennine; Barber, Nick; Quinn, Paul

    2016-04-01

    The opportunity to modify the function and dynamics of farm ditches is very high. There are many kilometres of ditch that could offer multiple benefits to pollution control and lowering flood risk. However, there is first a perception problem to overcome, in that most farmers wish to remove water from the land quickly and are irritated by the accumulation of sediment. Hence, we have built a series of demonstration ditches where the new operation of the ditch can be shown to trap substantial amounts of sediment and nutrients and also not cause any local flooding or water logging problems. The ditch itself is radically changed in shape and is widened as much as possible and usually has a flat bottom. The ditch will also contain a series of leaky barriers that will retain flow during storm events. In very large events an overflow structure is required. These features do have to be engineered to a good level of safety to avoid failure. Sediment must also be recovered from the ditch frequently (at least annually) which again could be a role fulfilled by the farmer. We will show a number of example ditch designs and the data captured in experiments. One feature typically captures 50% of the suspended sediment, 30% of total phosphorus and 20% of the nitrate in a single storm.

  19. Addressing healthcare.

    PubMed

    Daly, Rich

    2013-02-11

    Though President Barack Obama has rarely made healthcare references in his State of the Union addresses, health policy experts are hoping he changes that strategy this year. "The question is: Will he say anything? You would hope that he would, given that that was the major issue he started his presidency with," says Dr. James Weinstein, left, of the Dartmouth-Hitchcock health system. PMID:23487896

  20. Regional Management Units for Marine Turtles: A Novel Framework for Prioritizing Conservation and Research across Multiple Scales

    PubMed Central

    Wallace, Bryan P.; DiMatteo, Andrew D.; Hurley, Brendan J.; Finkbeiner, Elena M.; Bolten, Alan B.; Chaloupka, Milani Y.; Hutchinson, Brian J.; Abreu-Grobois, F. Alberto; Amorocho, Diego; Bjorndal, Karen A.; Bourjea, Jerome; Bowen, Brian W.; Dueñas, Raquel Briseño; Casale, Paolo; Choudhury, B. C.; Costa, Alice; Dutton, Peter H.; Fallabrino, Alejandro; Girard, Alexandre; Girondot, Marc; Godfrey, Matthew H.; Hamann, Mark; López-Mendilaharsu, Milagros; Marcovaldi, Maria Angela; Mortimer, Jeanne A.; Musick, John A.; Nel, Ronel; Pilcher, Nicolas J.; Seminoff, Jeffrey A.; Troëng, Sebastian; Witherington, Blair; Mast, Roderic B.

    2010-01-01

    Background Resolving threats to widely distributed marine megafauna requires definition of the geographic distributions of both the threats as well as the population unit(s) of interest. In turn, because individual threats can operate on varying spatial scales, their impacts can affect different segments of a population of the same species. Therefore, integration of multiple tools and techniques — including site-based monitoring, genetic analyses, mark-recapture studies and telemetry — can facilitate robust definitions of population segments at multiple biological and spatial scales to address different management and research challenges. Methodology/Principal Findings To address these issues for marine turtles, we collated all available studies on marine turtle biogeography, including nesting sites, population abundances and trends, population genetics, and satellite telemetry. We georeferenced this information to generate separate layers for nesting sites, genetic stocks, and core distributions of population segments of all marine turtle species. We then spatially integrated this information from fine- to coarse-spatial scales to develop nested envelope models, or Regional Management Units (RMUs), for marine turtles globally. Conclusions/Significance The RMU framework is a solution to the challenge of how to organize marine turtles into units of protection above the level of nesting populations, but below the level of species, within regional entities that might be on independent evolutionary trajectories. Among many potential applications, RMUs provide a framework for identifying data gaps, assessing high diversity areas for multiple species and genetic stocks, and evaluating conservation status of marine turtles. Furthermore, RMUs allow for identification of geographic barriers to gene flow, and can provide valuable guidance to marine spatial planning initiatives that integrate spatial distributions of protected species and human activities. In addition

  1. Multiple Chronic Conditions: Prevalence, Health Consequences, and Implications for Quality, Care Management, and Costs

    PubMed Central

    Shields, Alexandra E.; Lee, Todd A.; Gibson, Teresa B.; Marder, William D.; Weiss, Kevin B.; Blumenthal, David

    2007-01-01

    Persons with multiple chronic conditions are a large and growing segment of the US population. However, little is known about how chronic conditions cluster, and the ramifications of having specific combinations of chronic conditions. Clinical guidelines and disease management programs focus on single conditions, and clinical research often excludes persons with multiple chronic conditions. Understanding how conditions in combination impact the burden of disease and the costs and quality of care received is critical to improving care for the 1 in 5 Americans with multiple chronic conditions. This Medline review of publications examining somatic chronic conditions co-occurring with 1 or more additional specific chronic illness between January 2000 and March 2007 summarizes the state of our understanding of the prevalence and health challenges of multiple chronic conditions and the implications for quality, care management, and costs. PMID:18026807

  2. Modified Esthetic Splint Design for Management of Multiple Traumatic Injuries in Children: A Case Report.

    PubMed

    Garla, Bharath Kumar; Deshmukh, Seema; Murthy, Prashanth Sadashiva; Satish, G

    2015-09-01

    Traumatic injuries to the dento-alveolar structures are emergencies that compromise the quality of life of the patients. In addition to symptomatic management, definitive functional restoration and suitable rehabilitation becomes a major treatment objective in such cases. The dynamics of the traumatic forces may cause multiple injuries of different grades to the oral and para-oral structures, which makes comprehensive management a greater challenge to the dentist. The present case report elaborates a modified esthetic splint designed to treat multiple dental injuries in children, which can promote healing, restore optimal functionality along with esthetic rehabilitation to psychologically benefit the child during the time of recovery. PMID:26435631

  3. Modified Esthetic Splint Design for Management of Multiple Traumatic Injuries in Children: A Case Report

    PubMed Central

    Garla, Bharath Kumar; Deshmukh, Seema; Murthy, Prashanth Sadashiva; Satish, G

    2015-01-01

    Traumatic injuries to the dento-alveolar structures are emergencies that compromise the quality of life of the patients. In addition to symptomatic management, definitive functional restoration and suitable rehabilitation becomes a major treatment objective in such cases. The dynamics of the traumatic forces may cause multiple injuries of different grades to the oral and para-oral structures, which makes comprehensive management a greater challenge to the dentist. The present case report elaborates a modified esthetic splint designed to treat multiple dental injuries in children, which can promote healing, restore optimal functionality along with esthetic rehabilitation to psychologically benefit the child during the time of recovery. PMID:26435631

  4. Classroom Management Strategies to Address the Needs of Sudanese Refugee Learners. An Adult Literacy National Project Report

    ERIC Educational Resources Information Center

    Burgoyne, Ursula; Hull, Oksana

    2007-01-01

    This study examined the extent to which English language, literacy and numeracy teachers used classroom management strategies to meet the needs of adult Sudanese refugee learners. While teachers met the needs of these learners insofar as they coincided with those of other refugee groups, the highly oral language culture of these learners appeared…

  5. Effectively Adapting the Sport Management Curricula: Harnessing Internal and External Resources to Address Industry-Specific Needs

    ERIC Educational Resources Information Center

    Braunstein-Minkove, Jessica R.; DeLuca, Jaime R.

    2015-01-01

    Academic programs must constantly evolve in order to ensure that students are best prepared for success in internships and subsequent post-collegiate endeavors within the dynamic, rapidly changing sport industry. Based upon qualitative research, this work assesses and recommends areas of development in sport management curricula using internal and…

  6. 75 FR 36677 - Notice of Relocation/Change of Address for the Bureau of Land Management, Office of Pipeline...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-06-28

    ..., Office of Pipeline Monitoring, Alaska State Office AGENCY: Bureau of Land Management, Interior. ACTION... 4th Avenue, Suite 2, Anchorage, Alaska, is relocating to 188 West Northern Lights Boulevard, Suite 500... Pipeline Monitoring office at 411 West 4th Avenue, Suite 2, Anchorage, Alaska, will remain open during...

  7. Advances in Linked Air Quality, Farm Management and Biogeochemistry Models to Address Bidirectional Ammonia Flux in CMAQ

    EPA Science Inventory

    Recent increases in anthropogenic inputs of nitrogen to air, land and water media pose a growing threat to human health and ecosystems. Modeling of air-surface N flux is one area in need of improvement. Implementation of a linked air quality and cropland management system is de...

  8. "Advances in Linked Air Quality, Farm Management and Biogeochemistry Models to Address Bidrectional Ammonia Flux in CMAQ"

    EPA Science Inventory

    Recent increases in anthropogenic inputs of nitrogen to air, land and water media pose a growing threat to human health and ecosystems. Modeling of air-surface N flux is one area in need of improvement. Implementation of a linked air quality and cropland management system is de...

  9. 40 CFR 267.101 - What must I do to address corrective action for solid waste management units?

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... the supplemental portion of your standardized permit in accordance with this section and 40 CFR part... action for solid waste management units? 267.101 Section 267.101 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES (CONTINUED) STANDARDS FOR OWNERS AND OPERATORS OF HAZARDOUS...

  10. 40 CFR 267.101 - What must I do to address corrective action for solid waste management units?

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... the supplemental portion of your standardized permit in accordance with this section and 40 CFR part... action for solid waste management units? 267.101 Section 267.101 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES (CONTINUED) STANDARDS FOR OWNERS AND OPERATORS OF HAZARDOUS...

  11. 40 CFR 267.101 - What must I do to address corrective action for solid waste management units?

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... the supplemental portion of your standardized permit in accordance with this section and 40 CFR part... action for solid waste management units? 267.101 Section 267.101 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES (CONTINUED) STANDARDS FOR OWNERS AND OPERATORS OF HAZARDOUS...

  12. Addressing Disaster Risk Management and Adaptation to Climate Change in the Context of Sustainable Development in Africa

    NASA Astrophysics Data System (ADS)

    Osman Elasha, B. M. E.

    2015-12-01

    The IPCC Special Report on Managing the Risks of Extreme Events and Disasters to Advance Climate Change Adaptation (SREX) demonstrates that an extreme event which used to occur infrequently and perceived today as abnormal will be tomorrow's 'normal' weather. For example the drought events in the African Sahel which once came every decade could now come every couple of years bringing a new challenge and leading to severe disturbances and rapid environmental changes. The report identified and analyzed the problems associated with extreme climatic events, and examined how human responses to these events and the consequent disasters could contribute to adaptation objectives, and how adaptation to climate change could become better integrated with Disasters Risk Management (DRM) practices. Moreover, a number of studies explored the linkages and interactions between disasters and development and clearly demonstrates how the exposure to extremes and vulnerability to climate change can hinder development efforts, emphasizing the need for much smarter development and economic policies that consider managing disaster risk and implement adaptation measures as main components of sustainable development. The proposed presentation will provide an overview of findings from IPCC reports and other studies and will draw on existing experiences and lessons learned to explore the linkages between disaster risk management, adaptation and economic development in Africa. It will also shed light on some of the regional and global interventions which aim at mitigating the impacts of extremes and disasters in African countries characterized by high exposure & vulnerability and low adaptive capacity. It concludes by highlighting the need for broader cooperation and partnership between development partners and agencies working on disaster risk management & climate change adaptation including the private sector, bilateral and multilateral agencies in order to ensure sustainable development.

  13. Interval-parameter semi-infinite fuzzy-stochastic mixed-integer programming approach for environmental management under multiple uncertainties

    SciTech Connect

    Guo, P.; Huang, G.H.

    2010-03-15

    In this study, an interval-parameter semi-infinite fuzzy-chance-constrained mixed-integer linear programming (ISIFCIP) approach is developed for supporting long-term planning of waste-management systems under multiple uncertainties in the City of Regina, Canada. The method improves upon the existing interval-parameter semi-infinite programming (ISIP) and fuzzy-chance-constrained programming (FCCP) by incorporating uncertainties expressed as dual uncertainties of functional intervals and multiple uncertainties of distributions with fuzzy-interval admissible probability of violating constraint within a general optimization framework. The binary-variable solutions represent the decisions of waste-management-facility expansion, and the continuous ones are related to decisions of waste-flow allocation. The interval solutions can help decision-makers to obtain multiple decision alternatives, as well as provide bases for further analyses of tradeoffs between waste-management cost and system-failure risk. In the application to the City of Regina, Canada, two scenarios are considered. In Scenario 1, the City's waste-management practices would be based on the existing policy over the next 25 years. The total diversion rate for the residential waste would be approximately 14%. Scenario 2 is associated with a policy for waste minimization and diversion, where 35% diversion of residential waste should be achieved within 15 years, and 50% diversion over 25 years. In this scenario, not only landfill would be expanded, but also CF and MRF would be expanded. Through the scenario analyses, useful decision support for the City's solid-waste managers and decision-makers has been generated. Three special characteristics of the proposed method make it unique compared with other optimization techniques that deal with uncertainties. Firstly, it is useful for tackling multiple uncertainties expressed as intervals, functional intervals, probability distributions, fuzzy sets, and their

  14. Surgical Management of Pierre Robin Sequence: Using Mandibular Distraction Osteogenesis to Address Hypoventilation and Failure to Thrive in Infancy.

    PubMed

    Scott, Andrew R

    2016-04-01

    Mandibular hypoplasia may present in isolation or in the context of glossoptosis and a U-shaped, incomplete cleft palate. This latter triad is referred to as Pierre Robin sequence. Deleterious effects of micrognathia that may present during infancy are due primarily to glossoptosis or posterior displacement of the tongue. This tongue base prolapse may cause varying degrees of upper airway obstruction. A surgical option for management of tongue base airway obstruction secondary to mandibular hypoplasia is neonatal mandibular distraction osteogenesis. Herein, the author seeks to outline the benefits and limitations of early mandibular distraction osteogenesis as a way of managing airway obstruction and feeding difficulty in newborns with micrognathia. A description of the author's operative technique as well as potential complications and pitfalls will also be discussed. PMID:27097139

  15. Inaugural address

    NASA Astrophysics Data System (ADS)

    Joshi, P. S.

    2014-03-01

    From jets to cosmos to cosmic censorship P S Joshi Tata Institute of Fundamental Research, Homi Bhabha Road, Colaba, Mumbai 400005, India E-mail: psj@tifr.res.in 1. Introduction At the outset, I should like to acknowledge that part of the title above, which tries to capture the main flavour of this meeting, and has been borrowed from one of the plenary talks at the conference. When we set out to make the programme for the conference, we thought of beginning with observations on the Universe, but then we certainly wanted to go further and address deeper questions, which were at the very foundations of our inquiry, and understanding on the nature and structure of the Universe. I believe, we succeeded to a good extent, and it is all here for you in the form of these Conference Proceedings, which have been aptly titled as 'Vishwa Mimansa', which could be possibly translated as 'Analysis of the Universe'! It is my great pleasure and privilege to welcome you all to the ICGC-2011 meeting at Goa. The International Conference on Gravitation and Cosmology (ICGC) series of meetings are being organized by the Indian Association for General Relativity and Gravitation (IAGRG), and the first such meeting was planned and conducted in Goa in 1987, with subsequent meetings taking place at a duration of about four years at various locations in India. So, it was thought appropriate to return to Goa to celebrate the 25 years of the ICGC meetings. The recollections from that first meeting have been recorded elsewhere here in these Proceedings. The research and teaching on gravitation and cosmology was initiated quite early in India, by V V Narlikar at the Banares Hindu University, and by N R Sen in Kolkata in the 1930s. In course of time, this activity grew and gained momentum, and in early 1969, at the felicitation held for the 60 years of V V Narlikar at a conference in Ahmedabad, P C Vaidya proposed the formation of the IAGRG society, with V V Narlikar being the first President. This

  16. Opening addresses.

    PubMed

    Chukudebelu, W O; Lucas, A O; Ransome-kuti, O; Akinla, O; Obayi, G U

    1988-01-01

    The theme of the 3rd International Conference of the Society of Gynecology and Obstetrics of Nigeria (SOGON) held October 26, 1986 in Enugu was maternal morbidity and mortality in Africa. The opening addresses emphasize the high maternal mortality rate in Africa and SOGON's dedication to promoting women's health and welfare. In order to reduce maternal mortality, the scope of this problem must be made evident by gathering accurate mortality rates through maternity care monitoring and auditing. Governments, health professionals, educators, behavioral scientists, and communication specialists have a responsibility to improve maternal health services in this country. By making the population aware of this problem through education, measures can be taken to reduce the presently high maternal mortality rates. Nigerian women are physically unprepared for childbirth; therefore, balanced diets and disease prevention should be promoted. Since about 40% of deliveries are unmanaged, training for traditional birth attendants should be provided. Furthermore, family planning programs should discourage teenage pregnancies, encourage birth spacing and small families, and promote the use of family planning techniques among men. The problem of child bearing and rearing accompanied by hard work should also be investigated. For practices to change so that maternal mortality rates can be reduced, attitudes must be changed such that the current rates are viewed as unacceptable. PMID:12179275

  17. Self-Management, Perceived Control, and Subjective Quality of Life in Multiple Sclerosis: An Exploratory Study

    ERIC Educational Resources Information Center

    Bishop, Malachy; Frain, Michael P.; Tschopp, Molly K.

    2008-01-01

    Self-management has been shown to increase perceived control over both illness and nonillness aspects of life among people with chronic conditions but has not received significant research attention among persons with multiple sclerosis (MS). Based on relationships proposed in the illness intrusiveness and disability centrality models, this study…

  18. Coping with Workplace Stress: A Multiple-Group Comparison of Female Managers and Clerical Workers.

    ERIC Educational Resources Information Center

    Long, Bonita C.

    1998-01-01

    A causal model of workplace stress was refined and cross-validated. Multivariate analysis and multiple-group structural equation modeling were used to investigate the effects of social roles on patterns of coping with workplace stress and job satisfaction. Differences found between managers (n=249) and clerical workers (n=214) suggest power and…

  19. Opening Address

    NASA Astrophysics Data System (ADS)

    Yamada, T.

    2014-12-01

    Ladies and Gentlemen, it is my great honor and pleasure to present an opening address of the 3rd International Workshop on "State of the Art in Nuclear Cluster Physics"(SOTANCP3). On the behalf of the organizing committee, I certainly welcome all your visits to KGU Kannai Media Center belonging to Kanto Gakuin University, and stay in Yokohama. In particular, to whom come from abroad more than 17 countries, I would appreciate your participations after long long trips from your homeland to Yokohama. The first international workshop on "State of the Art in Nuclear Cluster Physics", called SOTANCP, was held in Strasbourg, France, in 2008, and the second one was held in Brussels, Belgium, in 2010. Then the third workshop is now held in Yokohama. In this period, we had the traditional 10th cluster conference in Debrecen, Hungary, in 2012. Thus we have the traditional cluster conference and SOTANCP, one after another, every two years. This obviously shows our field of nuclear cluster physics is very active and flourishing. It is for the first time in about 10 years to hold the international workshop on nuclear cluster physics in Japan, because the last cluster conference held in Japan was in Nara in 2003, about 10 years ago. The president in Nara conference was Prof. K. Ikeda, and the chairpersons were Prof. H. Horiuchi and Prof. I. Tanihata. I think, quite a lot of persons in this room had participated at the Nara conference. Since then, about ten years passed. So, this workshop has profound significance for our Japanese colleagues. The subjects of this workshop are to discuss "the state of the art in nuclear cluster physics" and also discuss the prospect of this field. In a couple of years, we saw significant progresses of this field both in theory and in experiment, which have brought better and new understandings on the clustering aspects in stable and unstable nuclei. I think, the concept of clustering has been more important than ever. This is true also in the

  20. Presidential address.

    PubMed

    Vohra, U

    1993-07-01

    The Secretary of India's Ministry of Health and Family Welfare serves as Chair of the Executive Council of the International Institute for Population Sciences in Bombay. She addressed its 35th convocation in 1993. Global population stands at 5.43 billion and increases by about 90 million people each year. 84 million of these new people are born in developing countries. India contributes 17 million new people annually. The annual population growth rate in India is about 2%. Its population size will probably surpass 1 billion by the 2000. High population growth rates are a leading obstacle to socioeconomic development in developing countries. Governments of many developing countries recognize this problem and have expanded their family planning programs to stabilize population growth. Asian countries that have done so and have completed the fertility transition include China, Japan, Singapore, South Korea, and Thailand. Burma, Malaysia, North Korea, Sri Lanka, and Vietnam have not yet completed the transition. Afghanistan, Bangladesh, Iran, Nepal, and Pakistan are half-way through the transition. High population growth rates put pressure on land by fragmenting finite land resources, increasing the number of landless laborers and unemployment, and by causing considerable rural-urban migration. All these factors bring about social stress and burden civic services. India has reduced its total fertility rate from 5.2 to 3.9 between 1971 and 1991. Some Indian states have already achieved replacement fertility. Considerable disparity in socioeconomic development exists among states and districts. For example, the states of Bihar, Madhya Pradesh, Rajasthan, and Uttar Pradesh have female literacy rates lower than 27%, while that for Kerala is 87%. Overall, infant mortality has fallen from 110 to 80 between 1981 and 1990. In Uttar Pradesh, it has fallen from 150 to 98, while it is at 17 in Kerala. India needs innovative approaches to increase contraceptive prevalence rates

  1. Projected groundwater balance as a state indicator for addressing sustainability and management challenges of overexploited crystalline aquifers

    NASA Astrophysics Data System (ADS)

    Sarah, S.; Ahmed, S.; Boisson, A.; Violette, S.; de Marsily, G.

    2014-11-01

    In India, particularly in semi-arid regions, groundwater levels are declining at alarming rates due to overexploitation and the sustainable exploitation of groundwater resources is in deep crisis. There is little or no information on groundwater sustainability indicators, which can signal towards the challenges in water management. In this study we downscaled an entire watershed into three zones based on the different hydrodynamic behaviour recorded at the borewell scale. A process-based simple, multi-parameter linear auto-regressive model was developed to predict groundwater levels, which uses recharge, groundwater withdrawal and irrigation return flow as input variables. A comprehensive and predictive long-term groundwater balance is used as a state indicator to evaluate the sustainability and management challenges in the watershed. Two groundwater withdrawal scenarios were designed to assess the impact of groundwater withdrawal on the groundwater balance. We found that geological heterogeneities play a crucial role in controlling groundwater fluctuations. The storage change in two different groundwater withdrawal scenarios shows gradually declining groundwater storage in both scenarios. A long-term assessment of the groundwater balance helps to analyse the state of the groundwater system and to locate priority zones for watershed interventions.

  2. Optimal regeneration planning for old-growth forest: addressing scientific uncertainty in endangered species recovery through adaptive management

    USGS Publications Warehouse

    Moore, C.T.; Conroy, M.J.

    2006-01-01

    Stochastic and structural uncertainties about forest dynamics present challenges in the management of ephemeral habitat conditions for endangered forest species. Maintaining critical foraging and breeding habitat for the endangered red-cockaded woodpecker (Picoides borealis) requires an uninterrupted supply of old-growth forest. We constructed and optimized a dynamic forest growth model for the Piedmont National Wildlife Refuge (Georgia, USA) with the objective of perpetuating a maximum stream of old-growth forest habitat. Our model accommodates stochastic disturbances and hardwood succession rates, and uncertainty about model structure. We produced a regeneration policy that was indexed by current forest state and by current weight of evidence among alternative model forms. We used adaptive stochastic dynamic programming, which anticipates that model probabilities, as well as forest states, may change through time, with consequent evolution of the optimal decision for any given forest state. In light of considerable uncertainty about forest dynamics, we analyzed a set of competing models incorporating extreme, but plausible, parameter values. Under any of these models, forest silviculture practices currently recommended for the creation of woodpecker habitat are suboptimal. We endorse fully adaptive approaches to the management of endangered species habitats in which predictive modeling, monitoring, and assessment are tightly linked.

  3. Welcome Address

    NASA Astrophysics Data System (ADS)

    Kiku, H.

    2014-12-01

    Ladies and Gentlemen, It is an honor for me to present my welcome address in the 3rd International Workshop on "State of the Art in Nuclear Cluster Physics"(SOTANCP3), as the president of Kanto Gakuin University. Particularly to those from abroad more than 17 countries, I am very grateful for your participation after long long trips from your home to Yokohama. On the behalf of the Kanto Gakuin University, we certainly welcome your visit to our university and stay in Yokohama. First I would like to introduce Kanto Gakuin University briefly. Kanto Gakuin University, which is called KGU, traces its roots back to the Yokohama Baptist Seminary founded in 1884 in Yamate, Yokohama. The seminary's founder was Albert Arnold Bennett, alumnus of Brown University, who came to Japan from the United States to establish a theological seminary for cultivating and training Japanese missionaries. Now KGU is a major member of the Kanto Gakuin School Corporation, which is composed of two kindergartens, two primary schools, two junior high schools, two senior high schools as well as KGU. In this university, we have eight faculties with graduate school including Humanities, Economics, Law, Sciences and Engineering, Architecture and Environmental Design, Human and Environmental Studies, Nursing, and Law School. Over eleven thousands students are currently learning in our university. By the way, my major is the geotechnical engineering, and I belong to the faculty of Sciences and Engineering in my university. Prof. T. Yamada, here, is my colleague in the same faculty. I know that the nuclear physics is one of the most active academic fields in the world. In fact, about half of the participants, namely, more than 50 scientists, come from abroad in this conference. Moreover, I know that the nuclear physics is related to not only the other fundamental physics such as the elementary particle physics and astrophysics but also chemistry, medical sciences, medical cares, and radiation metrology

  4. Tenth Warren K. Sinclair keynote address-the Fukushima nuclear power plant accident and comprehensive health risk management.

    PubMed

    Yamashita, Shunichi

    2014-02-01

    Just two years have passed since the Tokyo Electric Power Company-Fukushima Daiichi Nuclear Power Plant (NPP) accident, a multidimensional disaster that combined to destroy the local infrastructure on which the safety system depended and gave a serious impact to the world. Countermeasures including evacuation, sheltering, and control of the food chain were implemented in a timely manner by the Japanese government. However, there is a clear need for improvement, especially in the areas of nuclear safety and protection and also in the management of the radiation health risk during and even after the accident. To date there have been no acute radiation injuries. The radiation-related physical health consequences to the general public, including evacuees, are likely to be much lower than those arising from the Chernobyl nuclear reactor accident, because the radiation fallout and the subsequent environmental contamination were much more limited. However, the social, psychological, and economic impacts of the Fukushima NPP accident are expected to be considerable. Currently, continued monitoring and characterization of the levels of radioactivity in the environment and foods in Fukushima are vital for obtaining informed consent to the decisions on living in the areas already radiocontaminated and returning back to the evacuated areas once re-entry is permitted; it is also important to perform a realistic assessment of the radiation doses on the basis of measurements. We are currently implementing the official plans of the Fukushima Health Management Survey, which includes a basic survey for the estimation of the external doses that were received during the first 4 mo after the accident and four more detailed surveys (thyroid ultrasound examination, comprehensive health check-up, mental health and life-style survey, and survey of pregnant women and nursing mothers), with the aim to take care of the health of all of the residents of the Fukushima Prefecture for a long time

  5. Opening Address

    NASA Astrophysics Data System (ADS)

    Abalakin, V. K.

    1997-03-01

    Dear Colleagues, It is a great pleasure and honor for me to invite you on the occasion of the IAU Colloquium International Cooperation in Dissemination of the Astronomical Data to the Central (Pulkovo) Astronomical Observatory of the Russian Academy of Sciences. This distinguished gathering of experts in the vast field of modern methods for archiving and managing almost infinite astronomical data files of everlasting value will doubtlessly make a considerable and important contribution to success in the present and future research in astronomy. All of us are witnesses of a great technological, even psychological upturn that occurs in the everyday astronomical practice. The small but the most powerful handy devices known as desktop, laptop, or even palm-top PCs, have rendered a tedious calculating work and stressing search in the card-file or book-form catalogs to a pure pleasure and raised an admiration for those brilliant minds that have invented such a kind of hard- and software. The networks of all kinds and sorts -- Internet, Bitnet, World Wide Web, etc. -- have realized ancient dreams of a Man to fly with thought all over the world communicating with other human beings. But ... don't forget that the most real and valuable communication is the live one, when one can see the face and the eyes of his (or her) partner, listen to his voice as large as life, and the only opportunity for this is to stay together. And this just occurs at the colloquium like ours! So, let me heartily welcome you to the Pulkovo Observatory.

  6. Multiple sclerosis documentation system (MSDS): moving from documentation to management of MS patients.

    PubMed

    Ziemssen, Tjalf; Kempcke, Raimar; Eulitz, Marco; Großmann, Lars; Suhrbier, Alexander; Thomas, Katja; Schultheiss, Thorsten

    2013-09-01

    The long disease duration of multiple sclerosis and the increasing therapeutic options require a individualized therapeutic approach which should be carefully documented over years of observation. To switch from MS documentation to an innovative MS management, new computer- and internet-based tools could be implemented as we could demonstrate with the novel computer-based patient management system "multiple sclerosis management system 3D" (MSDS 3D). MSDS 3D allows documentation and management of visit schedules and mandatory examinations via defined study modules by integration of data input from various sources (patients, attending physicians and MS nurses). It provides forms for the documentation of patient visits as well as clinical and diagnostic findings. Information can be collected via interactive touch screens. Specific modules allow the management of highly efficacious treatments as natalizumab or fingolimod. MSDS can be used to transfer the documented data to databases as, e.g. the registry of the German MS society or REGIMS. MSDS has already been implemented successfully in clinical practice and is currently being evaluated in a multicenter setting. High-quality management and documentation are crucial for improvements in clinical practice and research work. PMID:23728704

  7. Perceived Impact of a Self-Management Program for Fatigue in Multiple Sclerosis

    PubMed Central

    Wilkinson, Amanda; Snowdon, Jessie

    2016-01-01

    Background: Fatigue in multiple sclerosis (MS) is reported to be one of its most debilitating symptoms, affecting personal, family, and community participation. Despite a high incidence of MS in New Zealand, there was no cohesive approach to support people with MS to manage their fatigue. This prompted the development of Minimise Fatigue, Maximise Life: Creating Balance with Multiple Sclerosis (MFML), a group-based, 6-week fatigue self-management program. This study explored the perceived impact of MFML for participants who attended the program. Methods: We undertook semistructured individual telephone interviews 1 (n = 23) and 3 (n = 11) months after delivery of the program. Data were analyzed for themes. Results: Two themes emerged from the data: achieving behavior change to manage fatigue and whole of life effects. These themes represent participants' perceived benefits of the program. Conclusions: This study provides evidence that the MFML fatigue self-management program positively affected the lives of participants. The findings suggest that participants had begun to successfully develop and integrate self-management skills into their everyday lives. This affected the individual personally and also their participation in family and community life. This study adds to the current knowledge and understanding of the positive effect that delivery of a fatigue self-management intervention can have for people with MS. PMID:26917995

  8. Balancing multiple objectives using a classification-based forest management system in Changbai Mountains, China.

    PubMed

    Zhao, Fuqiang; Yang, Jian; Liu, Zhihua; Dai, Limin; He, Hong S

    2011-12-01

    Contemporary forest management often consists of multiple objectives, including restoration of human-impacted forested landscapes toward their range of natural variability (RNV) and sustainable levels of timber production. Balancing multiple management objectives is often challenging due to intrinsic conflicts between these objectives and a lack of reference conditions for evaluating the effectiveness of forest restoration efforts. We used a spatially explicit forest landscape model to assess how well a classification-based forest management (CFM) system could achieve multiple objectives in a Korean pine broadleaf mixed forest ecosystem at Changbai Mountain in Northeast China. The CFM system divided the forest landscape into three management areas (Commercial Forest, Special Ecological Welfare Forest, and General Ecological Welfare Forest), each with its own management objectives and prescriptions, but with an overall goal of increasing the ecological and economic sustainability of the entire landscape. The zoning approach adopted in the Chinese CFM system is very similar to the TRIAD approach that is being advocated for managing public forests in Canada. In this study, a natural disturbance scenario and seven harvest scenarios (one identical to the current harvest regime and six alternative scenarios) were simulated to examine how tree species composition, age structure, and timber production at the landscape level can be affected by different strategies under the CFM system. The results indicated that the current forest management regime would not only fail to reach the designated timber production level but also move the forest landscape far away from its RNV. In order to return the currently altered forest landscape to approach its RNV while providing a stable level of timber production over time, harvest intensities should be reduced to a level that is equivalent to the amount of timber removals that would occur under the natural disturbances; and the

  9. Balancing Multiple Objectives Using a Classification-Based Forest Management System in Changbai Mountains, China

    NASA Astrophysics Data System (ADS)

    Zhao, Fuqiang; Yang, Jian; Liu, Zhihua; Dai, Limin; He, Hong S.

    2011-12-01

    Contemporary forest management often consists of multiple objectives, including restoration of human-impacted forested landscapes toward their range of natural variability (RNV) and sustainable levels of timber production. Balancing multiple management objectives is often challenging due to intrinsic conflicts between these objectives and a lack of reference conditions for evaluating the effectiveness of forest restoration efforts. We used a spatially explicit forest landscape model to assess how well a classification-based forest management (CFM) system could achieve multiple objectives in a Korean pine broadleaf mixed forest ecosystem at Changbai Mountain in Northeast China. The CFM system divided the forest landscape into three management areas (Commercial Forest, Special Ecological Welfare Forest, and General Ecological Welfare Forest), each with its own management objectives and prescriptions, but with an overall goal of increasing the ecological and economic sustainability of the entire landscape. The zoning approach adopted in the Chinese CFM system is very similar to the TRIAD approach that is being advocated for managing public forests in Canada. In this study, a natural disturbance scenario and seven harvest scenarios (one identical to the current harvest regime and six alternative scenarios) were simulated to examine how tree species composition, age structure, and timber production at the landscape level can be affected by different strategies under the CFM system. The results indicated that the current forest management regime would not only fail to reach the designated timber production level but also move the forest landscape far away from its RNV. In order to return the currently altered forest landscape to approach its RNV while providing a stable level of timber production over time, harvest intensities should be reduced to a level that is equivalent to the amount of timber removals that would occur under the natural disturbances; and the

  10. MR imaging and PET/CT in diagnosis and management of multiple myeloma.

    PubMed

    Ferraro, Regan; Agarwal, Ankit; Martin-Macintosh, Erica L; Peller, Patrick J; Subramaniam, Rathan M

    2015-01-01

    Multiple myeloma is a common hematologic malignancy among the elderly population. Although there have been many advances in treatment over the past few decades, the overall prognosis for the disease remains poor. Conventional radiography has long been the standard of reference for the imaging of multiple myeloma. However, 10%-20% of patients with multiple myeloma do not have evidence of disease at conventional radiography. There is a growing body of evidence supporting use of magnetic resonance (MR) imaging and 2-[fluorine-18]fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET)/computed tomography (CT) in diagnosis and management of multiple myeloma. MR imaging is useful in detection of bone marrow infiltration, a finding often missed at conventional radiography. FDG PET/CT is especially sensitive for the detection of extramedullary disease and can help detect the metabolically active lesions that often precede evidence of osseous destruction at conventional radiography. MR imaging and FDG PET/CT are useful tools that can provide essential information for diagnosis and management of patients with multiple myeloma. Both modalities allow accurate localization of disease after chemotherapy or autologous stem cell transplantation and can provide important prognostic information that can influence further clinical decision making regarding therapy, particularly when tumor serum markers may be a less reliable indicator of disease burden after repeated treatments. PMID:25763728

  11. Does audit improve diabetes care in a primary care setting? A management tool to address health system gaps

    PubMed Central

    Pruthu, T. K.; Majella, Marie Gilbert; Nair, Divya; Ramaswamy, Gomathi; Palanivel, C.; Subitha, L.; Kumar, S. Ganesh; Kar, Sitanshu Sekhar

    2015-01-01

    Introduction: Diabetes mellitus is one of the emerging epidemics. Regular clinical and biochemical monitoring of patients, adherence to treatment and counseling are cornerstones for prevention of complications. Clinical audits as a process of improving quality of patient care and outcomes by reviewing care against specific criteria and then reviewing the change can help in optimizing care. Objective: We aimed to audit the process of diabetes care using patient records and also to assess the effect of audit on process of care indicators among patients availing diabetes care from a rural health and training center in Puducherry, South India. Materials and Methods: A record based study was conducted to audit diabetes care among patients attending noncommunicable disease clinic in a rural health center of South India. Monitoring of blood pressure (BP), blood glucose, lipid profile and renal function test were considered for auditing in accordance with standard guidelines. Clinical audit cycle (CAC), a simple management tool was applied and re-audit was done after 1-year. Results: We reviewed 156 and 180 patients records during year-1 and year-2, respectively. In the audit year-1, out of 156 patients, 78 (50%), 70 (44.9%), 49 (31.4%) and 19 (12.2%) had got their BP, blood glucose, lipid profile and renal function tests done. Monitoring of blood glucose, BP, lipid profile and renal function improved significantly by 35%, 20.7%, 36.4% and 56.1% over 1-year. Conclusion: CAC improves process of diabetes care in a primary care setting with existing resources. PMID:26604621

  12. Rangeland management for multiple outcomes: Explicity integrating ecosystem services into management models

    Technology Transfer Automated Retrieval System (TEKTRAN)

    In recent decades, there has been increased interest in ecosystem services among landowners, and a growing diversity of stakeholders on rangelands. Given these changes, management cannot focus solely on maximizing ranch proceeds, but must also incorporate ecosystem service goals to sustain resources...

  13. Multiple large splenic abscesses managed with computed tomography-guided percutaneous catheter drainage in children.

    PubMed

    Yeom, Jung Sook; Park, Ji Sook; Seo, Ji-Hyun; Park, Eun Sil; Lim, Jae-Young; Park, Chan Hoo; Woo, Hyang Ok; Park, Jung Je; Cho, Jae Min; Youn, Hee-Shang

    2013-12-01

    Splenic abscess is a rare finding in children. Splenectomy combined with broad-spectrum antibiotics has been the treatment of choice for multiple splenic abscesses. Herein, we report the case of a 14-year-old girl with multiple large splenic abscesses that were successfully managed after two image-guided percutaneous drainage procedures and administration of intravenous antibiotics. Initially, an abscess located at the periphery in the lower pole of the spleen was aspirated under ultrasound guidance. Finally, another abscess located near the hilum of the spleen was drained under computed tomography guidance. To the best of our knowledge, this is the first report of multiple large splenic abscesses treated with computed tomography-guided percutaneous drainage. PMID:23597527

  14. Efficient Management of Multiple Piconets in an MC-CDMA-Based UWB System

    NASA Astrophysics Data System (ADS)

    Gong, Peng; Xue, Peng; Piao, Cheng Jie; Kim, Duk Kyung

    With multiple overlapped piconets, the IEEE 802.15.3 Medium Access Control (MAC) protocol uses a Parent/Child (P/C) or Parent/Neighbor (P/N) configuration to avoid inter-piconet interference. However, the throughput of a P/N or P/C configuration cannot exceed that of a single piconet. In the present paper we propose an efficient means of managing multiple piconets to cooperate with a Multi-Carrier Code Division Multiple Access (MC-CDMA) based UWB system. The proposed management approach uses an Intermediate Device (IDEV) to connect Piconet Coordinators (PNCs). A senior PNC adaptively arranges two simultaneous data transmission links with the proposed spreading matrices in each Channel Time Allocation (CTA) instead of a P/C or P/N configuration, which supports only a single link in each CTA. Simulation results demonstrate the proposed scheme can achieve a higher throughput with an acceptable compromise of link success probability in multiple overlapped piconets.

  15. Combining ecosystem service relationships and DPSIR framework to manage multiple ecosystem services.

    PubMed

    Xue, Hui; Li, Shiyu; Chang, Jie

    2015-03-01

    Ecosystem service (ES) relationship occurs due to two types of mechanisms: (1) interact directly or (2) interact through the impact of a shared factor. Identifying such mechanisms behind ES relationship within a single land-use/land-cover category and combining it with a system thinking framework is especially necessary for effective decision-making to manage multiple ESs generated by this land-use/land-cover. In this study, we use tea plantations in China to investigate mechanisms behind ES relationships. We find that tea production is positively correlated with four regulating services (i.e., carbon sequestration, soil N protection, soil P protection, and water conservation). Several regulating services, such as carbon sequestration and soil N, P, and K protection, have positive correlations with each other. Tea production, carbon sequestration, and soil retention are significantly correlated with local annual mean temperature and precipitation. We then establish driver-pressure-state-impact-response (DPSIR) framework for tea plantations, which has been widely used for environmental management issues. Integrating our findings of ES relationship into DPSIR framework, we can estimate how ES change is responding to two types of responses: response to control drivers and response to maintain or restore state. Scenario analysis showed that the responses to control drivers have a larger impact on ES. We discuss that DPSIR would favor managing multiple ES because it enables a more precise understanding of how ES interacts through the effects of factors from various hierarchies. Finally, we suggest integrating ES direct interaction into DPSIR framework. We think such integration could improve the ability of DPSIR framework to support decision-making in multiple ES management, specifically in at least three aspects: (1) favor to identify all possible response alternatives, (2) enable us to evaluate ES which cannot be assessed if without such combining, and (3) help to

  16. Stakeholders' expectations on connectivity research for water and land management addressed by a survey in the collaborative EU-COST Connecteur network

    NASA Astrophysics Data System (ADS)

    Smetanova, Anna; Paton, Eva N.; Keesstra, Saskia

    2016-04-01

    Transfer of knowledge across the science-society interface is essential for both, ethical and economic reasons, and inevitable for successful climate change adaptation and integrated management of sustainable, resilient landscapes. The transdisciplinary research of connectivity (which is the degree to which a system facilitates the movement of matter and energy through itself. It is an emergent property of the system state, Connecteur web resources,2015) has the potential to supply monitoring, modelling and management tools to land and water managers in order to reach these goals. The research of water and sediment connectivity has received significant and increasing scientific attention across the entire realm of the environmental disciplines, and the COST Action ES 1306 Connecteur facilitates the multi-sectorial collaboration in connectivity research at EU level. In order to appropriately address the transfer of the cutting edge research developments of the Connecteur network, the collaborative research project on stakeholders' perception of connectivity was conducted by the Working Group 5 "Transition of connectivity research towards sustainable land and water management". The questionnaire survey on stakeholder perception was conducted by volunteering scientist involved in the Connecteur network together from 19 European countries. Together 84 stakeholders from all mayor sectors in water and land management were asked about the main challenges of their work, their understanding of connectivity, the desired areas of cooperation with connectivity science, and the best tools for transferring knowledge. The results showed differences between different stakeholders groups in the way they percept and work with connectivity, as well as their requirement of knowledge transfers. While farmers, and (in lower extend) the agricultural administration officers articulated no, or little need for connectivity management, the majority of stakeholders involved in land and water

  17. Designing an Electronic Patient Management System for Multiple Sclerosis: Building a Next Generation Multiple Sclerosis Documentation System

    PubMed Central

    Kern, Raimar; Haase, Rocco; Eisele, Judith Christina; Thomas, Katja

    2016-01-01

    Background Technologies like electronic health records or telemedicine devices support the rapid mediation of health information and clinical data independent of time and location between patients and their physicians as well as among health care professionals. Today, every part of the treatment process from diagnosis, treatment selection, and application to patient education and long-term care may be enhanced by a quality-assured implementation of health information technology (HIT) that also takes data security standards and concerns into account. In order to increase the level of effectively realized benefits of eHealth services, a user-driven needs assessment should ensure the inclusion of health care professional perspectives into the process of technology development as we did in the development process of the Multiple Sclerosis Documentation System 3D. After analyzing the use of information technology by patients suffering from multiple sclerosis, we focused on the needs of neurological health care professionals and their handling of health information technology. Objective Therefore, we researched the status quo of eHealth adoption in neurological practices and clinics as well as health care professional opinions about potential benefits and requirements of eHealth services in the field of multiple sclerosis. Methods We conducted a paper-and-pencil–based mail survey in 2013 by sending our questionnaire to 600 randomly chosen neurological practices in Germany. The questionnaire consisted of 24 items covering characteristics of participating neurological practices (4 items), the current use of network technology and the Internet in such neurological practices (5 items), physicians’ attitudes toward the general and MS-related usefulness of eHealth systems (8 items) and toward the clinical documentation via electronic health records (4 items), and physicians’ knowledge about the Multiple Sclerosis Documentation System (3 items). Results From 600 mailed

  18. Goals set after completing a teleconference-delivered program for managing multiple sclerosis fatigue.

    PubMed

    Asano, Miho; Preissner, Katharine; Duffy, Rose; Meixell, Maggie; Finlayson, Marcia

    2015-01-01

    Setting goals can be a valuable skill to self-manage multiple sclerosis (MS) fatigue. A better understanding of the goals set by people with MS after completing a fatigue management program can assist health care professionals with tailoring interventions for clients. This study aimed to describe the focus of goals set by people with MS after a teleconference-delivered fatigue management program and to evaluate the extent to which participants were able to achieve their goals over time. In total, 485 goals were set by 81 participants. Over a follow-up period, 64 participants rated 284 goals regarding progress made toward goal achievement. Approximately 50% of the rated goals were considered achieved. The most common type of goal achieved was that of instrumental activities of daily living. Short-term goals were more likely to be achieved. This study highlights the need for and importance of promoting and teaching goal-setting skills to people with MS. PMID:25871602

  19. Robust set-point regulation for ecological models with multiple management goals.

    PubMed

    Guiver, Chris; Mueller, Markus; Hodgson, Dave; Townley, Stuart

    2016-05-01

    Population managers will often have to deal with problems of meeting multiple goals, for example, keeping at specific levels both the total population and population abundances in given stage-classes of a stratified population. In control engineering, such set-point regulation problems are commonly tackled using multi-input, multi-output proportional and integral (PI) feedback controllers. Building on our recent results for population management with single goals, we develop a PI control approach in a context of multi-objective population management. We show that robust set-point regulation is achieved by using a modified PI controller with saturation and anti-windup elements, both described in the paper, and illustrate the theory with examples. Our results apply more generally to linear control systems with positive state variables, including a class of infinite-dimensional systems, and thus have broader appeal. PMID:26242360

  20. How much detail and accuracy is required in plant growth sub-models to address questions about optimal management strategies in agricultural systems?

    PubMed Central

    Renton, Michael

    2011-01-01

    Background and aims Simulations that integrate sub-models of important biological processes can be used to ask questions about optimal management strategies in agricultural and ecological systems. Building sub-models with more detail and aiming for greater accuracy and realism may seem attractive, but is likely to be more expensive and time-consuming and result in more complicated models that lack transparency. This paper illustrates a general integrated approach for constructing models of agricultural and ecological systems that is based on the principle of starting simple and then directly testing for the need to add additional detail and complexity. Methodology The approach is demonstrated using LUSO (Land Use Sequence Optimizer), an agricultural system analysis framework based on simulation and optimization. A simple sensitivity analysis and functional perturbation analysis is used to test to what extent LUSO's crop–weed competition sub-model affects the answers to a number of questions at the scale of the whole farming system regarding optimal land-use sequencing strategies and resulting profitability. Principal results The need for accuracy in the crop–weed competition sub-model within LUSO depended to a small extent on the parameter being varied, but more importantly and interestingly on the type of question being addressed with the model. Only a small part of the crop–weed competition model actually affects the answers to these questions. Conclusions This study illustrates an example application of the proposed integrated approach for constructing models of agricultural and ecological systems based on testing whether complexity needs to be added to address particular questions of interest. We conclude that this example clearly demonstrates the potential value of the general approach. Advantages of this approach include minimizing costs and resources required for model construction, keeping models transparent and easy to analyse, and ensuring the model

  1. Multiple uses of indicators and indices in cumulative effects assessment and management

    SciTech Connect

    Canter, L.W.; Atkinson, S.F.

    2011-09-15

    Both environmental indicators and multi-metric indices are useful for describing baseline conditions and qualitatively predicting the cumulative consequences of multiple actions. Several examples and case studies associated with indicators and/or indices are presented herein. They can be easily modified for usage in CEAM. Habitat suitability models reflect special indices related to habitat needs and quality for specific species or broad habitat types. Such models have been used to address direct and indirect effects, and with some modification, they can be also used to address cumulative effects of multiple actions. This review has indicated that there are numerous examples of such tools which have been or could be used in both EIA and CEAM. Some key lessons are: (1) in conducting CEAM studies, it is useful to think from the mindset that 'I am the VEC or indicator, and what is my historical and current condition and how have I, or will I, be affected by multiple past, present, and future actions?'; (2) due to the likely absence of detailed information on future actions, the described tools can still be used to 'predict' future conditions by focusing on qualitative up-or-down changes in individual indicators or indices with their aggregated displays; and (3) numerous regional and site-specific tools are currently available, with one example being indices of biological integrity for specific watersheds and water bodies. Such tools, even though they may not have been developed for CEAM usage, can certainly benefit CEAM studies and practice. Finally, usage of selected and appropriate tools as described herein can aid in conducting science-based, systematic, and documentable CEAM studies.

  2. Clinical Utility of Glatiramer Acetate in the Management of Relapse Frequency in Multiple Sclerosis

    PubMed Central

    Fernández, Oscar

    2012-01-01

    Glatiramer acetate (GA) represents one of the most common disease-modifying therapies for multiple sclerosis. GA is currently approved for patients at high risk of developing clinically definite multiple sclerosis (CDMS) after having experienced a well-defined first clinical episode (clinically isolated syndrome or CIS) and for patients with relapsing-remitting multiple sclerosis (RRMS). GA’s efficacy and effectiveness to reduce relapse frequency have been proved in placebo-controlled and observational studies. Comparative trials have also confirmed the lack of significant differences over other choices of treatment in the management of relapse frequency, and long-term studies have supported its effect at extended periods of time. Additionally, RRMS patients with suboptimal response to interferon β may benefit from reduced relapse rate after switching to GA, and those with clinically isolated syndrome may benefit from delayed conversion to CDMS. All these results, together with its proven long-term safety and positive effect on patients’ daily living, support the favorable risk-benefit of GA for multiple sclerosis treatment. PMID:23650472

  3. Using multiple criteria decision analysis for supporting decisions of solid waste management.

    PubMed

    Cheng, Steven; Chan, Christine W; Huang, Guo H

    2002-01-01

    Design of solid-waste management systems requires consideration of multiple alternative solutions and evaluation criteria because the systems can have complex and conflicting impacts on different stakeholders. Multiple criteria decision analysis (MCDA) has been found to be a fruitful approach to solve this design problem. In this paper, the MCDA approach is applied to solve the landfill selection problem in Regina of Saskatchewan Canada. The systematic approach of MCDA helps decision makers select the most preferable decision and provides the basis of a decision support system. The techniques that are used in this study include: 1) Simple Weighted Addition method, 2) Weighted Product method, 3) TOPSIS, 4) cooperative game theory, and 5) ELECTRE. The results generated with these methods are compared and ranked so that the most preferable solution is identified. PMID:12090287

  4. Radiological management of multiple hepatic artery pseudoaneurysms associated with cholangitic abscesses

    PubMed Central

    Goyal, Ankur; Madhusudhan, Kumble S; Gamanagatti, Shivanand; Baruah, Bhaskar; Shalimar; Sharma, Raju

    2016-01-01

    Hepatic artery pseudoaneurysms (HAP) are uncommon, occurring mostly as a complication of trauma (accidental or iatrogenic). Liver abscess rarely causes HAP and multiple HAP associated with cholangitic abscesses have not been reported in the literature. We present a patient of acute necrotizing pancreatitis with stent block cholangitis and multiple cholangitic abscesses who developed hemorrhagic output through drainage catheter in the liver abscess. A multiphasic CT angiography demonstrated three HAP, which were treated with a combination of endovascular coil embolization and percutaneous thrombin injection. The fact that cholangitic abscesses may be associated with pseudoaneurysms should not be neglected, considering the potentially catastrophic complication and relatively easy radiological management. CT angiography permits accurate diagnosis and lays down the roadmap for endovascular procedures. PMID:27081232

  5. Different approaches for centralized and decentralized water system management in multiple decision makers' problems

    NASA Astrophysics Data System (ADS)

    Anghileri, D.; Giuliani, M.; Castelletti, A.

    2012-04-01

    There is a general agreement that one of the most challenging issues related to water system management is the presence of many and often conflicting interests as well as the presence of several and independent decision makers. The traditional approach to multi-objective water systems management is a centralized management, in which an ideal central regulator coordinates the operation of the whole system, exploiting all the available information and balancing all the operating objectives. Although this approach allows to obtain Pareto-optimal solutions representing the maximum achievable benefit, it is based on assumptions which strongly limits its application in real world contexts: 1) top-down management, 2) existence of a central regulation institution, 3) complete information exchange within the system, 4) perfect economic efficiency. A bottom-up decentralized approach seems therefore to be more suitable for real case applications since different reservoir operators may maintain their independence. In this work we tested the consequences of a change in the water management approach moving from a centralized toward a decentralized one. In particular we compared three different cases: the centralized management approach, the independent management approach where each reservoir operator takes the daily release decision maximizing (or minimizing) his operating objective independently from each other, and an intermediate approach, leading to the Nash equilibrium of the associated game, where different reservoir operators try to model the behaviours of the other operators. The three approaches are demonstrated using a test case-study composed of two reservoirs regulated for the minimization of flooding in different locations. The operating policies are computed by solving one single multi-objective optimal control problem, in the centralized management approach; multiple single-objective optimization problems, i.e. one for each operator, in the independent case

  6. Traffic Management Advisor: Iterative Field Development and Assessment at Multiple Sites

    NASA Technical Reports Server (NTRS)

    Sanford, Beverly D.; Lee, Katharine K.; Harwood, Kelly; Denery, Dallas G. (Technical Monitor)

    1995-01-01

    Previous studies have demonstrated the necessity of involving users in the development of automation aids, especially for complex domains such as air traffic control (ATC). Traditional development only demanded a single field test to validate a completed system, but a more iterative combination of development and assessment ensures that the technology meets the requirements of its application domain. Exposure across an adequate spectrum of field users is also required during development, and the use of multiple development sites provides an opportunity to consider individual facility cultures as they relate to implementation strategies. The development of the Center/TRACON Automation System (CTAS) Traffic Management Advisor (TMA) at the Denver and Dallas ATC facilities demonstrates successful iterative development and assessment at multiple field sites. The use of field development changes the nature of assessment. As development progresses, periodic assessments are required to validate that system development is progressing along an appropriate track. In the development of the TMA, assessments were performed based on software in the field, and input from traffic managers was analyzed and incorporated into subsequent releases of the TMA, to be reassessed in the field. This has led to a tool with operational suitability and broad user acceptance. Assessment at multiple sites provides a more generalizable perspective that allows the production of a system that is both generic enough to be used at different sites and tailored enough to be of use at any site. In addition to providing a better understanding of specific facility requirements, the use of multiple assessment sites in the development of TMA has provided an opportunity to consider individual facility operations, procedures and cultures as they relate to development and implementation strategies.

  7. Management of opioid use disorders among veterans in subacute rehab: Use of an interdisciplinary task force to address an emerging concern.

    PubMed

    Hinrichs, Kate L M; Sharma, Samata; Thurston, Joe; Sivashanker, Karthik; Chang, Grace H

    2016-01-01

    There is both rapidly growing need, and limited evidence-based guidelines, for the management of opioid use disorders in subacute rehab and other nonaddiction medical settings. Following 2 unintentional opioid overdoses within the Community Living Center (CLC), a VA (Veterans Administration) subacute rehab setting, an interdisciplinary CLC Addictions Task Force was created to address a critical issue: how to best meet the combined neuropsychiatric and medical needs of the opiate use disorder patient through a multifaceted treatment approach. The goals of the task force were to develop and institute educational initiatives for providers; create patient care guidelines; increase safety on the unit; improve provider confidence when caring for this high-risk population; and mitigate the risk of unintentional overdose. The task force divided into 4 working groups to meet these aims. Process and outcomes are discussed. We found that in-services by addiction specialists improved clinician comfort in caring for this high-risk patient group. Specific areas that yielded the greatest clinician satisfaction ratings included didactics on how to identify at-risk patients and techniques on how to manage the patient in a general rehab setting. Utilizing an interdisciplinary approach, and an iterative process, at all stages was critical to the success of the CLC Addictions Task Force, as it improved buy-in and motivation from all disciplines. Improvements have been made to enhance patient safety, improve communication amongst providers, and provide a foundation to improve patient outcomes. Our preliminary work to enhance the identification and management of opioid use disorders at our CLC is an important first step towards a standardized curriculum that could be applied to other VA and non-VA subacute rehab settings. PMID:26672391

  8. Pragmatic Metadata Management for Integration into Multiple Spatial Data Infrastructure Systems and Platforms

    NASA Astrophysics Data System (ADS)

    Benedict, K. K.; Scott, S.

    2013-12-01

    While there has been a convergence towards a limited number of standards for representing knowledge (metadata) about geospatial (and other) data objects and collections, there exist a variety of community conventions around the specific use of those standards and within specific data discovery and access systems. This combination of limited (but multiple) standards and conventions creates a challenge for system developers that aspire to participate in multiple data infrastrucutres, each of which may use a different combination of standards and conventions. While Extensible Markup Language (XML) is a shared standard for encoding most metadata, traditional direct XML transformations (XSLT) from one standard to another often result in an imperfect transfer of information due to incomplete mapping from one standard's content model to another. This paper presents the work at the University of New Mexico's Earth Data Analysis Center (EDAC) in which a unified data and metadata management system has been developed in support of the storage, discovery and access of heterogeneous data products. This system, the Geographic Storage, Transformation and Retrieval Engine (GSTORE) platform has adopted a polyglot database model in which a combination of relational and document-based databases are used to store both data and metadata, with some metadata stored in a custom XML schema designed as a superset of the requirements for multiple target metadata standards: ISO 19115-2/19139/19110/19119, FGCD CSDGM (both with and without remote sensing extensions) and Dublin Core. Metadata stored within this schema is complemented by additional service, format and publisher information that is dynamically "injected" into produced metadata documents when they are requested from the system. While mapping from the underlying common metadata schema is relatively straightforward, the generation of valid metadata within each target standard is necessary but not sufficient for integration into

  9. Patient and provider perspectives on the relationship between multiple morbidity management and disease prevention.

    PubMed

    Schoenberg, Nancy E; Tarasenko, Yelena N; Bardach, Shoshana H; Fleming, Steven T

    2015-04-01

    Despite competing demands of multiple morbidity (MM) management and disease prevention, our recent survey of 1,153 Appalachian residents aged 50 to 76 documented that individuals with MM were more likely to obtain colorectal cancer screening (CRCS) than those without MM. Nearly two thirds of respondents obtained CRCS, and the more MM, the greater the likelihood of screening. To gain insight into this relationship, we conducted nine focus groups, six with providers and three with patients. Three main explanations emerged: (a) patients' MM increases providers' vigilance for other health vulnerabilities; (b) having MM increases patients' own vigilance; and (c) patients' vigilance may stem from experiencing more symptoms, having a family history of cancer, and having successfully obtained health care. More frequent contact with health care providers appears to encourage preventive referral, especially in low-income populations that otherwise may not receive such counselling. We highlight participant recommendations to improve MM management and prevention. PMID:24652900

  10. Using Natural Language to Enable Mission Managers to Control Multiple Heterogeneous UAVs

    NASA Technical Reports Server (NTRS)

    Trujillo, Anna C.; Puig-Navarro, Javier; Mehdi, S. Bilal; Mcquarry, A. Kyle

    2016-01-01

    The availability of highly capable, yet relatively cheap, unmanned aerial vehicles (UAVs) is opening up new areas of use for hobbyists and for commercial activities. This research is developing methods beyond classical control-stick pilot inputs, to allow operators to manage complex missions without in-depth vehicle expertise. These missions may entail several heterogeneous UAVs flying coordinated patterns or flying multiple trajectories deconflicted in time or space to predefined locations. This paper describes the functionality and preliminary usability measures of an interface that allows an operator to define a mission using speech inputs. With a defined and simple vocabulary, operators can input the vast majority of mission parameters using simple, intuitive voice commands. Although the operator interface is simple, it is based upon autonomous algorithms that allow the mission to proceed with minimal input from the operator. This paper also describes these underlying algorithms that allow an operator to manage several UAVs.

  11. Patient and Provider Perspectives on the Relationship Between Multiple Morbidity Management and Disease Prevention

    PubMed Central

    Schoenberg, Nancy E.; Tarasenko, Yelena N.; Bardach, Shoshana H.; Fleming, Steven T.

    2016-01-01

    Despite competing demands of multiple morbidity (MM) management and disease prevention, our recent survey of 1,153 Appalachian residents aged 50 to 76 documented that individuals with MM were more likely to obtain colorectal cancer screening (CRCS) than those without MM. Nearly two thirds of respondents obtained CRCS, and the more MM, the greater the likelihood of screening. To gain insight into this relationship, we conducted nine focus groups, six with providers and three with patients. Three main explanations emerged: (a) patients’ MM increases providers’ vigilance for other health vulnerabilities; (b) having MM increases patients’ own vigilance; and (c) patients’ vigilance may stem from experiencing more symptoms, having a family history of cancer, and having successfully obtained health care. More frequent contact with health care providers appears to encourage preventive referral, especially in low-income populations that otherwise may not receive such counselling. We highlight participant recommendations to improve MM management and prevention. PMID:24652900

  12. The behavior of multiple independent managers and ecological traits interact to determine prevalence of weeds.

    PubMed

    Coutts, Shaun R; Yokomizo, Hiroyuki; Buckley, Yvonne M

    2013-04-01

    Management of damaging invasive plants is often undertaken by multiple decision makers, each managing only a small part of the invader's population. As weeds can move between properties and re-infest eradicated sites from unmanaged sources, the dynamics of multiple decision makers plays a significant role in weed prevalence and invasion risk at the landscape scale. We used a spatially explicit agent-based simulation to determine how individual agent behavior, in concert with weed population ecology, determined weed prevalence. We compared two invasive grass species that differ in ecology, control methods, and costs: Nassella trichotoma (serrated tussock) and Eragrostis curvula (African love grass). The way decision makers reacted to the benefit of management had a large effect on the extent of a weed. If benefits of weed control outweighed the costs, and either net benefit was very large or all agents were very sensitive to net benefits, then agents tended to act synchronously, reducing the pool of infested agents available to spread the weed. As N. trichotoma was more damaging than E. curvula and had more effective control methods, agents chose to manage it more often, which resulted in lower prevalence of N. trichotoma. A relatively low number of agents who were intrinsically less motivated to control weeds led to increased prevalence of both species. This was particularly apparent when long-distance dispersal meant each infested agent increased the invasion risk for a large portion of the landscape. In this case, a small proportion of land mangers reluctant to control, regardless of costs and benefits, could lead to the whole landscape being infested, even when local control stopped new infestations. Social pressure was important, but only if it was independent of weed prevalence, suggesting that early access to information, and incentives to act on that information, may be crucial in stopping a weed from infesting large areas. The response of our model to both

  13. Evaluation of a Fatigue Self-Management Program for People with Multiple Sclerosis

    PubMed Central

    Wilkinson, Amanda; Barclay, Amelia; Whiting, Hayley; Heynike, Christelle; Snowdon, Jessie

    2016-01-01

    Background: Fatigue is one of the most common and debilitating symptoms of multiple sclerosis (MS). The program “Minimise Fatigue, Maximise Life: Creating Balance with Multiple Sclerosis” (MFML) was created in New Zealand because of the lack of a fatigue management program for people with MS in that country. This program aims to empower individuals with MS to manage their own symptoms of fatigue. The objective of this study was to evaluate the MFML fatigue self-management program. Methods: Self-report questionnaires were used to measure impact of fatigue (5-item Modified Fatigue Impact Scale), self-efficacy (MS Self-efficacy Scale), and quality of life (12-item Short Form Health Status Survey [SF-12]) 1 month before (T1), at commencement of (T2) (to investigate the stability of questionnaire scores before the intervention), and at the end of (T3) the 6-week group-based program. Increased self-efficacy and quality of life scores and a decrease in reported impact of fatigue were the anticipated primary outcomes, with participants acting as their own controls. Results: Twenty-five women (aged 37–63 years) participated. Stability of scores for all the questionnaires was evidenced between T1 and T2. After the intervention (T3), scores showed a significant improvement in self-efficacy and impact of fatigue, with large effect sizes, but no change in either the physical or mental component summary of the SF-12. Conclusions: Despite the small sample size, this study showed an organized approach to the management of fatigue for people living with MS, and its outcomes demonstrated benefits for participants. PMID:27252598

  14. Sustainable Assessment for Large Science Classes: Non-Multiple Choice, Randomised Assignments through a Learning Management System

    ERIC Educational Resources Information Center

    Schultz, Madeleine

    2011-01-01

    This paper reports on the development of a tool that generates randomised, non-multiple choice assessment within the BlackBoard Learning Management System interface. An accepted weakness of multiple-choice assessment is that it cannot elicit learning outcomes from upper levels of Biggs' SOLO taxonomy. However, written assessment items require…

  15. Impact of comorbidity on fatigue management intervention outcomes among people with multiple sclerosis: an exploratory investigation.

    PubMed

    Finlayson, Marcia; Preissner, Katharine; Cho, Chi

    2013-01-01

    This exploratory secondary analysis examined whether the presence of six chronic health conditions moderated the effectiveness of a teleconference-delivered fatigue self-management education program for people with multiple sclerosis (MS). The longitudinal data used were from a randomized controlled trial involving 181 community-dwelling adults with MS. The primary outcome was fatigue impact, as measured by the Fatigue Impact Scale (FIS). Mixed-effects analysis of variance (ANOVA) models were used to determine the best-fitting model. Just under 65% (n = 112) of participants had at least one comorbid condition. Only diabetes and arthritis moderated all three FIS subscales over time. People with diabetes were slower to show improvement after intervention than people without diabetes. People with arthritis made much more dramatic initial gains compared with people without arthritis but had difficulty maintaining those gains over time. The results point to the need for greater attention to the impact of comorbidities on rehabilitation interventions. These exploratory findings suggest that fatigue self-management education protocols may need to be customized to people who are trying to incorporate MS fatigue self-management behaviors while simultaneously managing diabetes or arthritis. PMID:24453759

  16. Multi-objective, multiple participant decision support for water management in the Andarax catchment, Almeria

    NASA Astrophysics Data System (ADS)

    van Cauwenbergh, N.; Pinte, D.; Tilmant, A.; Frances, I.; Pulido-Bosch, A.; Vanclooster, M.

    2008-04-01

    Water management in the Andarax river basin (Almeria, Spain) is a multi-objective, multi-participant, long-term decision-making problem that faces several challenges. Adequate water allocation needs informed decisions to meet increasing socio-economic demands while respecting the environmental integrity of this basin. Key players in the Andarax water sector include the municipality of Almeria, the irrigators involved in the intensive greenhouse agricultural sector, and booming second residences. A decision support system (DSS) is developed to rank different sustainable planning and management alternatives according to their socio-economic and environmental performance. The DSS is intimately linked to sustainability indicators and is designed through a public participation process. Indicators are linked to criteria reflecting stakeholders concerns in the 2005 field survey, such as fulfilling water demand, water price, technical and economical efficiency, social and environmental impacts. Indicators can be partly quantified after simulating the operation of the groundwater reservoir over a 20-year planning period and partly through a parallel expert evaluation process. To predict the impact of future water demand in the catchment, several development scenarios are designed to be evaluated in the DSS. The successive multi-criteria analysis of the performance indicators permits the ranking of the different management alternatives according to the multiple objectives formulated by the different sectors/participants. This allows more informed and transparent decision-making processes for the Andarax river basin, recognizing both the socio-economic and environmental dimensions of water resources management.

  17. A Systematic Review of Stress-Management Interventions for Multiple Sclerosis Patients

    PubMed Central

    Reynard, Alison K.; Rae-Grant, Alexander

    2014-01-01

    Background: The objective of this study was to identify stress-management interventions used for people with multiple sclerosis (MS) and systematically evaluate the efficacy of these interventions. Methods: Several strategies were used to search for studies reported in articles published up to 2013. Results: Our initial search retrieved 117 publications, of which 8 met our criteria for review. Of the eight studies, one provided Class I evidence, five provided Class III evidence, and two provided Class IV evidence for the efficacy of stress-management interventions according to the evidence classification established by the American Academy of Neurology. Most studies showed positive changes in outcomes assessed; however, the range of methodological quality among the published studies made it difficult to draw conclusions. Conclusions: The promising findings for stress-management interventions highlight the need for future studies. Additional large, prospective, multicenter studies will help to define the role of stress-management interventions in the treatment and course of MS. Furthermore, including outcome measures based on biological and clinical markers of disease will prove useful in understanding potential underlying mechanisms. PMID:25337056

  18. Management of relapsed multiple myeloma: recommendations of the International Myeloma Working Group.

    PubMed

    Laubach, J; Garderet, L; Mahindra, A; Gahrton, G; Caers, J; Sezer, O; Voorhees, P; Leleu, X; Johnsen, H E; Streetly, M; Jurczyszyn, A; Ludwig, H; Mellqvist, U-H; Chng, W-J; Pilarski, L; Einsele, H; Hou, J; Turesson, I; Zamagni, E; Chim, C S; Mazumder, A; Westin, J; Lu, J; Reiman, T; Kristinsson, S; Joshua, D; Roussel, M; O'Gorman, P; Terpos, E; McCarthy, P; Dimopoulos, M; Moreau, P; Orlowski, R Z; Miguel, J S; Anderson, K C; Palumbo, A; Kumar, S; Rajkumar, V; Durie, B; Richardson, P G

    2016-05-01

    The prognosis for patients multiple myeloma (MM) has improved substantially over the past decade with the development of new, more effective chemotherapeutic agents and regimens that possess a high level of anti-tumor activity. In spite of this important progress, however, nearly all MM patients ultimately relapse, even those who experience a complete response to initial therapy. Management of relapsed MM thus represents a vital aspect of the overall care for patients with MM and a critical area of ongoing scientific and clinical research. This comprehensive manuscript from the International Myeloma Working Group provides detailed recommendations on management of relapsed disease, with sections dedicated to diagnostic evaluation, determinants of therapy, and general approach to patients with specific disease characteristics. In addition, the manuscript provides a summary of evidence from clinical trials that have significantly impacted the field, including those evaluating conventional dose therapies, as well as both autologous and allogeneic stem cell transplantation. Specific recommendations are offered for management of first and second relapse, relapsed and refractory disease, and both autologous and allogeneic transplant. Finally, perspective is provided regarding new agents and promising directions in management of relapsed MM. PMID:26710887

  19. Fully distributed monitoring architecture supporting multiple trackees and trackers in indoor mobile asset management application.

    PubMed

    Jeong, Seol Young; Jo, Hyeong Gon; Kang, Soon Ju

    2014-01-01

    A tracking service like asset management is essential in a dynamic hospital environment consisting of numerous mobile assets (e.g., wheelchairs or infusion pumps) that are continuously relocated throughout a hospital. The tracking service is accomplished based on the key technologies of an indoor location-based service (LBS), such as locating and monitoring multiple mobile targets inside a building in real time. An indoor LBS such as a tracking service entails numerous resource lookups being requested concurrently and frequently from several locations, as well as a network infrastructure requiring support for high scalability in indoor environments. A traditional centralized architecture needs to maintain a geographic map of the entire building or complex in its central server, which can cause low scalability and traffic congestion. This paper presents a self-organizing and fully distributed indoor mobile asset management (MAM) platform, and proposes an architecture for multiple trackees (such as mobile assets) and trackers based on the proposed distributed platform in real time. In order to verify the suggested platform, scalability performance according to increases in the number of concurrent lookups was evaluated in a real test bed. Tracking latency and traffic load ratio in the proposed tracking architecture was also evaluated. PMID:24662407

  20. Fully Distributed Monitoring Architecture Supporting Multiple Trackees and Trackers in Indoor Mobile Asset Management Application

    PubMed Central

    Jeong, Seol Young; Jo, Hyeong Gon; Kang, Soon Ju

    2014-01-01

    A tracking service like asset management is essential in a dynamic hospital environment consisting of numerous mobile assets (e.g., wheelchairs or infusion pumps) that are continuously relocated throughout a hospital. The tracking service is accomplished based on the key technologies of an indoor location-based service (LBS), such as locating and monitoring multiple mobile targets inside a building in real time. An indoor LBS such as a tracking service entails numerous resource lookups being requested concurrently and frequently from several locations, as well as a network infrastructure requiring support for high scalability in indoor environments. A traditional centralized architecture needs to maintain a geographic map of the entire building or complex in its central server, which can cause low scalability and traffic congestion. This paper presents a self-organizing and fully distributed indoor mobile asset management (MAM) platform, and proposes an architecture for multiple trackees (such as mobile assets) and trackers based on the proposed distributed platform in real time. In order to verify the suggested platform, scalability performance according to increases in the number of concurrent lookups was evaluated in a real test bed. Tracking latency and traffic load ratio in the proposed tracking architecture was also evaluated. PMID:24662407

  1. Hybrid MCDA Methods to Integrate Multiple Ecosystem Services in Forest Management Planning: A Critical Review

    NASA Astrophysics Data System (ADS)

    Uhde, Britta; Andreas Hahn, W.; Griess, Verena C.; Knoke, Thomas

    2015-08-01

    Multi-criteria decision analysis (MCDA) is a decision aid frequently used in the field of forest management planning. It includes the evaluation of multiple criteria such as the production of timber and non-timber forest products and tangible as well as intangible values of ecosystem services (ES). Hence, it is beneficial compared to those methods that take a purely financial perspective. Accordingly, MCDA methods are increasingly popular in the wide field of sustainability assessment. Hybrid approaches allow aggregating MCDA and, potentially, other decision-making techniques to make use of their individual benefits and leading to a more holistic view of the actual consequences that come with certain decisions. This review is providing a comprehensive overview of hybrid approaches that are used in forest management planning. Today, the scientific world is facing increasing challenges regarding the evaluation of ES and the trade-offs between them, for example between provisioning and regulating services. As the preferences of multiple stakeholders are essential to improve the decision process in multi-purpose forestry, participatory and hybrid approaches turn out to be of particular importance. Accordingly, hybrid methods show great potential for becoming most relevant in future decision making. Based on the review presented here, the development of models for the use in planning processes should focus on participatory modeling and the consideration of uncertainty regarding available information.

  2. Hybrid MCDA Methods to Integrate Multiple Ecosystem Services in Forest Management Planning: A Critical Review.

    PubMed

    Uhde, Britta; Hahn, W Andreas; Griess, Verena C; Knoke, Thomas

    2015-08-01

    Multi-criteria decision analysis (MCDA) is a decision aid frequently used in the field of forest management planning. It includes the evaluation of multiple criteria such as the production of timber and non-timber forest products and tangible as well as intangible values of ecosystem services (ES). Hence, it is beneficial compared to those methods that take a purely financial perspective. Accordingly, MCDA methods are increasingly popular in the wide field of sustainability assessment. Hybrid approaches allow aggregating MCDA and, potentially, other decision-making techniques to make use of their individual benefits and leading to a more holistic view of the actual consequences that come with certain decisions. This review is providing a comprehensive overview of hybrid approaches that are used in forest management planning. Today, the scientific world is facing increasing challenges regarding the evaluation of ES and the trade-offs between them, for example between provisioning and regulating services. As the preferences of multiple stakeholders are essential to improve the decision process in multi-purpose forestry, participatory and hybrid approaches turn out to be of particular importance. Accordingly, hybrid methods show great potential for becoming most relevant in future decision making. Based on the review presented here, the development of models for the use in planning processes should focus on participatory modeling and the consideration of uncertainty regarding available information. PMID:25896820

  3. Comprehensive Lifecycle Planning and Management System For Addressing Water Issues Associated With Shale Gas Development In New York, Pennsylvania, And West Virginia

    SciTech Connect

    Arthur, J. Daniel

    2012-07-01

    The objective of this project is to develop a modeling system to allow operators and regulators to plan all aspects of water management activities associated with shale gas development in the target project area of New York, Pennsylvania, and West Virginia (target area ), including water supply, transport, storage, use, recycling, and disposal and which can be used for planning, managing, forecasting, permit tracking, and compliance monitoring. The proposed project is a breakthrough approach to represent the entire shale gas water lifecycle in one comprehensive system with the capability to analyze impacts and options for operational efficiency and regulatory tracking and compliance, and to plan for future water use and disposition. It will address all of the major water-related issues of concern associated with shale gas development in the target area, including water withdrawal, transport, storage, use, treatment, recycling, and disposal. It will analyze the costs, water use, and wastes associated with the available options, and incorporate constraints presented by permit requirements, agreements, local and state regulations, equipment and material availability, etc. By using the system to examine the water lifecycle from withdrawals through disposal, users will be able to perform scenario analysis to answer "what if" questions for various situations. The system will include regulatory requirements of the appropriate state and regional agencies and facilitate reporting and permit applications and tracking. These features will allow operators to plan for more cost effective resource production. Regulators will be able to analyze impacts of development over an entire area. Regulators can then make informed decisions about the protections and practices that should be required as development proceeds. This modeling system will have myriad benefits for industry, government, and the public. For industry, it will allow planning all water management operations for a

  4. A Multiple Period Problem in Distributed Energy Management Systems Considering CO2 Emissions

    NASA Astrophysics Data System (ADS)

    Muroda, Yuki; Miyamoto, Toshiyuki; Mori, Kazuyuki; Kitamura, Shoichi; Yamamoto, Takaya

    Consider a special district (group) which is composed of multiple companies (agents), and where each agent responds to an energy demand and has a CO2 emission allowance imposed. A distributed energy management system (DEMS) optimizes energy consumption of a group through energy trading in the group. In this paper, we extended the energy distribution decision and optimal planning problem in DEMSs from a single period problem to a multiple periods one. The extension enabled us to consider more realistic constraints such as demand patterns, the start-up cost, and minimum running/outage times of equipment. At first, we extended the market-oriented programming (MOP) method for deciding energy distribution to the multiple periods problem. The bidding strategy of each agent is formulated by a 0-1 mixed non-linear programming problem. Secondly, we proposed decomposing the problem into a set of single period problems in order to solve it faster. In order to decompose the problem, we proposed a CO2 emission allowance distribution method, called an EP method. We confirmed that the proposed method was able to produce solutions whose group costs were close to lower-bound group costs by computational experiments. In addition, we verified that reduction in computational time was achieved without losing the quality of solutions by using the EP method.

  5. Analysis of management of patients with multiple injuries of the locomotor system.

    PubMed

    Matewski, Dariusz; Szymkowiak, Edward; Bilinski, Piotr

    2008-12-01

    Body injuries are very serious problems in industrialised countries and they are frequent causes of fatalities in our times. The variety and multiple combinations of body injuries are a challenge for the trauma team. On the basis of clinical and radiological documentation 315 patients with multiple injuries of the locomotor system (MILS) were included in the study. The criterion for inclusion of the patients into the study group was identification of MILS. The study showed that these injuries often involve young people (53%) (predominantly men) aged between 16 and 45 years. Road accidents were the most frequent cause of injuries -80.6%. MILS affected the lower limb in 49.,4%, upper limb in 33.2% and pelvis in 14.1%; 75% of the patients studied also suffered from concomitant injuries. The head and brain were involved in 92.9%, chest in 31.5% and abdomen in 21.3%. The mortality index for the population studied was 14%. An increasing value of the Injury Severity Score (ISS) or New Injury Severity Score (NISS) caused delay in surgical management of bone injuries and correlated with prolonged hospitalisation. Analysis emphasised the usefulness of the NISS as a valuable prognostic instrument in assessment of severity of injuries in patients with multiple injuries of the locomotor system. PMID:17609954

  6. Smart SUDS: recognising the multiple-benefit potential of sustainable surface water management systems.

    PubMed

    Jose, Roshni; Wade, Rebecca; Jefferies, Chris

    2015-01-01

    How can we make sustainable urban drainage systems (SUDS) smart? SUDS help us to manage surface water runoff from urban environments but they are capable of delivering much more. This paper looks beyond the water quantity and quality improvement functions of SUDS and investigates the multiple benefits that can be gained by implementing smart SUDS solutions. This work provides a new perspective, using methodologies not normally associated with SUDS research, to determine multiple benefits. The outputs of the work can potentially assist decision-makers, designer and planners in recognising the potential for multiple benefits that can be delivered by SUDS. The ecosystem services (ES) associated with a large redevelopment in Dundee, Scotland, UK, are identified and a public perception study together with public participatory geographical information system (PPGIS) methods was used to confirm the goods and benefits of the SUDS. The paper presents findings on the public perception of SUDS as they provide cultural benefits such as recreation, aesthetics and biodiversity. The results show that greenspace is important when choosing a location, and willingness to pay for greenspace is high in this area. This paper concludes that SUDS provide multi-functional benefits in relation to the ES, thereby justifying the cachet of being termed Smart SUDS. PMID:25633948

  7. Laparoscopic Management of Symptomatic Multiple Hepatic Cysts: a Combination of Deroofing and Radical Excision

    PubMed Central

    Palanivelu, Chinnusamy; Senthilkumar, Rangasamy; Madankumar, Madhupalayam Velusamy

    2007-01-01

    Background: Liver cysts have been estimated to occur in 5% of the population. Multiple liver cysts can also be part of the polycystic disease complex. Only symptomatic or complicated cysts need surgery. Traditionally, laparotomy is the procedure of choice. We present our experiences with laparoscopic management of both symptomatic multiple liver cysts and polycystic liver disease. Methods: Between 1995 and 2006, we treated 12 patients with large, multiple liver cysts, including 4 cases of polycystic liver disease. Most of the patients were elderly males. The lung and other organs were not involved in any case. Laparoscopic deroofing or radical excision with omentoplasty was successfully performed in these patients. Results: Postoperatively, 4 patients had fluid draining through the drainage tube for an average of 10 days. One patient had ascites that resolved spontaneously. Cysts recurred in 5 patients. Discussion: There are not many reports in the literature regarding large series of patients, further confirming the rarity of the disease. Liver cysts can occur as a part of polycystic renal and lung disease or isolated to the liver alone. Laparoscopic deroofing is the ideal treatment for nonpolycystic liver disease, and laparoscopic radical excision is ideal for polycystic liver disease. Simple needle aspiration or sclerotherapy is inadequate as recurrence is almost 100%. Conclusion: Currently, laparoscopy scores over laparotomy for the treatment of nonparasitic liver cysts as evidenced by this and other studies. PMID:18237512

  8. Dental Management of a Patient with Multiple Idiopathic Cervical Root Resorption.

    PubMed

    Ali, Rahat; Fayle, Stephen; Langley, David; Altaie, Asmaa; Nattress, Brian

    2015-09-01

    Multiple Idiopathic Cervical Root Resorption (MICRR) is a rare condition. It initiates at the cemento-enamel junction of multiple teeth. The lesions continue to grow until they unite, thereby undermining the entire coronal structure of affected teeth. Its distribution can vary from a single region to the entire dentition and the number of teeth affected by resorption tends to increase as the condition is followed over time. The teeth themselves appear clinically normal. The aetiology of MICRR is unknown and it is considered to be a diagnosis of exclusion. The condition tends to be progressive. Consequently, root treatments/surgical curettage and restoration of the lesions have been unsuccessful at arresting the condition. Affected teeth are often extracted in anticipation of catastrophic fracture and have been replaced with partial or complete dentures. In this case report, we describe how a young female patient was dentally managed over 10 years and ultimately rehabilitated with dental implants. CPD/CLINICAL RELEVANCE: Patients suspected of having multiple idiopathic cervical root resorption may require specialist, multidisciplinary care and require referral to an appropriate secondary care unit for treatment planning and potential oral rehabilitation. PMID:26630864

  9. An Analysis of Student Affairs Professionals' Management of Role Conflict and Multiple Roles in Relation to Work/Life Balance

    ERIC Educational Resources Information Center

    Mayo, Nicole Lepone

    2013-01-01

    The purpose of this inquiry is to study how student affairs professionals manage role conflict in relation to work/life balance based on the challenging culture of the field. The underlying goals are to identify the barriers or challenges of managing multiple roles as a student affairs administrator and identify strategies to assist employees in…

  10. Percutaneous Vertebroplasty for Pain Management in Patients with Multiple Myeloma: Is Radiofrequency Ablation Necessary?

    SciTech Connect

    Orgera, Gianluigi; Krokidis, Miltiadis; Matteoli, Marco; Varano, Gianluca Maria; La Verde, Giacinto; David, Vincenzo; Rossi, Michele

    2013-05-08

    PurposeThis study was designed to investigate the added role of radiofrequency ablation (RFA) to vertebroplasty on the pain management of patients with multiple myeloma (MM).MethodsThirty-six patients (51–82 years) with vertebral localization of MM were randomly divided into two groups: 18 patients (group A) who underwent RFA and then vertebroplasty, and 18 patients (group B) who underwent only vertebroplasty. Primary endpoints were technical success and pain relief score rate measured by the visual analogue pain scores (VAS) and Roland–Morris Questionnaire (RMQ); secondary endpoint was the amount of administered analgesia. Survival and complications were compared.ResultsTechnical success was 100 % in both groups. The VAS score (at 24 h and 6 weeks postprocedure) decreased in equal manner for both groups from a mean of 9.1–3.4 and 2.0 for group A and from a mean of 9.3–3.0 and 2.3 for group B; RMQ mean score was 19.8 for group A and 19.9 for group B and decreased to a mean of 9.6 and 8.2 for group A and 9.5 and 8.7 for group B. The amount of medication was equally decreased in the two groups. No statistically significant difference was noted. No major complication occurred and two patients died from other causes.ConclusionsThe use of percutaneous vertebroplasty alone appears to be effective for the pain management of the patients with vertebral involvement of multiple myeloma. The use of RFA that includes cost and time does not offer any clear added benefit on the midterm pain management of such patients.

  11. [Fluid management and care for multiple organ dysfunction syndrome in patients with extensive burns].

    PubMed

    Shinozawa, Yotaro

    2005-12-01

    Burn shock and multiple organ dysfunction syndrome (MODS) are the main causes of death in patients with extensive burns, and thus fluid management and care for MODS are crucial in the treatment of these patients. Several fluid formulas have been developed, although there is still controversy over the best formula. The important point is to understand how to deal with the different side effects inevitable with each fluid therapy: fluid restriction and/or diuretic administration in the refilling phase in fluid therapy with crystalloid, care for hypernatremia and/or a hyperosmolar state in fluid therapy with hypertonic lactated solution (HLS), etc. Precise fluid management is needed for aged patients, patients with extensive inhalation injury, extensive electric injury, and myocardial dysfunction, or patients in whom the start of fluid treatment was delayed. MODS in extensively burned patients is attributed to overwhelming burn stress and complicated sepsis, including bacterial translocation (BT). A dysfunctioning organ impairs another organ (organ interrelationships), and therefore substitution and/or recovery of a dysfunctioning organ are crucial. Debridement of skin with third-degree burns, suppression of BT, sanitary airway management, avoidance of unnecessary stress, and mediator modulation to stop the mediator cascade inducing MODS are also crucial. PMID:16869126

  12. Upstream water resource management to address downstream pollution concerns: A policy framework with application to the Nakdong River basin in South Korea

    NASA Astrophysics Data System (ADS)

    Yoon, Taeyeon; Rhodes, Charles; Shah, Farhed A.

    2015-02-01

    An empirical framework for assisting with water quality management is proposed that relies on open-source hydrologic data. Such data are measured periodically at fixed water stations and commonly available in time-series form. To fully exploit the data, we suggest that observations from multiple stations should be combined into a single long-panel data set, and an econometric model developed to estimate upstream management effects on downstream water quality. Selection of the model's functional form and explanatory variables would be informed by rating curves, and idiosyncrasies across and within stations handled in an error term by testing contemporary correlation, serial correlation, and heteroskedasticity. Our proposed approach is illustrated with an application to the Nakdong River basin in South Korea. Three alternative policies to achieve downstream BOD level targets are evaluated: upstream water treatment, greater dam discharge, and development of a new water source. Upstream water treatment directly cuts off incoming pollutants, thereby presenting the smallest variation in its downstream effects on BOD levels. Treatment is advantageous when reliability of water quality is a primary concern. Dam discharge is a flexible tool, and may be used strategically during a low-flow season. We consider development of a new water corridor from an extant dam as our third policy option. This turns out to be the most cost-effective way for securing lower BOD levels in the downstream target city. Even though we consider a relatively simple watershed to illustrate the usefulness of our approach, it can be adapted easily to analyze more complex upstream-downstream issues.

  13. On Energy Trading Decision Methods in Distributed Energy Management Systems with Multiple Customers

    NASA Astrophysics Data System (ADS)

    Miyamoto, Toshiyuki; Sugimoto, Yohei; Mori, Kazuyuki; Kitamura, Shoichi; Yamamoto, Takaya

    This paper addresses an operation and energy purchase planning problem under the CO2 emissions regulation for corporate entities. Considering energy trading, more efficient energy consumption may be possible. We have studied an agent-based planning system, called Distributed Energy Management Systems (DEMSs), which intends to reduce energy consumption. In the DEMSs, CO2 emissions regulation is imposed on each corporate entity, and electrical and thermal energy trading among the entities are allowed. We have proposed an energy trading decision method based on the Market Oriented Programming (MOP). In this paper, we propose trading decision methods for the group composed of several customers and several suppliers. Experimental results show effectiveness of the proposed method.

  14. Addressing problems of employee performance.

    PubMed

    McConnell, Charles R

    2011-01-01

    Employee performance problems are essentially of 2 kinds: those that are motivational in origin and those resulting from skill deficiencies. Both kinds of problems are the province of the department manager. Performance problems differ from problems of conduct in that traditional disciplinary processes ordinarily do not apply. Rather, performance problems are addressed through educational and remedial processes. The manager has a basic responsibility in ensuring that everything reasonable is done to help each employee succeed. There are a number of steps the manager can take to address employee performance problems. PMID:21537142

  15. Managing the effects of multiple stressors on aquatic ecosystems under water scarcity. The GLOBAQUA project.

    PubMed

    Navarro-Ortega, Alícia; Acuña, Vicenç; Bellin, Alberto; Burek, Peter; Cassiani, Giorgio; Choukr-Allah, Redouane; Dolédec, Sylvain; Elosegi, Arturo; Ferrari, Federico; Ginebreda, Antoni; Grathwohl, Peter; Jones, Colin; Rault, Philippe Ker; Kok, Kasper; Koundouri, Phoebe; Ludwig, Ralf Peter; Merz, Ralf; Milacic, Radmila; Muñoz, Isabel; Nikulin, Grigory; Paniconi, Claudio; Paunović, Momir; Petrovic, Mira; Sabater, Laia; Sabaterb, Sergi; Skoulikidis, Nikolaos Th; Slob, Adriaan; Teutsch, Georg; Voulvoulis, Nikolaos; Barceló, Damià

    2015-01-15

    Water scarcity is a serious environmental problem in many European regions, and will likely increase in the near future as a consequence of increased abstraction and climate change. Water scarcity exacerbates the effects of multiple stressors, and thus results in decreased water quality. It impacts river ecosystems, threatens the services they provide, and it will force managers and policy-makers to change their current practices. The EU-FP7 project GLOBAQUA aims at identifying the prevalence, interaction and linkages between stressors, and to assess their effects on the chemical and ecological status of freshwater ecosystems in order to improve water management practice and policies. GLOBAQUA assembles a multidisciplinary team of 21 European plus 2 non-European scientific institutions, as well as water authorities and river basin managers. The project includes experts in hydrology, chemistry, biology, geomorphology, modelling, socio-economics, governance science, knowledge brokerage, and policy advocacy. GLOBAQUA studies six river basins (Ebro, Adige, Sava, Evrotas, Anglian and Souss Massa) affected by water scarcity, and aims to answer the following questions: how does water scarcity interact with other existing stressors in the study river basins? How will these interactions change according to the different scenarios of future global change? Which will be the foreseeable consequences for river ecosystems? How will these in turn affect the services the ecosystems provide? How should management and policies be adapted to minimise the ecological, economic and societal consequences? These questions will be approached by combining data-mining, field- and laboratory-based research, and modelling. Here, we outline the general structure of the project and the activities to be conducted within the fourteen work-packages of GLOBAQUA. PMID:25005236

  16. Managing the effects of multiple stressors on aquatic ecosystems under water scarcity. The GLOBAQUA project

    PubMed Central

    Navarro-Ortega, Alícia; Acuña, Vicenç; Bellin, Alberto; Burek, Peter; Cassiani, Giorgio; Choukr-Allah, Redouane; Dolédec, Sylvain; Elosegi, Arturo; Ferrari, Federico; Ginebreda, Antoni; Grathwohl, Peter; Jones, Colin; Rault, Philippe Ker; Kok, Kasper; Koundouri, Phoebe; Ludwig, Ralf Peter; Merz, Ralf; Milacic, Radmila; Muñoz, Isabel; Nikulin, Grigory; Paniconi, Claudio; Paunović, Momir; Petrovic, Mira; Sabater, Laia; Sabaterb, Sergi; Skoulikidis, Nikolaos Th.; Slob, Adriaan; Teutsch, Georg; Voulvoulis, Nikolaos; Barceló, Damià

    2015-01-01

    Water scarcity is a serious environmental problem in many European regions, and will likely increase in the near future as a consequence of increased abstraction and climate change. Water scarcity exacerbates the effects of multiple stressors, and thus results in decreased water quality. It impacts river ecosystems, threatens the services they provide, and it will force managers and policy-makers to change their current practices. The EU-FP7 project GLOBAQUA aims at identifying the prevalence, interaction and linkages between stressors, and to assess their effects on the chemical and ecological status of freshwater ecosystems in order to improve water management practice and policies. GLOBAQUA assembles a multidisciplinary team of 21 European plus 2 non-European scientific institutions, as well as water authorities and river basin managers. The project includes experts in hydrology, chemistry, biology, geomorphology, modelling, socio-economics, governance science, knowledge brokerage, and policy advocacy. GLOBAQUA studies six river basins (Ebro, Adige, Sava, Evrotas, Anglian and Souss Massa) affected by water scarcity, and aims to answer the following questions: how does water scarcity interact with other existing stressors in the study river basins? How will these interactions change according to the different scenarios of future global change? Which will be the foreseeable consequences for river ecosystems? How will these in turn affect the services the ecosystems provide? How should management and policies be adapted to minimise the ecological, economic and societal consequences? These questions will be approached by combining data-mining, field- and laboratory-based research, and modelling. Here, we outline the general structure of the project and the activities to be conducted within the fourteen work-packages of GLOBAQUA. PMID:25005236

  17. Impact of Proactive Case Management by Multiple Sclerosis Specialist Nurses on Use of Unscheduled Care and Emergency Presentation in Multiple Sclerosis

    PubMed Central

    Quinn, Debbie; Bowen, Amy

    2015-01-01

    Background: Multiple sclerosis (MS) affects approximately 100,000 people in the United Kingdom, with rising emergency admissions to the hospital. The multiple sclerosis specialist nurse plays a pivotal role in managing MS care in the United Kingdom, and there is anecdotal evidence that this role can help avoid emergency presentations and unnecessary hospital admissions. Methods: A retrospective service evaluation took place in one established MS nursing service. The impact of the introduction of proactive nurse-led management and a rapid response service on rates of emergency presentation, hospital admission, and bed use was examined. The primary intervention was the introduction of extra nursing hours (6 hours per week) and the reallocation of some routine administrative duties, which allowed the service to move to a proactive management model aimed at avoiding the need for unplanned care. In addition, a care pathway was implemented in the emergency department for patients with MS who did present. Results: Reduction in utilization was from a mean of 2700 bed-days per year (2002–2006) to a mean of 198 bed-days per year (2007–2013). Conclusions: During a 10-year period, moving from reactive management to proactive management demonstrated an increase in complex specialist nursing interventions and led to a decrease in emergency presentation and bed use at the local acute-care center. PMID:26300701

  18. Therapeutic Approach to the Management of Pediatric Demyelinating Disease: Multiple Sclerosis and Acute Disseminated Encephalomyelitis.

    PubMed

    Brenton, J Nicholas; Banwell, Brenda L

    2016-01-01

    Acquired pediatric demyelinating diseases manifest acutely with optic neuritis, transverse myelitis, acute disseminated encephalomyelitis, or with various other acute deficits in focal or polyfocal areas of the central nervous system. Patients may experience a monophasic illness (as in the case of acute disseminated encephalomyelitis) or one that may manifest as a chronic, relapsing disease [e.g., multiple sclerosis (MS)]. The diagnosis of pediatric MS and other demyelinating disorders of childhood has been facilitated by consensus statements regarding diagnostic definitions. Treatment of pediatric MS has been modeled after data obtained from clinical trials in adult-onset MS. There are now an increasing number of new therapeutic agents for MS, and many will be formally studied for use in pediatric patients. There are important efficacy and safety concerns regarding the use of these therapies in children and young adults. This review will discuss acute management as well as chronic immunotherapies in acquired pediatric demyelination. PMID:26496907

  19. The comprehensive clinical management of multiple myeloma and related-plasma cell disorders.

    PubMed

    Richardson, Paul G; Bladé, Joan

    2014-02-01

    Whilst we think of multiple myeloma and related plasma cell disorders as incurable to date, never before has there been such hope and enthusiasm about advances in the research and treatment of these various diseases. Translational research is very much at the forefront of progress for further refining targeted therapies and continuing to improve clinical efficacy. Whilst some of these advances in the last decade have been truly dramatic in their scope and timing, it is also worth noting that relatively incremental changes have favorably impacted on patient outcome, and this comprehensive clinical management review captures these accordingly. We hope therefore that this concise overview will give readers, be they specialist hemato-oncologists, or other providers and researchers in the field, an enlightening insight into the exciting future of therapeutic opportunities, as well as a practical 'hands on' approach. PMID:24483345

  20. A practical approach to the diagnosis and management of sleep disorders in patients with multiple sclerosis

    PubMed Central

    Braley, Tiffany J.; Chervin, Ronald D.

    2015-01-01

    Patients with multiple sclerosis (MS) are at increased risk for comorbid sleep disturbances, which can profoundly contribute to poor functional status and fatigue. Insomnia, sleep-disordered breathing, and restless legs syndrome are among the most common sleep disorders experienced by patients with MS. Despite their impact, these underlying sleep disorders may escape routine clinical evaluations in persons with MS, thereby leading to missed opportunities to optimize functional status and quality of life in patients with MS. A practical, systematic approach to the evaluation and treatment of sleep disorders in MS, in the context of MS-specific variables that may influence risk for these conditions or response to therapy, is recommended to facilitate early diagnosis and successful treatment. This review summarizes the most common sleep disorders experienced by persons with MS, and offers a practical approach to diagnosis and management of these conditions. PMID:26600873

  1. Dimethyl fumarate in the management of multiple sclerosis: appropriate patient selection and special considerations.

    PubMed

    Prosperini, Luca; Pontecorvo, Simona

    2016-01-01

    Delayed-release dimethyl fumarate (DMF), also known as gastroresistant DMF, is the most recently approved oral disease-modifying treatment (DMT) for relapsing multiple sclerosis. Two randomized clinical trials (Determination of the Efficacy and Safety of Oral Fumarate in Relapsing-Remitting MS [DEFINE] and Comparator and an Oral Fumarate in Relapsing-Remitting Multiple Sclerosis [CONFIRM]) demonstrated significant efficacy in reducing relapse rate and radiological signs of disease activity, as seen on magnetic resonance imaging. The DEFINE study also indicated a significant effect of DMF on disability worsening, while the low incidence of confirmed disability worsening in the CONFIRM trial rendered an insignificant reduction among the DMF-treated groups when compared to placebo. DMF also demonstrated a good safety profile and acceptable tolerability, since the most common side effects (gastrointestinal events and flushing reactions) are usually transient and mild to moderate in severity. Here, we discuss the place in therapy of DMF for individuals with relapsing multiple sclerosis, providing a tentative therapeutic algorithm to manage newly diagnosed patients and those who do not adequately respond to self-injectable DMTs. Literature data supporting the potential role of DMF as a first-line therapy are presented. The possibility of using DMF as switching treatment or even as an add-on strategy in patients with breakthrough disease despite self-injectable DMTs will also be discussed. Lastly, we argue about the role of DMF as an exit strategy from natalizumab-treated patients who are considered at risk for developing multifocal progressive leukoencephalopathy. PMID:27042079

  2. Dimethyl fumarate in the management of multiple sclerosis: appropriate patient selection and special considerations

    PubMed Central

    Prosperini, Luca; Pontecorvo, Simona

    2016-01-01

    Delayed-release dimethyl fumarate (DMF), also known as gastroresistant DMF, is the most recently approved oral disease-modifying treatment (DMT) for relapsing multiple sclerosis. Two randomized clinical trials (Determination of the Efficacy and Safety of Oral Fumarate in Relapsing–Remitting MS [DEFINE] and Comparator and an Oral Fumarate in Relapsing-Remitting Multiple Sclerosis [CONFIRM]) demonstrated significant efficacy in reducing relapse rate and radiological signs of disease activity, as seen on magnetic resonance imaging. The DEFINE study also indicated a significant effect of DMF on disability worsening, while the low incidence of confirmed disability worsening in the CONFIRM trial rendered an insignificant reduction among the DMF-treated groups when compared to placebo. DMF also demonstrated a good safety profile and acceptable tolerability, since the most common side effects (gastrointestinal events and flushing reactions) are usually transient and mild to moderate in severity. Here, we discuss the place in therapy of DMF for individuals with relapsing multiple sclerosis, providing a tentative therapeutic algorithm to manage newly diagnosed patients and those who do not adequately respond to self-injectable DMTs. Literature data supporting the potential role of DMF as a first-line therapy are presented. The possibility of using DMF as switching treatment or even as an add-on strategy in patients with breakthrough disease despite self-injectable DMTs will also be discussed. Lastly, we argue about the role of DMF as an exit strategy from natalizumab-treated patients who are considered at risk for developing multifocal progressive leukoencephalopathy. PMID:27042079

  3. Multiple sclerosis, an autoimmune inflammatory disease: prospects for its integrative management.

    PubMed

    Kidd, P M

    2001-12-01

    Multiple sclerosis (MS) is aptly named for the many scars it produces in the brain and spinal cord. A sometimes fatal, often debilitating disease, MS features autoimmune inflammatory attack against the myelin insulation of neurons. Thymus derived (T) cells sensitized against myelin self-antigens secrete tumor necrosis factor, cytokines, prostaglandins, and other inflammatory mediators that strip away the myelin and sometimes destroy the axons. Familial and twin inheritance studies indicate MS is mildly heritable. No single MS locus has been identified, but an HLA haplotype has been implicated. Unique geographic distribution of the disease is best attributed to some combination of vitamin D abnormality and dietary patterns. No pharmaceutical or other therapies exist that confer prolonged remission on MS, and obvious interrelationships between toxic, infectious, and dietary factors make a persuasive case for integrative management. The time-proven MS diet meticulously keeps saturated fats low, includes three fish meals per week, and eliminates allergenic foods. Dietary supplementation for MS minimally requires potent vitamin supplementation, along with the thiol antioxidants, the anti-inflammatory omega-3 fatty acids, and adaptogenic phytonutrients. Gut malabsorption and dysbiosis can be corrected using digestive enzymes and probiotics. Long-term hyperbaric oxygen therapy can slow or remit the disease. Transdermal histamine offers promise, and adenosine monophosphate may sometimes benefit. Chronic viruses and other infectious load must be aggressively treated and exercise should maintain muscle tone and balance. Early intervention with integrative modalities has the potential to make MS a truly manageable disease. PMID:11804546

  4. Assessing Four Quality Indicators for Multiple Sclerosis Management Through Patient-Reported Data

    PubMed Central

    Pozniak, Alyssa; Hadden, Louise

    2016-01-01

    Background: Although hundreds of quality indicators (QIs) have been developed for various chronic conditions, QIs specific to multiple sclerosis (MS) care have only recently been developed. We sought to examine the extent to which the self-reported care of individuals with MS meets four recently developed MS QIs related to treatment of depression, spasticity, and fatigue and timely initiation of disease-modifying agents (DMAs) for relapsing MS. Methods: Using the Sonya Slifka Study data, we examined the proportion of the MS population meeting four QIs (based on patient-reported data) in a sample of individuals with MS in 2007–2009. For the three diagnoses, meeting the QI was defined as receiving appropriate medication or seeing a provider for treatment of the diagnosis; for timely initiation, it was defined as receiving a DMA within 3 months of a relapsing MS diagnosis. We also examined differences in characteristics between respondents who met the QI versus those who did not. Results: Approximately two-thirds of people with MS in this sample, per the predefined criteria, met the QIs for treatment of depression, management of spasticity, and DMA initiation within 3 months of a relapsing diagnosis, and approximately one-fifth met the QI for management of fatigue. There were some significant differences in characteristics between respondents who met the QIs and those who did not. Conclusions: This study examined a subset of MS QIs based on patient-reported data. Additional data sources are needed to fully assess compliance with MS QIs. PMID:27551245

  5. Integrated management of natural resources: dealing with ambiguous issues, multiple actors and diverging frames.

    PubMed

    Dewulf, A; Craps, M; Bouwen, R; Taillieu, T; Pahl-Wostl, C

    2005-01-01

    Uncertainty is an increasingly important concern when trying to manage complex systems of interrelated natural resources. Scientific knowledge or necessary information may be lacking or incomplete. Additionally, the multiple and interdependent users of those resources may diverge in defining what really is at stake. When they frame issues in very different ways, ambiguity results, i.e., the existence of two or more equally plausible interpretation possibilities. Environmental management in these conditions implies a shift in attention from solving clearly delineated problems to continuous negotiating and tuning between different actors and expertise domains. This requires dealing with the frame differences in a reciprocal way by mutually acknowledging frames and connecting them. Some or all parties will have to revise, enlarge or reframe the way they relate to the issues and to each other, in order to support mutual understanding and common action. The contribution of experts does not consist then in providing total predictability nor in predefining issues and solutions, but in supporting a joint learning and negotiation process among different actors and in feeding this process with relevant information. Behavioural simulations may play an important function to stimulate multi-actor learning and negotiation processes. PMID:16304943

  6. Waste management under multiple complexities: Inexact piecewise-linearization-based fuzzy flexible programming

    SciTech Connect

    Sun Wei; Huang, Guo H.; Lv Ying; Li Gongchen

    2012-06-15

    Highlights: Black-Right-Pointing-Pointer Inexact piecewise-linearization-based fuzzy flexible programming is proposed. Black-Right-Pointing-Pointer It's the first application to waste management under multiple complexities. Black-Right-Pointing-Pointer It tackles nonlinear economies-of-scale effects in interval-parameter constraints. Black-Right-Pointing-Pointer It estimates costs more accurately than the linear-regression-based model. Black-Right-Pointing-Pointer Uncertainties are decreased and more satisfactory interval solutions are obtained. - Abstract: To tackle nonlinear economies-of-scale (EOS) effects in interval-parameter constraints for a representative waste management problem, an inexact piecewise-linearization-based fuzzy flexible programming (IPFP) model is developed. In IPFP, interval parameters for waste amounts and transportation/operation costs can be quantified; aspiration levels for net system costs, as well as tolerance intervals for both capacities of waste treatment facilities and waste generation rates can be reflected; and the nonlinear EOS effects transformed from objective function to constraints can be approximated. An interactive algorithm is proposed for solving the IPFP model, which in nature is an interval-parameter mixed-integer quadratically constrained programming model. To demonstrate the IPFP's advantages, two alternative models are developed to compare their performances. One is a conventional linear-regression-based inexact fuzzy programming model (IPFP2) and the other is an IPFP model with all right-hand-sides of fussy constraints being the corresponding interval numbers (IPFP3). The comparison results between IPFP and IPFP2 indicate that the optimized waste amounts would have the similar patterns in both models. However, when dealing with EOS effects in constraints, the IPFP2 may underestimate the net system costs while the IPFP can estimate the costs more accurately. The comparison results between IPFP and IPFP3 indicate

  7. Managing the effects of multiple stressors on aquatic ecosystems under water scarcity

    NASA Astrophysics Data System (ADS)

    Barceló Cullerés, Damià; Ludwig, Ralf

    2015-04-01

    Water and water-related services are major components of the human wellbeing, and as such are major factors of socio-economic development in Europe; yet freshwater systems are under threat by a variety of stressors (organic and inorganic pollution, geomorphological alterations, land cover change, water abstraction, invasive species and pathogens. Some stressors, such as water scarcity, can be a stressor on its own because of its structural character, and drive the effects of other stressors. The relevance of water scarcity as a stressor is more important in semi-arid regions, such as the Mediterranean basin, which are characterized by highly variable river flows and the occurrence of low flows. This has resulted in increases in frequency and magnitude of extreme flow events. Furthermore, in other European regions such as eastern Germany, western Poland and England, water demand exceeds water availability and water scarcity has become an important management issue. Water scarcity is most commonly associated with inappropriate water management, with resulting river flow reductions. It has become one of the most important drivers of change in freshwater ecosystems. Conjoint occurrence of a myriad of stressors (chemical, geomorphological, biological) under water scarcity will produce novel and unfamiliar synergies and most likely very pronounced effects. Within this context, GLOBAQUA has assembled a multidisciplinary team of leading scientists in the fields of hydrology, chemistry, ecology, ecotoxicology, economy, sociology, engineering and modeling in order to study the interaction of multiple stressors within the frame of strong pressure on water resources. The aim is to achieve a better understanding how current management practices and policies could be improved by identifying the main drawbacks and alternatives.

  8. Epidemiology of Patients With Multiple Trauma and the Quality of Their Prehospital Respiration Management in Kashan, Iran: Six Months Assessment

    PubMed Central

    Adib-Hajbaghery, Mohsen; Maghaminejad, Farzaneh

    2014-01-01

    Background: Respiration management is an important and critical issue in prehospital transportation phase of multiple trauma patients. However, the quality of this important care has not been assessed in Iran Emergency Medical Services’ (EMS). Objectives: This study was conducted to investigate the quality of prehospital respiration management in patients with multiple trauma, referred to the Shahid Beheshti Trauma Center, Kashan, Iran. Patients and Methods: This cross-sectional study was conducted in the first six months of 2013. All the 400 patients with multiple trauma, transferred by EMS to the Shahid Beheshti Medical Center, were recruited. The study instrument was a checklist, which was completed through observation. Descriptive statistics were presented. Results: Out of all included individuals, 301 were males (75.2%) and 99 were females (24.8%). The most common mechanism of trauma was traffic accident (87.25%). Furthermore, 71.7% of the patients were injured in head and neck and chest areas. The quality of consciousness monitoring and airway management was desirable in 95% of the cases. However, the quality of monitoring patients’ respiration was only desirable in 42% of the cases. Only 18.6% of the patients received oxygen therapy during prehospital transportation. Conclusions: The quality of monitoring patients’ respiration and oxygen therapy was undesirable in most patients with multiple trauma. Therefore, the EMS workers should be retrained to apply proper respiration management in patients with multiple trauma. PMID:25147774

  9. Management of chronic neuropathic pain: a protocol for a multiple treatment comparison meta-analysis of randomised controlled trials

    PubMed Central

    Mulla, Sohail M; Buckley, D Norman; Moulin, Dwight E; Couban, Rachel; Izhar, Zain; Agarwal, Arnav; Panju, Akbar; Wang, Li; Kallyth, Sun Makosso; Turan, Alparslan; Montori, Victor M; Sessler, Daniel I; Thabane, Lehana; Guyatt, Gordon H; Busse, Jason W

    2014-01-01

    Introduction Chronic neuropathic pain is associated with reduced health-related quality of life and substantial socioeconomic costs. Current research addressing management of chronic neuropathic pain is limited. No review has evaluated all interventional studies for chronic neuropathic pain, which limits attempts to make inferences regarding the relative effectiveness of treatments. Methods and analysis We will conduct a systematic review of all randomised controlled trials evaluating therapies for chronic neuropathic pain. We will identify eligible trials, in any language, by a systematic search of CINAHL, EMBASE, MEDLINE, AMED, HealthSTAR, DARE, PsychINFO and the Cochrane Central Registry of Controlled Trials. Eligible trials will be: (1) enrol patients presenting with chronic neuropathic pain, and (2) randomise patients to alternative interventions (pharmacological or non-pharmacological) or an intervention and a control arm. Pairs of reviewers will, independently and in duplicate, screen titles and abstracts of identified citations, review the full texts of potentially eligible trials and extract information from eligible trials. We will use a modified Cochrane instrument to evaluate risk of bias of eligible studies, recommendations from the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) to inform the outcomes we will collect, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to evaluate our confidence in treatment effects. When possible, we will conduct: (1) in direct comparisons, a random-effects meta-analysis to establish the effect of reported therapies on patient-important outcomes; and (2) a multiple treatment comparison meta-analysis within a Bayesian framework to assess the relative effects of treatments. We will define a priori hypotheses to explain heterogeneity between studies, and conduct meta-regression and subgroup analyses consistent with the current best practices

  10. Addressing medical coding and billing part II: a strategy for achieving compliance. A risk management approach for reducing coding and billing errors.

    PubMed Central

    Adams, Diane L.; Norman, Helen; Burroughs, Valentine J.

    2002-01-01

    Medical practice today, more than ever before, places greater demands on physicians to see more patients, provide more complex medical services and adhere to stricter regulatory rules, leaving little time for coding and billing. Yet, the need to adequately document medical records, appropriately apply billing codes and accurately charge insurers for medical services is essential to the medical practice's financial condition. Many physicians rely on office staff and billing companies to process their medical bills without ever reviewing the bills before they are submitted for payment. Some physicians may not be receiving the payment they deserve when they do not sufficiently oversee the medical practice's coding and billing patterns. This article emphasizes the importance of monitoring and auditing medical record documentation and coding application as a strategy for achieving compliance and reducing billing errors. When medical bills are submitted with missing and incorrect information, they may result in unpaid claims and loss of revenue to physicians. Addressing Medical Audits, Part I--A Strategy for Achieving Compliance--CMS, JCAHO, NCQA, published January 2002 in the Journal of the National Medical Association, stressed the importance of preparing the medical practice for audits. The article highlighted steps the medical practice can take to prepare for audits and presented examples of guidelines used by regulatory agencies to conduct both medical and financial audits. The Medicare Integrity Program was cited as an example of guidelines used by regulators to identify coding errors during an audit and deny payment to providers when improper billing occurs. For each denied claim, payments owed to the medical practice are are also denied. Health care is, no doubt, a costly endeavor for health care providers, consumers and insurers. The potential risk to physicians for improper billing may include loss of revenue, fraud investigations, financial sanction

  11. Researching the mental health needs of hard-to-reach groups: managing multiple sources of evidence

    PubMed Central

    2009-01-01

    Background Common mental health problems impose substantial challenges to patients, carers, and health care systems. A range of interventions have demonstrable efficacy in improving the lives of people experiencing such problems. However many people are disadvantaged, either because they are unable to access primary care, or because access does not lead to adequate help. New methods are needed to understand the problems of access and generate solutions. In this paper we describe our methodological approach to managing multiple and diverse sources of evidence, within a research programme to increase equity of access to high quality mental health services in primary care. Methods We began with a scoping review to identify the range and extent of relevant published material, and establish key concepts related to access. We then devised a strategy to collect - in parallel - evidence from six separate sources: a systematic review of published quantitative data on access-related studies; a meta-synthesis of published qualitative data on patient perspectives; dialogues with local stakeholders; a review of grey literature from statutory and voluntary service providers; secondary analysis of patient transcripts from previous qualitative studies; and primary data from interviews with service users and carers. We synthesised the findings from these diverse sources, made judgements on key emerging issues in relation to needs and services, and proposed a range of potential interventions. These proposals were debated and refined using iterative electronic and focus group consultation procedures involving international experts, local stakeholders and service users. Conclusions Our methods break new ground by generating and synthesising multiple sources of evidence, connecting scientific understanding with the perspectives of users, in order to develop innovative ways to meet the mental health needs of under-served groups. PMID:20003275

  12. Surgical management of multiple supernumerary teeth and an impacted maxillary permanent central incisor.

    PubMed

    Rallan, Mandeep; Rallan, Neelakshi Singh; Goswami, Mousumi; Rawat, Kamini

    2013-01-01

    Hyperdontia is the condition of having supernumerary teeth, or teeth which appear in addition to the regular number of teeth. It is a developmental anomaly and has been argued to arise from multiple aetiologies. The most common site is the maxillary incisor region; but the prevalence of more than three teeth supernumerary tooth is less than 1%. A case of 13 year male patient is reported with a multiple impacted supernumerary tooth in maxillary anterior region hindering the eruption of right permanent central incisor. The supernumerary tooth was treated via surgical approach followed by an interim prosthesis for permanent central incisor which later on erupted in due course of time. Background Supernumerary teeth may be defined as any teeth or tooth substance in excess of the usual configuration of 20 deciduous and 32 permanent teeth. The presence of supernumerary teeth in the premaxillary region often poses unique diagnostic and managerial concerns for the practitioner. Rarely is the surplus number compensated by an absence or deficiency of other teeth. Therefore, the dysfunctional nature of supernumerary teeth and their ability to create a variety of pathological disturbances in the normal eruption and position of adjacent teeth warrants their early detection and prudent management. Approximately 76-86% of cases represent single-tooth hyperdontia, with two supernumerary teeth noted in 12-23% and three or more extra teeth noted in less than 1% of cases. Multiple supernumerary teeth are also associated with many syndromes like cleidocranial dysplasia and Gardner’s syndrome etc. However, it is rare to find multiple supernumeraries in individuals with no other associated disease or syndrome. In such cases, the maxillary anterior region is the common site of occurrence. The exact aetiology is not clearly understood. The supernumerary teeth result from any disturbance in the initiation and proliferation stages of odontogenesis. There are several theories regarding the

  13. Calculation of Flight Deck Interval Management Assigned Spacing Goals Subject to Multiple Scheduling Constraints

    NASA Technical Reports Server (NTRS)

    Robinson, John E.

    2014-01-01

    The Federal Aviation Administration's Next Generation Air Transportation System will combine advanced air traffic management technologies, performance-based procedures, and state-of-the-art avionics to maintain efficient operations throughout the entire arrival phase of flight. Flight deck Interval Management (FIM) operations are expected to use sophisticated airborne spacing capabilities to meet precise in-trail spacing from top-of-descent to touchdown. Recent human-in-the-loop simulations by the National Aeronautics and Space Administration have found that selection of the assigned spacing goal using the runway schedule can lead to premature interruptions of the FIM operation during periods of high traffic demand. This study compares three methods for calculating the assigned spacing goal for a FIM operation that is also subject to time-based metering constraints. The particular paradigms investigated include: one based upon the desired runway spacing interval, one based upon the desired meter fix spacing interval, and a composite method that combines both intervals. These three paradigms are evaluated for the primary arrival procedures to Phoenix Sky Harbor International Airport using the entire set of Rapid Update Cycle wind forecasts from 2011. For typical meter fix and runway spacing intervals, the runway- and meter fix-based paradigms exhibit moderate FIM interruption rates due to their inability to consider multiple metering constraints. The addition of larger separation buffers decreases the FIM interruption rate but also significantly reduces the achievable runway throughput. The composite paradigm causes no FIM interruptions, and maintains higher runway throughput more often than the other paradigms. A key implication of the results with respect to time-based metering is that FIM operations using a single assigned spacing goal will not allow reduction of the arrival schedule's excess spacing buffer. Alternative solutions for conducting the FIM operation

  14. Waste management under multiple complexities: inexact piecewise-linearization-based fuzzy flexible programming.

    PubMed

    Sun, Wei; Huang, Guo H; Lv, Ying; Li, Gongchen

    2012-06-01

    To tackle nonlinear economies-of-scale (EOS) effects in interval-parameter constraints for a representative waste management problem, an inexact piecewise-linearization-based fuzzy flexible programming (IPFP) model is developed. In IPFP, interval parameters for waste amounts and transportation/operation costs can be quantified; aspiration levels for net system costs, as well as tolerance intervals for both capacities of waste treatment facilities and waste generation rates can be reflected; and the nonlinear EOS effects transformed from objective function to constraints can be approximated. An interactive algorithm is proposed for solving the IPFP model, which in nature is an interval-parameter mixed-integer quadratically constrained programming model. To demonstrate the IPFP's advantages, two alternative models are developed to compare their performances. One is a conventional linear-regression-based inexact fuzzy programming model (IPFP2) and the other is an IPFP model with all right-hand-sides of fussy constraints being the corresponding interval numbers (IPFP3). The comparison results between IPFP and IPFP2 indicate that the optimized waste amounts would have the similar patterns in both models. However, when dealing with EOS effects in constraints, the IPFP2 may underestimate the net system costs while the IPFP can estimate the costs more accurately. The comparison results between IPFP and IPFP3 indicate that their solutions would be significantly different. The decreased system uncertainties in IPFP's solutions demonstrate its effectiveness for providing more satisfactory interval solutions than IPFP3. Following its first application to waste management, the IPFP can be potentially applied to other environmental problems under multiple complexities. PMID:22370050

  15. European Myeloma Network Guidelines for the Management of Multiple Myeloma-related Complications

    PubMed Central

    Terpos, Evangelos; Kleber, Martina; Engelhardt, Monika; Zweegman, Sonja; Gay, Francesca; Kastritis, Efstathios; van de Donk, Niels W.C.J.; Bruno, Benedetto; Sezer, Orhan; Broijl, Annemiek; Bringhen, Sara; Beksac, Meral; Larocca, Alessandra; Hajek, Roman; Musto, Pellegrino; Johnsen, Hans Erik; Morabito, Fortunato; Ludwig, Heinz; Cavo, Michele; Einsele, Hermann; Sonneveld, Pieter; Dimopoulos, Meletios A.; Palumbo, Antonio

    2015-01-01

    The European Myeloma Network provides recommendations for the management of the most common complications of multiple myeloma. Whole body low-dose computed tomography is more sensitive than conventional radiography in depicting osteolytic disease and thus we recommend it as the novel standard for the detection of lytic lesions in myeloma (grade 1A). Myeloma patients with adequate renal function and bone disease at diagnosis should be treated with zoledronic acid or pamidronate (grade 1A). Symptomatic patients without lytic lesions on conventional radiography can be treated with zoledronic acid (grade 1B), but its advantage is not clear for patients with no bone involvement on computed tomography or magnetic resonance imaging. In asymptomatic myeloma, bisphosphonates are not recommended (grade 1A). Zoledronic acid should be given continuously, but it is not clear if patients who achieve at least a very good partial response benefit from its continuous use (grade 1B). Treatment with erythropoietic-stimulating agents may be initiated in patients with persistent symptomatic anemia (hemoglobin <10g/dL) in whom other causes of anemia have been excluded (grade 1B). Erythropoietic agents should be stopped after 6–8 weeks if no adequate hemoglobin response is achieved. For renal impairment, bortezomib-based regimens are the current standard of care (grade 1A). For the management of treatment-induced peripheral neuropathy, drug modification is needed (grade 1C). Vaccination against influenza is recommended; vaccination against streptococcus pneumonia and hemophilus influenza is appropriate, but efficacy is not guaranteed due to suboptimal immune response (grade 1C). Prophylactic aciclovir (or valacyclovir) is recommended for patients receiving proteasome inhibitors, autologous or allogeneic transplantation (grade 1A). PMID:26432383

  16. European Myeloma Network guidelines for the management of multiple myeloma-related complications.

    PubMed

    Terpos, Evangelos; Kleber, Martina; Engelhardt, Monika; Zweegman, Sonja; Gay, Francesca; Kastritis, Efstathios; van de Donk, Niels W C J; Bruno, Benedetto; Sezer, Orhan; Broijl, Annemiek; Bringhen, Sara; Beksac, Meral; Larocca, Alessandra; Hajek, Roman; Musto, Pellegrino; Johnsen, Hans Erik; Morabito, Fortunato; Ludwig, Heinz; Cavo, Michele; Einsele, Hermann; Sonneveld, Pieter; Dimopoulos, Meletios A; Palumbo, Antonio

    2015-10-01

    The European Myeloma Network provides recommendations for the management of the most common complications of multiple myeloma. Whole body low-dose computed tomography is more sensitive than conventional radiography in depicting osteolytic disease and thus we recommend it as the novel standard for the detection of lytic lesions in myeloma (grade 1A). Myeloma patients with adequate renal function and bone disease at diagnosis should be treated with zoledronic acid or pamidronate (grade 1A). Symptomatic patients without lytic lesions on conventional radiography can be treated with zoledronic acid (grade 1B), but its advantage is not clear for patients with no bone involvement on computed tomography or magnetic resonance imaging. In asymptomatic myeloma, bisphosphonates are not recommended (grade 1A). Zoledronic acid should be given continuously, but it is not clear if patients who achieve at least a very good partial response benefit from its continuous use (grade 1B). Treatment with erythropoietic-stimulating agents may be initiated in patients with persistent symptomatic anemia (hemoglobin <10g/dL) in whom other causes of anemia have been excluded (grade 1B). Erythropoietic agents should be stopped after 6-8 weeks if no adequate hemoglobin response is achieved. For renal impairment, bortezomib-based regimens are the current standard of care (grade 1A). For the management of treatment-induced peripheral neuropathy, drug modification is needed (grade 1C). Vaccination against influenza is recommended; vaccination against streptococcus pneumonia and hemophilus influenza is appropriate, but efficacy is not guaranteed due to suboptimal immune response (grade 1C). Prophylactic aciclovir (or valacyclovir) is recommended for patients receiving proteasome inhibitors, autologous or allogeneic transplantation (grade 1A). PMID:26432383

  17. Managing multiple diffuse pressures on water quality and ecological habitat: Spatially targeting effective mitigation actions at the landscape scale.

    NASA Astrophysics Data System (ADS)

    Joyce, Hannah; Reaney, Sim

    2015-04-01

    than absolute sense at the landscape scale. Riparian woodland planting is proposed as one mitigation action to address these pressures. This planting disconnects the transfer of material from the landscape to the river channel by promoting increased infiltration and also provides river shading and hence decreases the rate of water heating. To identify the optimal locations for riparian woodland planting, a Monte Carlo based approach was used to identify multiple mitigation options and their influence on the pressures identified. These results were integrated into a decision support tool, which allows the user to explore the implications of individual and a set of pressures. This is achieved by allowing the user to change the importance of different pressures to identify the optimal locations for a custom combination of pressures. For example, reductions in flood risk can be prioritized over reductions in fine sediment. This approach provides an innovative way of identifying and targeting multiple diffuse pressures at the catchment scale simultaneously, which has presented a challenge in previous management efforts. The approach has been tested in the River Ribble Catchment, North West England.

  18. Exercise, Diet, and Stress Management as Mediators between Functional Disability and Health-Related Quality of Life in Multiple Sclerosis

    ERIC Educational Resources Information Center

    Sung, Connie; Chiu, Chung-Yi; Lee, Eun-Jeong; Bezyak, Jill; Chan, Fong; Muller, Veronica

    2013-01-01

    The main objective of this study was to examine the mediational and moderational effect of exercise, diet, and stress management on the relationship between functional disability and health-related quality of life. Quantitative descriptive research design using multiple regression and correlation techniques was used. Participants were 215…

  19. Management Development Training; Multiple Measurement of Its Effect When Used to Increase the Impact of a Long Term Motivational Program.

    ERIC Educational Resources Information Center

    Camealy, John Bremer

    This field investigation applied multiple measures to determine effects of management development training when used to increase the benefits from a long term motivational program. Two experimental groups and a control group were used. Instruments applied included the Miner Sentence Completion Scale, the Leadership Opinion Questionnaire (LOQ), and…

  20. 15 CFR 921.33 - Boundary changes, amendments to the management plan, and addition of multiple-site components.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 15 Commerce and Foreign Trade 3 2012-01-01 2012-01-01 false Boundary changes, amendments to the... REGULATIONS Reserve Designation and Subsequent Operation § 921.33 Boundary changes, amendments to the management plan, and addition of multiple-site components. (a) Changes in the boundary of a Reserve and...

  1. 15 CFR 921.33 - Boundary changes, amendments to the management plan, and addition of multiple-site components.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 15 Commerce and Foreign Trade 3 2011-01-01 2011-01-01 false Boundary changes, amendments to the... REGULATIONS Reserve Designation and Subsequent Operation § 921.33 Boundary changes, amendments to the management plan, and addition of multiple-site components. (a) Changes in the boundary of a Reserve and...

  2. 15 CFR 921.33 - Boundary changes, amendments to the management plan, and addition of multiple-site components.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 15 Commerce and Foreign Trade 3 2010-01-01 2010-01-01 false Boundary changes, amendments to the... REGULATIONS Reserve Designation and Subsequent Operation § 921.33 Boundary changes, amendments to the management plan, and addition of multiple-site components. (a) Changes in the boundary of a Reserve and...

  3. 15 CFR 921.33 - Boundary changes, amendments to the management plan, and addition of multiple-site components.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 15 Commerce and Foreign Trade 3 2014-01-01 2014-01-01 false Boundary changes, amendments to the... REGULATIONS Reserve Designation and Subsequent Operation § 921.33 Boundary changes, amendments to the management plan, and addition of multiple-site components. (a) Changes in the boundary of a Reserve and...

  4. 15 CFR 921.33 - Boundary changes, amendments to the management plan, and addition of multiple-site components.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 15 Commerce and Foreign Trade 3 2013-01-01 2013-01-01 false Boundary changes, amendments to the... REGULATIONS Reserve Designation and Subsequent Operation § 921.33 Boundary changes, amendments to the management plan, and addition of multiple-site components. (a) Changes in the boundary of a Reserve and...

  5. Design of Experiments with Multiple Independent Variables: A Resource Management Perspective on Complete and Reduced Factorial Designs

    ERIC Educational Resources Information Center

    Collins, Linda M.; Dziak, John J.; Li, Runze

    2009-01-01

    An investigator who plans to conduct an experiment with multiple independent variables must decide whether to use a complete or reduced factorial design. This article advocates a resource management perspective on making this decision, in which the investigator seeks a strategic balance between service to scientific objectives and economy.…

  6. Overview of recent trends in diagnosis and management of leptomeningeal multiple myeloma.

    PubMed

    Yellu, Mahender R; Engel, Jessica M; Ghose, Abhimanyu; Onitilo, Adedayo A

    2016-03-01

    Neurological complications related to multiple myeloma (MM) are not uncommon; however, direct involvement of the central nervous system (CNS) is extremely rare and represents a diagnostic and therapeutic challenge. Significant survival difference has been noted with the introduction of novel therapy in patients with MM, but their effect on the incidence and their use for management of leptomeningeal myeloma (LMM) is uncertain. Analysis of published data demonstrates its recent increased incidence, median time to CNS presentation, and slight improvement in median survival after diagnosis of LMM. Less common MM isotypes have been overrepresented in LMM. CNS relapse occurred mostly in patients with Durie-Salmon stage III MM. Despite treatments, standard or experimental, the survival rates of LMM remain dismal. Monitoring high risk patients closely, even after achieving complete remission, may be useful in early detection of LMM. As we gain better understanding of LMM, we recommend that future research and clinical care focus on earlier diagnosis and development of more efficient CNS-directed therapy to improve survival in this patient population. Copyright © 2014 John Wiley & Sons, Ltd. PMID:25524637

  7. A decision framework for prioritizing multiple management actions for threatened marine megafauna.

    PubMed

    Fuentes, M M P B; Blackwood, J; Jones, B; Kim, M; Leis, B; Limpus, C J; Marsh, H; Mitchell, J; Pouzols, F M; Pressey, R L; Visconti, P

    2015-01-01

    Resources for conserving biodiversity are invariably insufficient. This situation creates the need for transparent, systematic frameworks to help stakeholders prioritize the allocation of resources across multiple management actions. We developed a novel framework that explicitly prioritizes actions to minimize the impacts of several threats across a species' range. The framework uses a budget constraint and maximizes conservation outcomes from a set of management actions, accounting for the likelihood of the action being successfully applied and accepted by local and Indigenous communities. This approach is novel in that it integrates local knowledge and expert opinion with optimization software, thereby minimizing assumptions about likelihood of success of actions and their effectiveness. To test the framework, we used the eastern Gulf of Carpentaria and Torres Strait population of the flatback turtle, Natator depressus, as a case study. This approach allowed the framework to be applied in a data-poor context, a situation common in conservation planning. The framework identified the best set of actions to maximize the conservation of flatback eggs for scenarios with different budgets and management parameters and allowed comparisons between optimized and preselected scenarios. Optimized scenarios considered all implementable actions to explore how to best allocate resources with a specified budget and focus. Preselected scenarios were used to evaluate current allocations of funds and/or potential budget allocations suggested by different stakeholders. Scenarios that used a combination of aerial and ground strategies to reduce predation of eggs performed better than scenarios that focused only on reducing harvest of eggs. The performances of optimized and preselected scenarios were generally similar among scenarios that targeted similar threats. However, the cost-effectiveness of optimized scenarios was usually higher than that of preselected scenarios

  8. The interactive responses of water quality and hydrology to changes in multiple stressors, and implications for the long-term effective management of phosphorus.

    PubMed

    Crossman, J; Whitehead, P G; Futter, M N; Jin, L; Shahgedanova, M; Castellazzi, M; Wade, A J

    2013-06-01

    Soluble reactive phosphorus (SRP) plays a key role in eutrophication, a global problem decreasing habitat quality and in-stream biodiversity. Mitigation strategies are required to prevent SRP fluxes from exceeding critical levels, and must be robust in the face of potential changes in climate, land use and a myriad of other influences. To establish the longevity of these strategies it is therefore crucial to consider the sensitivity of catchments to multiple future stressors. This study evaluates how the water quality and hydrology of a major river system in the UK (the River Thames) respond to alterations in climate, land use and water resource allocations, and investigates how these changes impact the relative performance of management strategies over an 80-year period. In the River Thames, the relative contributions of SRP from diffuse and point sources vary seasonally. Diffuse sources of SRP from agriculture dominate during periods of high runoff, and point sources during low flow periods. SRP concentrations rose under any future scenario which either increased a) surface runoff or b) the area of cultivated land. Under these conditions, SRP was sourced from agriculture, and the most effective single mitigation measures were those which addressed diffuse SRP sources. Conversely, where future scenarios reduced flow e.g. during winters of reservoir construction, the significance of point source inputs increased, and mitigation measures addressing these issues became more effective. In catchments with multiple point and diffuse sources of SRP, an all-encompassing effective mitigation approach is difficult to achieve with a single strategy. In order to attain maximum efficiency, multiple strategies might therefore be employed at different times and locations, to target the variable nature of dominant SRP sources and pathways. PMID:23542675

  9. Awards and Addresses Summary

    PubMed Central

    2008-01-01

    Each year at the annual ASHG meeting, addresses are given in honor of the society and a number of award winners. A summary of each of these addresses is given below. On the next pages, we have printed the Presidential Address and the addresses for the William Allan Award. The other addresses, accompanied by pictures of the speakers, can be found at www.ashg.org.

  10. Evaluating integrated watershed management using multiple criteria analysis--a case study at Chittagong Hill Tracts in Bangladesh.

    PubMed

    Biswas, Shampa; Vacik, Harald; Swanson, Mark E; Haque, S M Sirajul

    2012-05-01

    Criteria and indicators assessment is one of the ways to evaluate management strategies for mountain watersheds. One framework for this, Integrated Watershed Management (IWM), was employed at Chittagong Hill Tracts region of Bangladesh using a multi-criteria analysis approach. The IWM framework, consisting of the design and application of principles, criteria, indicators, and verifiers (PCIV), facilitates active participation by diverse professionals, experts, and interest groups in watershed management, to explicitly address the demands and problems to measure the complexity of problems in a transparent and understandable way. Management alternatives are developed to fulfill every key component of IWM considering the developed PCIV set and current situation of the study area. Different management strategies, each focusing on a different approach (biodiversity conservation, flood control, soil and water quality conservation, indigenous knowledge conservation, income generation, watershed conservation, and landscape conservation) were assessed qualitatively on their potential to improve the current situation according to each verifier of the criteria and indicator set. Analytic Hierarchy Process (AHP), including sensitivity analysis, was employed to identify an appropriate management strategy according to overall priorities (i.e., different weights of each principle) of key informants. The AHP process indicated that a strategy focused on conservation of biodiversity provided the best option to address watershed-related challenges in the Chittagong Hill Tracts, Bangladesh. PMID:21674224

  11. Striving for Balance: The Co-Existence of Multi-, Inter- and Transdisciplinary Curricula in Information Management Education To Address Information Imbalances on Tertiary Level.

    ERIC Educational Resources Information Center

    Fairer-Wessels, Felicite A.

    Within the South African tertiary education context, information management is taught from a variety of perspectives, including computer science, business management, informatics, and library and information science. Each discipline has a particular multidisciplinary focus dealing with its fundamentals. To investigate information management…

  12. AB019. Longitudinal asthma management profiles: visualisation of patient histories using multiple data sources

    PubMed Central

    Van Ganse, Eric; Herbage, Sandrine; Dima, Alexandra L.; de Bruin, Marijn; Texier, Nathalie; Jacoud, Flore; Nolin, Maëva; Langlois, Carole; Laforest, Laurent

    2016-01-01

    Background Electronic medical records (EMR) offer valuable information for research and clinical case management, but are currently underused. Barriers to EMR use include the limited information on medication use and health outcomes provided by single data sources, the challenge of linking multiple sources, and the lack of methods to integrate all information to reconstitute patients’ complete medical trajectories. The ASTRO-LAB cohort study, assessing the safety of long-acting β-agonists (LABA) in asthma, collected data from direct patient follow-up and healthcare databases, and thus allowed a more comprehensive exploration of medication use patterns, asthma control and exacerbations over time. To develop longitudinal asthma management patient profiles for the ASTROLAB cohort by integrating data on prescription and dispensation events, and patient-reported medication exposure and occurrence of severe asthma exacerbations (SAEx). Methods Children and adults with persistent asthma (aged 6–40) were included in France and the United Kingdom (UK) if on a stable therapy pattern of either LABA without inhaled corticosteroids (ICs), ICs without LABAs, LABAs and ICs in separate canisters, or fixed-dose combination (FDC) for ≥6 of 12 baseline months. The main study outcome was occurrence of asthma-related courses of oral corticosteroids, unscheduled medical contacts or death (SAEx). Patients were followed for ≤24 months via 4-monthly computer-assisted telephone interviews (CATIs) inquiring on recent asthma control, medication use, and SAEx, and via monthly text messages. Linkage was performed with prescription data (UK primary care records, physician reports in France) and dispensing data (French health insurance records). Prescription and exposure patterns were described and data visualization plots of longitudinal medication management profiles during follow-up developed for each patient. Results At inclusion, of 1,051 patients [(48.3% women, mean (SD) age =21

  13. Identifying and Addressing Vaccine Hesitancy

    PubMed Central

    Kestenbaum, Lori A.; Feemster, Kristen A.

    2015-01-01

    In the 20th century, the introduction of multiple vaccines significantly reduced childhood morbidity, mortality, and disease outbreaks. Despite, and perhaps because of, their public health impact, an increasing number of parents and patients are choosing to delay or refuse vaccines. These individuals are described as vaccine hesitant. This phenomenon has developed due to the confluence of multiple social, cultural, political and personal factors. As immunization programs continue to expand, understanding and addressing vaccine hesitancy will be crucial to their successful implementation. This review explores the history of vaccine hesitancy, its causes, and suggested approaches for reducing hesitancy and strengthening vaccine acceptance. PMID:25875982

  14. Identifying and addressing vaccine hesitancy.

    PubMed

    Kestenbaum, Lori A; Feemster, Kristen A

    2015-04-01

    In the 20th century, the introduction of multiple vaccines significantly reduced childhood morbidity, mortality, and disease outbreaks. Despite, and perhaps because of, their public health impact, an increasing number of parents and patients are choosing to delay or refuse vaccines. These individuals are described as "vaccine hesitant." This phenomenon has developed due to the confluence of multiple social, cultural, political, and personal factors. As immunization programs continue to expand, understanding and addressing vaccine hesitancy will be crucial to their successful implementation. This review explores the history of vaccine hesitancy, its causes, and suggested approaches for reducing hesitancy and strengthening vaccine acceptance. PMID:25875982

  15. The Impact of Conservation Management on the Community Composition of Multiple Organism Groups in Eutrophic Interconnected Man-Made Ponds.

    PubMed

    Lemmens, Pieter; Mergeay, Joachim; Van Wichelen, Jeroen; De Meester, Luc; Declerck, Steven A J

    2015-01-01

    Ponds throughout the world are subjected to a variety of management measures for purposes of biodiversity conservation. Current conservation efforts typically comprise a combination of multiple measures that directly and indirectly impact a wide range of organism groups. Knowledge of the relative impact of individual measures on different taxonomic groups is important for the development of effective conservation programs. We conducted a field study of 28 man-made ponds, representing four management types differing in the frequency of periodic pond drainage and the intensity of fish stock management. We disentangled the relative importance of direct and indirect effects of pond management measures on the community composition of phytoplankton, zooplankton, aquatic macro-invertebrates, submerged and emergent vascular plants. With the exception of phytoplankton, pond management had strong effects on the community composition of all investigated biota. Whether management affected communities directly or indirectly through its impact on fish communities or local environmental conditions in the pond varied between organism groups. Overall, the impact of pond drainage regime and fish community characteristics on the community composition of target organism groups were more important than local environmental conditions. The majority of taxa were negatively associated with fish density, whereas multiple emergent plant species and several taxa of aquatic macro-invertebrates were positively affected by increased drainage frequency. The effects of fish community and drainage tended to be largely independent. The present study indicates that pond drainage is an important element for biodiversity conservation in eutrophicated shallow and interconnected man-made ponds. PMID:26422390

  16. The Impact of Conservation Management on the Community Composition of Multiple Organism Groups in Eutrophic Interconnected Man-Made Ponds

    PubMed Central

    Lemmens, Pieter; Mergeay, Joachim; Van Wichelen, Jeroen; De Meester, Luc; Declerck, Steven A. J.

    2015-01-01

    Ponds throughout the world are subjected to a variety of management measures for purposes of biodiversity conservation. Current conservation efforts typically comprise a combination of multiple measures that directly and indirectly impact a wide range of organism groups. Knowledge of the relative impact of individual measures on different taxonomic groups is important for the development of effective conservation programs. We conducted a field study of 28 man-made ponds, representing four management types differing in the frequency of periodic pond drainage and the intensity of fish stock management. We disentangled the relative importance of direct and indirect effects of pond management measures on the community composition of phytoplankton, zooplankton, aquatic macro-invertebrates, submerged and emergent vascular plants. With the exception of phytoplankton, pond management had strong effects on the community composition of all investigated biota. Whether management affected communities directly or indirectly through its impact on fish communities or local environmental conditions in the pond varied between organism groups. Overall, the impact of pond drainage regime and fish community characteristics on the community composition of target organism groups were more important than local environmental conditions. The majority of taxa were negatively associated with fish density, whereas multiple emergent plant species and several taxa of aquatic macro-invertebrates were positively affected by increased drainage frequency. The effects of fish community and drainage tended to be largely independent. The present study indicates that pond drainage is an important element for biodiversity conservation in eutrophicated shallow and interconnected man-made ponds. PMID:26422390

  17. Data Management for Flexible Access - Implementation and Lessons Learned from work with Multiple User Communities

    NASA Astrophysics Data System (ADS)

    Benedict, K. K.; Scott, S.; Hudspeth, W. B.

    2012-12-01

    There is no shortage of community-specific and generic data discovery and download platforms and protocols (e.g. CUAHSI HIS, DataONE, GeoNetwork Open Source, GeoPortal, OGC CSW, OAI PMH), documentation standards (e.g. FGDC, ISO 19115, EML, Dublin Core), data access and visualization standards and models (e.g. OGC WxS, OpenDAP), and general-purpose web service models (i.e. REST & SOAP) upon which Geo-informatics cyberinfrastructure (CI) may be built. When attempting to develop a robust platform that may service a wide variety of users and use cases the challenge is one of identifying which existing platform (if any) may support those current needs while also allowing for future expansion for additional capabilities. In the case of the implementation of a data storage, discovery and delivery platform to support the multiple projects at the Earth Data Analysis Center at UNM, no single platform or protocol met the joint requirements of two initial applications (the New Mexico Resource Geographic Information System [http://rgis.unm.edu] and the New Mexico EPSCoR Data Portal [http://nmepscor.org/dataportal]) and furthermore none met anticipated additional requirements as new applications of the platform emerged. As a result of this assessment three years ago EDAC embarked on the development of the Geographic Storage, Transformation, and Retrieval Engine (GSToRE) platform as a general purpose platform upon which n-tiered geospatially enabled data intensive applications could be built. When initially released in 2010 the focus was on the publication of dynamically generated Open Geospatial Consortium services based upon a PostgreSQL/PostGIS backend database. The identification of additional service interface requirements (implementation of the DataONE API and CUAHSI WaterML services), use cases provided by the NM EPSCoR education working group, and expanded metadata publication needs have led to a significant update to the underlying data management tier for GSToRE - the

  18. Diagnosis, risk stratification and management of monoclonal gammopathy of undetermined significance and smoldering multiple myeloma.

    PubMed

    van de Donk, N W C J; Mutis, T; Poddighe, P J; Lokhorst, H M; Zweegman, S

    2016-05-01

    Monoclonal gammopathy of undetermined significance (MGUS) is one of the most common premalignant disorders. IgG and IgA MGUS are precursor conditions of multiple myeloma (MM), whereas light-chain MGUS is a precursor condition of light-chain MM. Smoldering MM (SMM) is a precursor condition with higher tumor burden and higher risk of progression to symptomatic MM compared to MGUS. Assessment of the risk of progression of patients with asymptomatic monoclonal gammopathies is based on various factors including clonal burden, as well as biological characteristics, such as cytogenetic abnormalities and light-chain production. Several models have been constructed that are useful in daily practice for predicting risk of progression of MGUS or SMM. Importantly, the plasma cell clone may occasionally be responsible for severe organ damage through the production of a M-protein which deposits in tissues or has autoantibody activity. These disorders are rare and often require therapy directed at eradication of the underlying clone. Importantly, recent studies have shown that asymptomatic patients with a bone marrow plasma cell percentage ≥60%, free light-chain ratio ≥100, or >1 focal lesion on MRI (myeloma-defining events) have a 80% risk of developing symptomatic MM within 2 years. These patients are now considered to have MM requiring therapy, similar to patients with symptomatic disease. In this review, we provide an overview of the new diagnostic criteria of the monoclonal gammopathies and discuss risk of progression to active MM. We also provide recommendations for the management of patients with MGUS and SMM including risk-adapted follow-up. PMID:27161311

  19. Clinical efficacy and management of monoclonal antibodies targeting CD38 and SLAMF7 in multiple myeloma.

    PubMed

    van de Donk, Niels W C J; Moreau, Philippe; Plesner, Torben; Palumbo, Antonio; Gay, Francesca; Laubach, Jacob P; Malavasi, Fabio; Avet-Loiseau, Hervé; Mateos, Maria-Victoria; Sonneveld, Pieter; Lokhorst, Henk M; Richardson, Paul G

    2016-02-11

    Immunotherapeutic strategies are emerging as promising therapeutic approaches in multiple myeloma (MM), with several monoclonal antibodies in advanced stages of clinical development. Of these agents, CD38-targeting antibodies have marked single agent activity in extensively pretreated MM, and preliminary results from studies with relapsed/refractory patients have shown enhanced therapeutic efficacy when daratumumab and isatuximab are combined with other agents. Furthermore, although elotuzumab (anti-SLAMF7) has no single agent activity in advanced MM, randomized trials in relapsed/refractory MM have demonstrated significantly improved progression-free survival when elotuzumab is added to lenalidomide-dexamethasone or bortezomib-dexamethasone. Importantly, there has been no significant additive toxicity when these monoclonal antibodies are combined with other anti-MM agents, other than infusion-related reactions specific to the therapeutic antibody. Prevention and management of infusion reactions is important to avoid drug discontinuation, which may in turn lead to reduced efficacy of anti-MM therapy. Therapeutic antibodies interfere with several laboratory tests. First, interference of therapeutic antibodies with immunofixation and serum protein electrophoresis assays may lead to underestimation of complete response. Strategies to mitigate interference, based on shifting the therapeutic antibody band, are in development. Furthermore, daratumumab, and probably also other CD38-targeting antibodies, interfere with blood compatibility testing and thereby complicate the safe release of blood products. Neutralization of the therapeutic CD38 antibody or CD38 denaturation on reagent red blood cells mitigates daratumumab interference with transfusion laboratory serologic tests. Finally, therapeutic antibodies may complicate flow cytometric evaluation of normal and neoplastic plasma cells, since the therapeutic antibody can affect the availability of the epitope for binding

  20. Magnetic content addressable memories

    NASA Astrophysics Data System (ADS)

    Jiang, Zhenye

    Content Addressable Memories are designed with comparison circuits built into every bit cell. This parallel structure can increase the speed of searching from O(n) (as with Random Access Memories) to O(1), where n is the number of entries being searched. The high cost in hardware limits the application of CAM within situations where higher searching speed is extremely desired. Spintronics technology can build non-volatile Magnetic RAM with only one device for one bit cell. There are various technologies involved, like Magnetic Tunnel Junctions, off-easy-axis programming method, Synthetic Anti-Ferromagnetic tri-layers, Domain Wall displacement, Spin Transfer Torque tri-layers and etc. With them, particularly the Tunnel Magneto-Resistance variation in MTJ due to difference in magnetization polarity of the two magnets, Magnetic CAM can be developed with reduced hardware cost. And this is demonstrated by the discussion in this dissertation. Six MCAM designs are discussed. In the first design, comparand (C), local information (S) and their complements are stored into 4 MTJs connected in XOR gate pattern. The other five designs have one or two stacks for both information storage and comparison, and full TMR ratio can be taken advantage of. Two challenges for the five are specifically programming C without changing S and selectively programming a cell out of an array. The solutions to specific programming are: by confining the programming field for C in a ring structure design; by using field programming and spin polarized current programming respectively for C and S in the SAF+DW and SAF+STT tri-layer design; by making use of the difference in thresholds between direct mode and toggle mode switching in the SAF+SAF design. The problem of selective programming is addressed by off-easy-axis method and by including SAF tri-layers. Cell with STT tri-layers for both C and S can completely avoid the problems of specific and selective programming, but subject to the limit of

  1. Utilizing findings from a gender-based analysis to address chronic disease prevention and management among African-American women in a Michigan community.

    PubMed

    Lombard, Wendy; Burke, Jodi; Waddell, Sandra; Franke, Arthur

    2015-08-01

    This research note underscores the importance of including strategies to address gender-based disparities when planning and implementing community health improvement programs. Working in collaboration with the Inkster Partnership for a Healthier Community (IPHC), the National Kidney Foundation of Michigan conducted a gender-based analysis as part of its broader community health needs assessment efforts in Inkster, MI. The findings from these studies revealed significant challenges impacting women that were not being adequately addressed within the community. In response to these findings, the IPHC created a strategic action plan to respond to the highest priority needs by increasing community awareness of and linkages to resources that provide supportive services for low-income African-American women. PMID:25542367

  2. Performance and function of a high-speed multiple star topology image management system at Mayo Clinic Scottsdale.

    PubMed

    Pavlicek, W; Zavalkovskiy, B; Eversman, W G

    1999-05-01

    -speed performance of the local star connection to what is now called the short-term storage (STS). Performance was measured and 25 chest examinations (17 MB each) transferred in just over 4 minutes. Integration of the radiology information management system (RIMS) was modified to provide location-specific report and examination interfaces, thereby allowing local filtering of the worklist to remote and near real-time consultation, and remote examination monitoring of modalities are addressed with this technologic approach. The installation of the single database ITS environment has occurred for testing prior to implementation. PMID:10342202

  3. Development and Evaluation of a Pilot Nurse Case Management Model to Address Multidrug-Resistant Tuberculosis (MDR-TB) and HIV in South Africa

    PubMed Central

    Farley, Jason E.; Kelly, Ana M.; Reiser, Katrina; Brown, Maria; Kub, Joan; Davis, Jeane G.; Walshe, Louise; Van der Walt, Martie

    2014-01-01

    Setting Multidrug-resistant tuberculosis (MDR-TB) unit in KwaZulu-Natal, South Africa. Objective To develop and evaluate a nurse case management model and intervention using the tenets of the Chronic Care Model to manage treatment for MDR-TB patients with a high prevalence of human immunodeficiency virus (HIV) co-infection. Design A quasi-experimental pilot programme utilizing a nurse case manager to manage care for 40 hospitalized MDR-TB patients, 70% HIV co-infected, during the intensive phase of MDR-TB treatment. Patients were followed for six months to compare proximal outcomes identified in the model between the pre- and post-intervention period. Results The greatest percent differences between baseline and six-month MDR-TB proximal outcomes were seen in the following three areas: baseline symptom evaluation on treatment initiation (95% improvement), baseline and monthly laboratory evaluations completed per guidelines (75% improvement), and adverse drug reactions acted upon by medical and/or nursing intervention (75% improvement). Conclusion Improvements were identified in guideline-based treatment and monitoring of adverse drug reactions following implementation of the nurse case management intervention. Further study is required to determine if the intervention introduced in this model will ultimately result in improvements in final MDR-TB treatment outcomes. PMID:25405988

  4. Designing monitoring programs in an adaptive management context for regional multiple species conservation plans

    USGS Publications Warehouse

    Atkinson, A.J.; Trenham, P.C.; Fisher, R.N.; Hathaway, S.A.; Johnson, B.S.; Torres, S.G.; Moore, Y.C.

    2004-01-01

    critical management uncertainties; and 3) implementing long-term monitoring and adaptive management. Ultimately, the success of regional conservation planning depends on the ability of monitoring programs to confront the challenges of adaptively managing and monitoring complex ecosystems and diverse arrays of sensitive species.

  5. Surgical management of isolated multiple ventricular septal defects. Logical approach in 130 cases.

    PubMed

    Serraf, A; Lacour-Gayet, F; Bruniaux, J; Ouaknine, R; Losay, J; Petit, J; Binet, J P; Planché, C

    1992-03-01

    From January 1980 through September 1990, 130 children underwent surgical closure of isolated multiple ventricular septal defects (mean age 14 +/- 18 months, mean weight 7.0 +/- 4.4 kg). Sixty-one were less than 1 year of age. Sixty-one children had pulmonary protection, 51 had pulmonary artery banding, and 10 had pulmonary valve stenosis. All other patients had severe pulmonary hypertension (mean systolic pressure 75.7 +/- 20.5 mm Hg and already disabling heart failure (New York Heart Association classes III and IV). The surgical management was based on the location of the defects and the ventricular dominance that were assessed preoperatively and intraoperatively. Midtrabecular ventricular septal defects were always centered by the moderator band and were therefore divided into low trabecular, midtrabecular, and high trabecular defects. The perimembranous septum was involved in 102 patients, the trabecular in 121, the inlet septum in 12, and the infundibular septum in 9. Fifty patients had the "Swiss cheese" form of the lesion. Closure of the ventricular septal defects included Dacron patch and mattress sutures. They were always first approached through a right atriotomy, which was sufficient for complete repair in 82 patients. In midtrabecular ventricular septal defects, section of the moderator band (n = 24) allowed closure of all the defects with a single Dacron patch. In 48 patients a right atriotomy and a right (n = 32) or left (n = 14) (particularly for low trabecular ventricular septal defects) or both right and left (n = 2) ventriculotomies were necessary to secure the repair. The hospital mortality rate was 7.7% (10 patients). The causes of deaths were residual ventricular septal defect (n = 5), pulmonary hypertension (n = 2), hypoplastic right ventricle (n = 1) and left ventricle (n = 1), and myocardial infarction (n = 1). Among eighteen survivors with residual ventricular septal defect, six were reoperated on; there were two deaths. A permanent

  6. Multiple stakeholders in multi-criteria decision-making in the context of Municipal Solid Waste Management: A review

    SciTech Connect

    Soltani, Atousa; Hewage, Kasun; Reza, Bahareh; Sadiq, Rehan

    2015-01-15

    Highlights: • We review Municipal Solid Waste Management studies with focus on multiple stakeholders. • We focus on studies with multi-criteria decision analysis methods and discover their trends. • Most studies do not offer solutions for situations where stakeholders compete for more benefits or have unequal voting powers. • Governments and experts are the most participated stakeholders and AHP is the most dominant method. - Abstract: Municipal Solid Waste Management (MSWM) is a complicated process that involves multiple environmental and socio-economic criteria. Decision-makers look for decision support frameworks that can guide in defining alternatives, relevant criteria and their weights, and finding a suitable solution. In addition, decision-making in MSWM problems such as finding proper waste treatment locations or strategies often requires multiple stakeholders such as government, municipalities, industries, experts, and/or general public to get involved. Multi-criteria Decision Analysis (MCDA) is the most popular framework employed in previous studies on MSWM; MCDA methods help multiple stakeholders evaluate the often conflicting criteria, communicate their different preferences, and rank or prioritize MSWM strategies to finally agree on some elements of these strategies and make an applicable decision. This paper reviews and brings together research on the application of MCDA for solving MSWM problems with more focus on the studies that have considered multiple stakeholders and offers solutions for such problems. Results of this study show that AHP is the most common approach in consideration of multiple stakeholders and experts and governments/municipalities are the most common participants in these studies.

  7. Framework for Address Cooperative Extended Transactions

    1997-12-01

    The Framework for Addressing Cooperative Extended Transactions (FACET) is an object-oriented software framework for building models of complex, cooperative behaviors of agents. it can be used to implement simulation models of societal processes such as the complex interplay of participating individuals and organizations engaged in multiple concurrent transactions in pursuit of their various goals. These transactions can be patterned on, for example, clinical guidelines and procedures, business practices, government and corporate policies, etc. FACET canmore » also address other complex behaviors such as biological life cycles or manufacturing processes. FACET includes generic software objects representing the fundamental classes of agent -- Person and Organization - with mechanisms for resource management, including resolution of conflicting requests for participation and/or use of the agent's resources. The FACET infrastructure supports stochastic behavioral elements and coping mechanisms by which specified special conditions and events can cause an active cooperative process to be preempted, diverting the participants onto appropriate alternative behavioral pathways.« less

  8. Decision Aids for Multiple-Decision Disease Management as Affected by Weather Input Errors

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Many disease management decision support systems (DSS) rely, exclusively or in part, on weather inputs to calculate an indicator for disease hazard. Error in the weather inputs, typically due to forecasting, interpolation or estimation from off-site sources, may affect model calculations and manage...

  9. Evaluation and management of the patient with multiple syringomas: A systematic review of the literature.

    PubMed

    Williams, Kiyanna; Shinkai, Kanade

    2016-06-01

    Syringomas are benign adnexal tumors with distinct histopathologic features, including the characteristic comma ("tadpole") shaped tail comprised of dilated, cystic eccrine ducts. Clinically, syringomas typically present in adolescent females predominantly in the periorbital region. They may present as solitary or multiple lesions, and more rare sites of involvement include the genitals, palms, scalp, and the chest. Over the past 50 years, there have been >800 reported cases of syringoma either alone or in conjunction with a systemic syndrome, most commonly Down syndrome. The primary aim of this systematic review is to discuss the clinical features and associations of syringomas with a focus on the patient with multiple syringomas. Its secondary aims are to explore pathophysiology with a focus on multiple syringomas and provide comprehensive data on both traditional and novel treatments. Importantly, multiple syringomas present across a broad clinical spectrum. Though noted in many textbooks to be related to tumor syndromes, the association of syringomas with inherited tumor syndromes is only rarely reported in the literature. Despite multiple reported cases of syringoma, the pathophysiology remains poorly understood and treatment continues to pose a significant challenge. PMID:26850654

  10. Management of citation verification requests for multiple projects at Sandia National Laboratories

    SciTech Connect

    Crawford, C.S.

    1995-12-31

    Sandia National Laboratories` (SNL) Technical Library is now responsible for providing citation verification management support for all references cited in technical reports issued by the Nuclear Waste Management (NWM) Program. This paper dancing how this process is managed for the Yucca Mountain Site Characterization (YWP), Waste Isolation Pilot Plant (WIPP), Idaho National Engineering Laboratory (INEL), and Greater Confinement Disposal (GCD) projects. Since technical reports are the main product of these projects, emphasis is placed on meeting the constantly evolving needs of these customers in a timely and cost-effective manner.

  11. Management of women with multiple sclerosis through pregnancy and after childbirth

    PubMed Central

    Coyle, Patricia K.

    2016-01-01

    Multiple sclerosis (MS) is a major acquired neurologic disease of young adults. The prototypic patient is a young woman of reproductive age. Gender preference is becoming more pronounced, since MS is increasing specifically among women. Any healthcare provider who deals with MS must be prepared to discuss pregnancy issues, and provide appropriate counseling. This is now complicated by the availability of multiple treatment options. There is growing literature on which to base recommendations, particularly regarding washout periods. After a brief background introduction, this review will discuss state-of-the-art family planning counseling in the treatment era, divided into prepregnancy, pregnancy, and postpartum MS issues. PMID:27134675

  12. Guideline for the diagnosis and management of multiple sclerosis in children.

    PubMed

    Govender, Rajeshree

    2013-09-01

    Paediatric multiple sclerosis (MS) represents a particular MS subgroup with unique diagnostic challenges. Due to the narrow window of environmental exposures and clinical disease expression, children with MS may represent an important study population for gaining a better understanding of the pathogenesis of the disease. The International Paediatric MS Study Group (IPMSSG) was formulated to clarify the diagnostic and therapeutic dilemmas in this population. This guideline was adapted from the International Paediatric Multiple Sclerosis Study Group guideline and endorsed by PANDA, South Africa.  PMID:24300690

  13. Data Base Design with GIS in Ecosystem Based Multiple Use Forest Management in Artvin, Turkey: A Case Study in Balcı Forest Management Planning Unit.

    PubMed

    Yolasığmaz, Hacı Ahmet; Keleş, Sedat

    2009-01-01

    In Turkey, the understanding of planning focused on timber production has given its place on Multiple Use Management (MUM). Because the whole infrastructure of forestry with inventory system leading the way depends on timber production, some cases of bottle neck are expected during the transition period. Database design, probably the most important stage during the transition to MUM, together with the digital basic maps making up the basis of this infrastructure constitute the main point of this article. Firstly, the forest management philosophy of Turkey in the past was shortly touched upon in the article. Ecosystem Based Multiple Use Forest Management (EBMUFM) approaches was briefly introduced. The second stage of the process of EBMUFM, database design was described by examining the classical planning infrastructure and the coverage to be produced and consumed were suggested in the form of lists. At the application stage, two different geographical databases were established with GIS in Balcı Planning Unit of the years 1984 and 2006. Following that the related basic maps are produced. Timely diversity of the planning unit of 20 years is put forward comparatively with regard to the stand parameters such as tree types, age class, development stage, canopy closure, mixture, volume and increment. PMID:22573978

  14. A sting in the spit: widespread cross-infection of multiple RNA viruses across wild and managed bees.

    PubMed

    McMahon, Dino P; Fürst, Matthias A; Caspar, Jesicca; Theodorou, Panagiotis; Brown, Mark J F; Paxton, Robert J

    2015-05-01

    Declining populations of bee pollinators are a cause of concern, with major repercussions for biodiversity loss and food security. RNA viruses associated with honeybees represent a potential threat to other insect pollinators, but the extent of this threat is poorly understood. This study aims to attain a detailed understanding of the current and ongoing risk of emerging infectious disease (EID) transmission between managed and wild pollinator species across a wide range of RNA viruses. Within a structured large-scale national survey across 26 independent sites, we quantify the prevalence and pathogen loads of multiple RNA viruses in co-occurring managed honeybee (Apis mellifera) and wild bumblebee (Bombus spp.) populations. We then construct models that compare virus prevalence between wild and managed pollinators. Multiple RNA viruses associated with honeybees are widespread in sympatric wild bumblebee populations. Virus prevalence in honeybees is a significant predictor of virus prevalence in bumblebees, but we remain cautious in speculating over the principle direction of pathogen transmission. We demonstrate species-specific differences in prevalence, indicating significant variation in disease susceptibility or tolerance. Pathogen loads within individual bumblebees may be high and in the case of at least one RNA virus, prevalence is higher in wild bumblebees than in managed honeybee populations. Our findings indicate widespread transmission of RNA viruses between managed and wild bee pollinators, pointing to an interconnected network of potential disease pressures within and among pollinator species. In the context of the biodiversity crisis, our study emphasizes the importance of targeting a wide range of pathogens and defining host associations when considering potential drivers of population decline. PMID:25646973

  15. A conspiracy of optimism: Sustained yield, multiple use, and intensive management on the national forests, 1945-1991

    SciTech Connect

    Hirt, P.W.

    1991-01-01

    This study focuses on two core national forest management policies; sustained yield and multiple use. Public and elected officials attempt to apply principles of sustainable development to publicly-owned forest lands to ensure that a wide variety of both market and nonmarket forest values are preserved for the benefit of present and future generations. Interest groups, the Forest Service, and policy makers have conceived of sustained yield and multiple use in different and evolving ways over the years. This study explores how these principles have been variously defined and either implemented or thwarted. After World War Two, with escalating demands on national forest resources, the US Forest Service turned to intensive management as a technological method of enhancing natural forest productivity and mitigating the environmental effects of increased use. But the agency's optimistic vision of efficient, sustained production of forest commodities through technical mastery over nature has met overwhelming fiscal, environmental, technical, and political obstacles. Changing public values since the 1960s and popularization of ecology have initiated a growing skepticism toward the premises of intensive management.

  16. Nanoscale content-addressable memory

    NASA Technical Reports Server (NTRS)

    Davis, Bryan (Inventor); Principe, Jose C. (Inventor); Fortes, Jose (Inventor)

    2009-01-01

    A combined content addressable memory device and memory interface is provided. The combined device and interface includes one or more one molecular wire crossbar memories having spaced-apart key nanowires, spaced-apart value nanowires adjacent to the key nanowires, and configurable switches between the key nanowires and the value nanowires. The combination further includes a key microwire-nanowire grid (key MNG) electrically connected to the spaced-apart key nanowires, and a value microwire-nanowire grid (value MNG) electrically connected to the spaced-apart value nanowires. A key or value MNGs selects multiple nanowires for a given key or value.

  17. A virtual approach to evaluate therapies for management of multiple myeloma induced bone disease

    PubMed Central

    Genever, Paul G.; Fagan, Michael J.

    2015-01-01

    Summary Multiple myeloma bone disease is devastating for patients and a major cause of morbidity. The disease leads to bone destruction by inhibiting osteoblast activity while stimulating osteoclast activity. Recent advances in multiple myeloma research have improved our understanding of the pathogenesis of multiple myeloma‐induced bone disease and suggest several potential therapeutic strategies. However, the effectiveness of some potential therapeutic strategies still requires further investigation and optimization. In this paper, a recently developed mathematical model is extended to mimic and then evaluate three therapies of the disease, namely: bisphosphonates, bortezomib and TGF‐β inhibition. The model suggests that bisphosphonates and bortezomib treatments not only inhibit bone destruction, but also reduce the viability of myeloma cells. This contributes to the current debate as to whether bisphosphonate therapy has an anti‐tumour effect. On the other hand, the analyses indicate that treatments designed to inhibit TGF‐β do not reduce bone destruction, although it appears that they might reduce the viability of myeloma cells, which again contributes to the current controversy regarding the efficacy of TGF‐β inhibition in multiple myeloma‐induced bone disease. © 2015 The Authors. International Journal for Numerical Methods in Biomedical Engineering published by John Wiley & Sons Ltd. PMID:26198466

  18. Two Persons with Multiple Disabilities Use Orientation Technology with Auditory Cues to Manage Simple Indoor Traveling

    ERIC Educational Resources Information Center

    Lancioni, Giulio E.; Singh, Nirbhay N.; O'Reilly, Mark F.; Sigafoos, Jeff; Campodonico, Francesca; Oliva, Doretta

    2010-01-01

    This study was an effort to extend the evaluation of orientation technology for promoting independent indoor traveling in persons with multiple disabilities. Two participants (adults) were included, who were to travel to activity destinations within occupational settings. The orientation system involved (a) cueing sources only at the destinations…

  19. Bridging the management-science partnership gap: Adaptive grazing management experiment in shortgrass steppe

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The Adaptive Grazing Management experiment (2013-2023) in shortgrass steppe of Colorado addresses a critical gap in grazing management: lack of management-science partnerships to more fully understand the effect of management decisions for multiple ecosystem goods and services at ranch-scales. A Sta...

  20. Addressivity in cogenerative dialogues

    NASA Astrophysics Data System (ADS)

    Hsu, Pei-Ling

    2014-03-01

    Ashraf Shady's paper provides a first-hand reflection on how a foreign teacher used cogens as culturally adaptive pedagogy to address cultural misalignments with students. In this paper, Shady drew on several cogen sessions to showcase his journey of using different forms of cogens with his students. To improve the quality of cogens, one strategy he used was to adjust the number of participants in cogens. As a result, some cogens worked and others did not. During the course of reading his paper, I was impressed by his creative and flexible use of cogens and at the same time was intrigued by the question of why some cogens work and not others. In searching for an answer, I found that Mikhail Bakhtin's dialogism, especially the concept of addressivity, provides a comprehensive framework to address this question. In this commentary, I reanalyze the cogen episodes described in Shady's paper in the light of dialogism. My analysis suggests that addressivity plays an important role in mediating the success of cogens. Cogens with high addressivity function as internally persuasive discourse that allows diverse consciousnesses to coexist and so likely affords productive dialogues. The implications of addressivity in teaching and learning are further discussed.

  1. Analysing the effectiveness of vendor-managed inventory in a single-warehouse, multiple-retailer system

    NASA Astrophysics Data System (ADS)

    Rahim, Mohd Kamarul Irwan Abdul; Aghezzaf, El-Houssaine; Limère, Veronique; Raa, Birger

    2016-06-01

    This paper considers a two-stage supply chain, consisting of a single warehouse and multiple retailers facing deterministic demands, under a vendor-managed inventory (VMI) policy. It presents a two-phase optimisation approach for coordinating the shipments in this VMI system. The first phase uses direct shipping from the supplier to all retailers to minimise the overall inventory costs. Then, in the second phase, the retailers are clustered using a construction heuristic in order to optimise the transportation costs while satisfying some additional restrictions. The improvement of the system's performance through coordinated VMI replenishments against the system with direct shipping only is shown and discussed in the comparative analysis section.

  2. Flash memory management system and method utilizing multiple block list windows

    NASA Technical Reports Server (NTRS)

    Chow, James (Inventor); Gender, Thomas K. (Inventor)

    2005-01-01

    The present invention provides a flash memory management system and method with increased performance. The flash memory management system provides the ability to efficiently manage and allocate flash memory use in a way that improves reliability and longevity, while maintaining good performance levels. The flash memory management system includes a free block mechanism, a disk maintenance mechanism, and a bad block detection mechanism. The free block mechanism provides efficient sorting of free blocks to facilitate selecting low use blocks for writing. The disk maintenance mechanism provides for the ability to efficiently clean flash memory blocks during processor idle times. The bad block detection mechanism provides the ability to better detect when a block of flash memory is likely to go bad. The flash status mechanism stores information in fast access memory that describes the content and status of the data in the flash disk. The new bank detection mechanism provides the ability to automatically detect when new banks of flash memory are added to the system. Together, these mechanisms provide a flash memory management system that can improve the operational efficiency of systems that utilize flash memory.

  3. Evolving the Optical Transport Network Management to Integrate Multiple Technologies and Services

    NASA Astrophysics Data System (ADS)

    Comi, Alberto; Gallina, Marco

    Optical networks are evolving at a fast pace from traditional synchronous digital hierarchy/synchronous optical network (SDH/SONET) and wavelength division multiplexing (WDM) infrastructures, used by client network layers in overlay mode, to a converged multi-service and multi-technology network able to transport traditional time division multiplexing (TDM) traffic and new packet traffic in a flexible way. Alcatel-Lucent is leading the network transformation required by network providers to offer data transport while guaranteeing the same quality and reliability typical of classical transport services. The introduction of new data communication services requires an evolution of the network management platform that needs to integrate new management applications associated with the new technologies and services. The resulting network has to be integrated from service provisioning and management system viewpoints to optimize its use and to reduce the in-field modifications of the transport network. This article describes specificities in the management of multi-service networks, identifying the management architecture able to support the rapid evolution of such environment.

  4. Psychotherapeutic and psychosocial interventions for managing stress in multiple sclerosis: the contribution of mindfulness-based interventions.

    PubMed

    Muñoz San José, A; Oreja-Guevara, C; Cebolla Lorenzo, S; Carrillo Notario, L; Rodríguez Vega, B; Bayón Pérez, C

    2016-03-01

    Depression or anxiety in multiple sclerosis (MS) has been linked to a more severe course of the disease and higher numbers of relapses, in addition to poorer treatment adherence and exacerbated immune system dysregulation. Recent investigations indicate that psychotherapeutic interventions for stress management, such as mindfulness-based interventions (MBIs), could improve quality of life, depression, anxiety, and fatigue in MS patients. Mindfulness fosters the ability to slow down and observe experiences as they truly are, which improves affect regulation. Mindfulness is acquired through training; its advantage over other psychotherapeutic interventions is that effects may remain over time, since cultivating mindfulness depends on regular practising of abilities learned during training. The objective of this article is to review the current evidence of psychotherapeutic and psychosocial interventions, including MBIs for stress management, and their beneficial effects on MS patients. PMID:26385015

  5. A Multiple Agent Model of Human Performance in Automated Air Traffic Control and Flight Management Operations

    NASA Technical Reports Server (NTRS)

    Corker, Kevin; Pisanich, Gregory; Condon, Gregory W. (Technical Monitor)

    1995-01-01

    A predictive model of human operator performance (flight crew and air traffic control (ATC)) has been developed and applied in order to evaluate the impact of automation developments in flight management and air traffic control. The model is used to predict the performance of a two person flight crew and the ATC operators generating and responding to clearances aided by the Center TRACON Automation System (CTAS). The purpose of the modeling is to support evaluation and design of automated aids for flight management and airspace management and to predict required changes in procedure both air and ground in response to advancing automation in both domains. Additional information is contained in the original extended abstract.

  6. “United Pedicle Flap” for management of multiple gingival recessions

    PubMed Central

    Chopra, Aditi; Sivaraman, Karthik; Bhat, Subraya Giliyar

    2016-01-01

    Numerous surgical procedures have evolved and are being modified with time to treat gingival recession by manipulating gingival or mucosal tissues in various ways. However, the decision to choose the most appropriate technique for a given recession site still remains a challenging task for clinicians. Mucogingival deformities such as shallow vestibule, frenal pull, or inadequate attached gingiva complicate the decision and limit the treatment options to an invasive procedure involving soft tissue grafts. The situation is further comprised if there is a nonavailability of adequate donor tissue and patients' unwillingness for procedures involving a second surgical site. In such situations, the recession either remains untreated or has poor treatment outcomes. This case report presents a modified pedicle graft technique for treatment of multiple gingival recessions with shallow vestibule and inadequate attached gingiva. The technique is a promising therapeutic alternative to invasive surgical procedures such as soft tissue grafts for treatment of multiple gingival recessions. PMID:27563212

  7. GWM-VI: groundwater management with parallel processing for multiple MODFLOW versions

    USGS Publications Warehouse

    Banta, Edward R.; Ahlfeld, David P.

    2013-01-01

    Groundwater Management–Version Independent (GWM–VI) is a new version of the Groundwater Management Process of MODFLOW. The Groundwater Management Process couples groundwater-flow simulation with a capability to optimize stresses on the simulated aquifer based on an objective function and constraints imposed on stresses and aquifer state. GWM–VI extends prior versions of Groundwater Management in two significant ways—(1) it can be used with any version of MODFLOW that meets certain requirements on input and output, and (2) it is structured to allow parallel processing of the repeated runs of the MODFLOW model that are required to solve the optimization problem. GWM–VI uses the same input structure for files that describe the management problem as that used by prior versions of Groundwater Management. GWM–VI requires only minor changes to the input files used by the MODFLOW model. GWM–VI uses the Joint Universal Parameter IdenTification and Evaluation of Reliability Application Programming Interface (JUPITER-API) to implement both version independence and parallel processing. GWM–VI communicates with the MODFLOW model by manipulating certain input files and interpreting results from the MODFLOW listing file and binary output files. Nearly all capabilities of prior versions of Groundwater Management are available in GWM–VI. GWM–VI has been tested with MODFLOW-2005, MODFLOW-NWT (a Newton formulation for MODFLOW-2005), MF2005-FMP2 (the Farm Process for MODFLOW-2005), SEAWAT, and CFP (Conduit Flow Process for MODFLOW-2005). This report provides sample problems that demonstrate a range of applications of GWM–VI and the directory structure and input information required to use the parallel-processing capability.

  8. 40 CFR 80.174 - Addresses.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 40 Protection of Environment 16 2011-07-01 2011-07-01 false Addresses. 80.174 Section 80.174... FUELS AND FUEL ADDITIVES Detergent Gasoline § 80.174 Addresses. (a) The detergent additive sample required under § 80.161(b)(2) shall be sent to: Manager, Fuels and Technical Analysis Group,...

  9. Managing the critical zone to obtain and sustain multiple benefits from working landscapes: The value of partnerships between LTAR and NSF CZO networks

    NASA Astrophysics Data System (ADS)

    Lohse, K. A.; Seyfried, M. S.; Pierson, F. B.

    2015-12-01

    The Critical Zone Observatories add value to earth system science and society by addressing research gaps to understand the critical zone, the surface skin of the earth that extends from the top of the tree canopy to the lower limits of the groundwater. The Critical Zone (CZ) sustains life on earth and provides food, shelter, forage, and fuel and other services to human well-being. This Zone is also where most of human activities take place and thus subject to change and degradation. Managing the critical zone to obtain and sustain these services will require initiatives, policies and incentives that maintain and enhance this zone. The Critical Zone Observatories are seeking to address major gaps in understanding how earth surface evolves over time and how it will respond to future changes. Many of these gaps in our understanding occur at the interface between disciplines, across space and deep time scales, and multiple dimensions. For example, the Reynolds Creek CZO seeks to understand the role of soil environmental variables such as soil moisture and depth that vary across complex terrain in governing soil carbon storage and turnover in a semi-arid environment. For this reason, soil samples are being collected to depth of bedrock. Other networks and agencies such as the new LTAR and NEON are quantifying soil carbon at more shallow depths that will likely capture the variability in near surface soil carbon that is more sensitive to management and climate changes but may underestimate the total stores of carbon on the landscape. The CZOs also provide a platform to conduct interdisciplinary to transdisciplinary science by integrating across geological, soil, hydrologic, ecological, and social sciences to understand the critical zone. The emergence of the CZO Network and the LTAR network brings the opportunity to standardize methods and test hypotheses and ask questions across broad environmental conditions and gradients that could not be achieved with single

  10. Technical assistance to Ohio closure sites; Technologies to address leachate from the on-site disposal facility at Fernald Environmental Management Project, Ohio

    SciTech Connect

    Hazen, Terry

    2002-08-26

    On August 6-7, 2002, a Technical Assistance Team (''Team'') from the U.S. Department of Energy (DOE) Subsurface Contaminants Focus Area (SCFA) met with Fernald Environmental Management Project (FEMP) personnel in Ohio to assess approaches to remediating uranium-contaminated leachate from the On-Site Disposal Facility (OSDF). The Team was composed of technical experts from national labs, technology centers, and industry and was assembled in response to a request from the FEMP Aquifer Restoration Project. Dave Brettschneider of Fluor Fernald, Inc., requested that a Team of experts be convened to review technologies for the removal of uranium in both brine ion exchange regeneration solution from the Advanced Wastewater Treatment facility and in the leachate from the OSDF. The Team was asked to identify one or more technologies for bench-scale testing as a cost effective alternative to remove uranium so that the brine regeneration solution from the Advanced Waste Water Treatment facility and the leachate from the OSDF can be discharged without further treatment. The Team was also requested to prepare a recommended development and demonstration plan for the alternative technologies. Finally, the Team was asked to make recommendations on the optimal technical solution for field implementation. The Site's expected outcomes for this effort are schedule acceleration, cost reduction, and better long-term stewardship implementation. To facilitate consideration of the most appropriate technologies, the Team was divided into two groups to consider the brine and the leachate separately, since they represent different sources with different constraints on solutions, e.g., short-term versus very long-term and concentrated versus dilute contaminant matrices. This report focuses on the technologies that are most appropriate for the leachate from the OSDF. Upon arriving at FEMP, project personnel asked the Team to concentrate its efforts on evaluating potential technologies and

  11. Multiple myeloma: 2016 update on diagnosis, risk-stratification, and management.

    PubMed

    Rajkumar, S Vincent

    2016-07-01

    Multiple myeloma accounts for approximately 10% of hematologic malignancies.The diagnosis requires ≥10% clonal bone marrow plasma cells or a biopsy proven plasmacytoma plus evidence of one or more multiple myeloma defining events (MDE): CRAB (hypercalcemia, renal failure, anemia, or lytic bone lesions) features felt related to the plasma cell disorder, bone marrow clonal plasmacytosis ≥60%, serum involved/uninvolved free light chain (FLC) ratio ≥100 (provided involved FLC is ≥100 mg/L), or >1 focal lesion on magnetic resonance imaging. Patients with del(17p), t(14;16), and t(14;20) have high-risk multiple myeloma. Patients with t(4;14) translocation and gain(1q) have intermediate-risk. All others are considered standard-risk. Initial treatment consists of bortezomib, lenalidomide, dexamethasone (VRD). In high-risk patients, carfilzomib, lenalidomide, dexamethasone (KRD) is an alternative to VRD. In eligible patients, initial therapy is given for approximately 3-4 months followed by autologous stem cell transplantation (ASCT). Standard risk patients can opt for delayed ASCT at first relapse. Patients not candidates for transplant are treated with Rd until progression, or alternatively, a triplet regimen such as VRD for approximately 12-18 months. After ASCT, lenalidomide maintenance is considered for standard risk patients especially in those who are not in very good partial response or better, while maintenance with a bortezomib-based regimen is needed for patients with intermediate or high-risk disease. Patients with indolent relapse can be treated with 2-drug or 3-drug combinations. Patients with more aggressive relapse require a triplet regimen or a combination of multiple active agents. Am. J. Hematol. 91:720-734, 2016. © 2016 Wiley Periodicals, Inc. PMID:27291302

  12. Hereditary melanoma: Update on syndromes and management: Genetics of familial atypical multiple mole melanoma syndrome.

    PubMed

    Soura, Efthymia; Eliades, Philip J; Shannon, Kristen; Stratigos, Alexander J; Tsao, Hensin

    2016-03-01

    Malignant melanoma is considered the most lethal skin cancer if it is not detected and treated during its early stages. About 10% of melanoma patients report a family history of melanoma; however, individuals with features of true hereditary melanoma (ie, unilateral lineage, multigenerational, multiple primary lesions, and early onset of disease) are in fact quite rare. Although many new loci have been implicated in hereditary melanoma, CDKN2A mutations remain the most common. Familial melanoma in the presence of multiple atypical nevi should raise suspicion for a germline CDKN2A mutation. These patients have a high risk of developing multiple primary melanomas and internal organ malignancies, especially pancreatic cancer; therefore, a multidisciplinary approach is necessary in many cases. The value of dermoscopic examination and total body photography performed at regular intervals has been suggested by a number of studies, and should therefore be considered for these patients and their first-degree relatives. In addition, genetic counseling with the possibility of testing can be a valuable adjunct for familial melanoma patients. This must be performed with care, however, and only by qualified individuals trained in cancer risk analysis. PMID:26892650

  13. Implications for multiple sclerosis in the era of the Affordable Care Act: the shifting managed care landscape.

    PubMed

    Mathis, A Scott; Owens, Gary M

    2014-12-01

    Multiple sclerosis (MS) is a disorder of the central nervous system that is associated with disability, reduced quality of life, extensive medical and nonmedical costs, and lost productivity. Specialty medications that are crucial to effective disease management, helping to prevent debilitating episodes of relapse, account for a substantial portion of the medical expenditures associated with MS. Although these therapies are not considered cost-effective by conventional definitions, they are comparable to one another in cost-effectiveness estimates, leaving the complex task of designing cost-efficient formulary management strategies to managed care professionals. Current epidemiologic data suggest that most patients with MS are covered by some form of healthcare insurance, but plan designs and formulary restrictions may still create access barriers for some patients. The Affordable Care Act (ACA) is recent federal legislation that seeks to provide new consumer protections, improve healthcare quality and accessibility while mitigating expenditures, and increase accountability of healthcare insurance companies. The impact of the ACA on specialty pharmaceuticals is unclear at this time, but it does appear to have already begun improving healthcare coverage across the population. Managed care professionals must work within the confines of the ACA to provide better and more affordable care that targets overall cost reductions rather than just pharmacy expenses. PMID:25734889

  14. Multiple myeloma

    PubMed Central

    2010-01-01

    Abstract Advances in the imaging and treatment of multiple myeloma have occurred over the past decade. This article summarises the current status and highlights how an understanding of both is necessary for optimum management. PMID:20159661

  15. Managing the Advantages and Challenges of Multiple Library Consortia: The View from within the Library

    ERIC Educational Resources Information Center

    Jin, Xudong; Maurer, Margaret Beecher

    2007-01-01

    The authors are both managers in OhioLINK libraries and have complex experiences working within a variety of simultaneous library consortial agreements. Their librarians'-eye view of consortia allows for a discussion of the nature of that landscape, some perspectives on the benefits and advantages of consortia as well as thoughts on the challenges…

  16. The Experiences of Mothers of Children with Autism: Managing Multiple Roles

    ERIC Educational Resources Information Center

    Safe, Anneleise; Joosten, Annette; Molineux, Matthew

    2012-01-01

    Background: Mothers of children with autism experience poorer health and wellbeing compared to mothers of children with other disabilities or typically-developing children. This qualitative phenomenological study aimed to explore the daily life experiences of mothers of children with autism, and the strategies they use to manage their roles, their…

  17. Market Orientation in Managing Relationships with Multiple Constituencies of Croatian Higher Education

    ERIC Educational Resources Information Center

    Pavicic, Jurica; Alfirevic, Niksa; Mihanovic, Zoran

    2009-01-01

    In this paper, market orientation in Croatian higher education (HE) is discussed within the context of stakeholder-oriented management. Drawing on existing studies, the "classical" empirical model, describing the market orientation of generic nonprofit organisations, has been adapted to the contingencies of the Croatian HE sector. Empirical…

  18. FME Senior Project Managers: A Juggling Act of Multiple Projects | Poster

    Cancer.gov

    By Peggy Pearl, Contributing Writer It was not until the 1950s that organizations in the United States began to apply project management tools and techniques to complex construction and engineering projects (http://en.m.wikipedia.org/wiki/Project_life_cycle).

  19. The Career Indecision of Managers and Professionals: An Examination of Multiple Subtypes [and] Comments [and] Rejoinder.

    ERIC Educational Resources Information Center

    Callanan, Gerard A.; And Others

    1992-01-01

    Cluster analysis of data from 397 banking managers and professionals revealed 4 subtypes: chronic and developmental career-undecided employees and vigilant and hypervigilant career-decided employees. (Reactions from Tiedeman, Krumboltz, and Hall and rejoinder from Greenhaus and Callanan are provided.) (SK)

  20. ePortfolios in the Workplace for Human Capital Management: A Multiple Case Study

    ERIC Educational Resources Information Center

    Lievens, Ronald

    2015-01-01

    This study researches whether the ePortfolio is a suitable instrument for human capital management in the business environment. The implementation of ePortfolio systems in five different organizations is analyzed. It considers whether ePortfolio implementations were successful, and relevant critical success factors were identified. For the latter…

  1. Explicating the Complexity of Participative Management: An Investigation of Multiple Dimensions.

    ERIC Educational Resources Information Center

    Somech, Anit

    2002-01-01

    Uses sample of 99 elementary principals in Israel to examine simultaneously 5 dimensions of participative management: decision domain, degree of participation, structure, target of participation, and rationale. Finds, for example, that principals tend to involve teachers more in the technical domain than the managerial domain. (Contains 76…

  2. Multiple leaf measurements improve effectiveness of the cholorophyll meter in drum wheat nitrogen management

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Simple and rapid methods are needed to measure durum wheat (Triticum durum L.) nitrogen (N) status and make on-site N application decisions for increased crop yield and grain quality. Although chlorophyll meters (SPAD meters) have been widely tested for cereal crop N management, significant variatio...

  3. Tools to study and manage grazing behavior at multiple scales to enhance the sustainability of livestock

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Free-ranging animal behavior is a multifaceted and complex phenomenon within rangeland ecology that must be understood and ultimately managed. Improving behavioral studies requires tools appropriate for use at the landscape scale. Though tools alone do not assure research will generate accurate in...

  4. Leadership in Higher Education: Examining the Narratives of Research Managers from Multiple Lenses

    ERIC Educational Resources Information Center

    Calma, Angelito

    2015-01-01

    This study explores the narratives behind how academics in formal leadership positions perceive their roles as leaders and their leadership development. Fifteen leaders in their varying capacities as managers of research in their universities participated to illustrate the complexities and challenges associated with their roles. Using narrative…

  5. The Anger Management Project: A Group Intervention for Anger in People with Physical and Multiple Disabilities

    ERIC Educational Resources Information Center

    Hagiliassis, Nick; Gulbenkoglu, Hrepsime; Di Marco, Mark; Young, Suzanne; Hudson, Alan

    2005-01-01

    Background: This paper describes the evaluation of a group program designed specifically to meet the anger management needs of a group of individuals with various levels of intellectual disability and/or complex communication needs. Method: Twenty-nine individuals were randomly assigned to an intervention group or a waiting-list comparison group.…

  6. Deriving Multiple Benefits from Carbon Market-Based Savanna Fire Management: An Australian Example

    PubMed Central

    Russell-Smith, Jeremy; Yates, Cameron P.; Edwards, Andrew C.; Whitehead, Peter J.; Murphy, Brett P.; Lawes, Michael J.

    2015-01-01

    Carbon markets afford potentially useful opportunities for supporting socially and environmentally sustainable land management programs but, to date, have been little applied in globally significant fire-prone savanna settings. While fire is intrinsic to regulating the composition, structure and dynamics of savanna systems, in north Australian savannas frequent and extensive late dry season wildfires incur significant environmental, production and social impacts. Here we assess the potential of market-based savanna burning greenhouse gas emissions abatement and allied carbon biosequestration projects to deliver compatible environmental and broader socio-economic benefits in a highly biodiverse north Australian setting. Drawing on extensive regional ecological knowledge of fire regime effects on fire-vulnerable taxa and communities, we compare three fire regime metrics (seasonal fire frequency, proportion of long-unburnt vegetation, fire patch-size distribution) over a 15-year period for three national parks with an indigenously (Aboriginal) owned and managed market-based emissions abatement enterprise. Our assessment indicates improved fire management outcomes under the emissions abatement program, and mostly little change or declining outcomes on the parks. We attribute improved outcomes and putative biodiversity benefits under the abatement program to enhanced strategic management made possible by the market-based mitigation arrangement. For these same sites we estimate quanta of carbon credits that could be delivered under realistic enhanced fire management practice, using currently available and developing accredited Australian savanna burning accounting methods. We conclude that, in appropriate situations, market-based savanna burning activities can provide transformative climate change mitigation, ecosystem health, and community benefits in northern Australia, and, despite significant challenges, potentially in other fire-prone savanna settings. PMID:26630453

  7. Deriving Multiple Benefits from Carbon Market-Based Savanna Fire Management: An Australian Example.

    PubMed

    Russell-Smith, Jeremy; Yates, Cameron P; Edwards, Andrew C; Whitehead, Peter J; Murphy, Brett P; Lawes, Michael J

    2015-01-01

    Carbon markets afford potentially useful opportunities for supporting socially and environmentally sustainable land management programs but, to date, have been little applied in globally significant fire-prone savanna settings. While fire is intrinsic to regulating the composition, structure and dynamics of savanna systems, in north Australian savannas frequent and extensive late dry season wildfires incur significant environmental, production and social impacts. Here we assess the potential of market-based savanna burning greenhouse gas emissions abatement and allied carbon biosequestration projects to deliver compatible environmental and broader socio-economic benefits in a highly biodiverse north Australian setting. Drawing on extensive regional ecological knowledge of fire regime effects on fire-vulnerable taxa and communities, we compare three fire regime metrics (seasonal fire frequency, proportion of long-unburnt vegetation, fire patch-size distribution) over a 15-year period for three national parks with an indigenously (Aboriginal) owned and managed market-based emissions abatement enterprise. Our assessment indicates improved fire management outcomes under the emissions abatement program, and mostly little change or declining outcomes on the parks. We attribute improved outcomes and putative biodiversity benefits under the abatement program to enhanced strategic management made possible by the market-based mitigation arrangement. For these same sites we estimate quanta of carbon credits that could be delivered under realistic enhanced fire management practice, using currently available and developing accredited Australian savanna burning accounting methods. We conclude that, in appropriate situations, market-based savanna burning activities can provide transformative climate change mitigation, ecosystem health, and community benefits in northern Australia, and, despite significant challenges, potentially in other fire-prone savanna settings. PMID:26630453

  8. Multiple Myeloma, Version 2.2016

    PubMed Central

    Anderson, Kenneth C.; Alsina, Melissa; Atanackovic, Djordje; Biermann, J. Sybil; Chandler, Jason C.; Costello, Caitlin; Djulbegovic, Benjamin; Fung, Henry C.; Gasparetto, Cristina; Godby, Kelly; Hofmeister, Craig; Holmberg, Leona; Holstein, Sarah; Huff, Carol Ann; Kassim, Adetola; Krishnan, Amrita Y.; Kumar, Shaji K.; Liedtke, Michaela; Lunning, Matthew; Raje, Noopur; Singhal, Seema; Smith, Clayton; Somlo, George; Stockerl-Goldstein, Keith; Treon, Steven P.; Weber, Donna; Yahalom, Joachim; Shead, Dorothy A.; Kumar, Rashmi

    2016-01-01

    Multiple myeloma (MM) is a malignant neoplasm of plasma cells that accumulate in bone marrow, leading to bone destruction and marrow failure. Recent statistics from the American Cancer Society indicate that the incidence of MM is increasing. The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) included in this issue address management of patients with solitary plasmacytoma and newly diagnosed MM. PMID:26553768

  9. Symptomatic Management of Multiple Sclerosis–Associated Tremor Among Participants in the NARCOMS Registry

    PubMed Central

    Salter, Amber R.; Rinker, John R.

    2016-01-01

    Background: Tremor affects 25% to 58% of patients with multiple sclerosis (MS) and is associated with poor prognosis and increased disability. MS-related tremor is difficult to treat, and data regarding patient-reported characterization and response to treatment are limited. We describe the symptomatic treatment of tremor in 508 enrollees in the North American Research Committee on Multiple Sclerosis (NARCOMS) Registry who self-reported tremor. Methods: From 777 surveys sent to NARCOMS participants who indicated mild or greater tremor using the Tremor and Coordination Scale, we compiled data regarding disability, tremor severity, symptomatic medication use, and reported response to medications. Results: Symptomatic medications reported to reduce tremor were used by 238 respondents (46.9%). Symptomatic medication use was associated with increased rates of unemployment and disability, and many other characteristics were similar between groups. Symptomatic drug use was more likely in participants reporting moderate (53.9%) or severe (51.3%) tremor than in those with mild (36.6%) or totally disabling (35.0%) tremor. This disparity held true across multiple tremor severity scores. The most commonly used drug classes were anticonvulsants (50.8%) and benzodiazepines (46.2%), with gabapentin and clonazepam used most often in their respective classes. Conclusions: Tremor in MS remains poorly treated; less than half of the participants reported benefit from symptomatic medications. Patients with moderate-to-severe tremor are more likely to report tremor benefit than are those with mild or disabling tremor. γ-Aminobutyric acid–active medications were most commonly reported as beneficial. PMID:27252602

  10. Addressing Social Issues.

    ERIC Educational Resources Information Center

    Schoebel, Susan

    1991-01-01

    Maintains that advertising can help people become more aware of social responsibilities. Describes a successful nationwide newspaper advertising competition for college students in which ads address social issues such as literacy, drugs, teen suicide, and teen pregnancy. Notes how the ads have helped grassroots programs throughout the United…

  11. States Address Achievement Gaps.

    ERIC Educational Resources Information Center

    Christie, Kathy

    2002-01-01

    Summarizes 2 state initiatives to address the achievement gap: North Carolina's report by the Advisory Commission on Raising Achievement and Closing Gaps, containing an 11-point strategy, and Kentucky's legislation putting in place 10 specific processes. The North Carolina report is available at www.dpi.state.nc.us.closingthegap; Kentucky's…

  12. Address of the President

    ERIC Educational Resources Information Center

    Ness, Frederic W.

    1976-01-01

    The president of the Association of American Colleges addresses at the 62nd annual meeting the theme of the conference: "Looking to the Future--Liberal Education in a Radically Changing Society." Contributions to be made by AAC are examined. (LBH)

  13. Addressing Sexual Harassment

    ERIC Educational Resources Information Center

    Young, Ellie L.; Ashbaker, Betty Y.

    2008-01-01

    This article discusses ways on how to address the problem of sexual harassment in schools. Sexual harassment--simply defined as any unwanted and unwelcome sexual behavior--is a sensitive topic. Merely providing students, parents, and staff members with information about the school's sexual harassment policy is insufficient; schools must take…

  14. Space sciences - Keynote address

    NASA Technical Reports Server (NTRS)

    Alexander, Joseph K.

    1990-01-01

    The present status and projected future developments of the NASA Space Science and Applications Program are addressed. Emphasis is given to biochemistry experiments that are planned for the Space Station. Projects for the late 1990s which will study the sun, the earth's magnetosphere, and the geosphere are briefly discussed.

  15. Nonsurgical management of multiple splenic abscesses in an obese patient that underwent laparoscopic sleeve gastrectomy: case report and review of literature.

    PubMed

    Schiavo, Luigi; Scalera, Giuseppe; De Sena, Gabriele; Ciorra, Francesca R; Pagliano, Pasquale; Barbarisi, Alfonso

    2015-10-01

    Sleeve gastrectomy (SG) is a surgical weight-loss procedure. Splenic abscess is a rare complication of SG. Four cases of splenic abscess after SG have been reported, all managed by surgical intervention. We report the first documented case of multiple splenic abscesses following SG managed conservatively by an integrated medical treatment. PMID:26509027

  16. 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

  17. Investigation into rainwater use by cotton under multiple irrigation management conditions in the Texas High Plains

    NASA Astrophysics Data System (ADS)

    Goebel, T.; Lascano, R. J.

    2012-12-01

    Irrigation management practices in the Texas High Plains (THP) might be improved if we could ascertain the proportion of rainfall utilized by the crop in any given rainfall event. For instance, the primary source of irrigation water in the THP is pumped from the Ogallala Aquifer (OA), and can be enriched in 18O compared to rainfall-captured water. Given this expected difference, it should be possible to determine if the crop is utilizing the water from a rainfall event. To this end, cotton was grown using three irrigation management practices: subsurface drip, center pivot, and no irrigation (dry land). The water used for irrigation was pumped from the Ogallala aquifer, and rainfall was gathered in a rain gauge with mineral oil to prevent evaporation. Additionally, plant and soil samples were collected following each precipitation event every two hours and every eight hours respectively. Water was then extracted from the soil and plant samples using cryogenic vacuum distillation, and analyzed for 18O/16O ratios using the DLT-100 Liquid-Water Isotope Analyzer from Los Gatos Research Inc. The difference in isotope concentrations in the extracts from soils was used to determine infiltration depth into the soil profile at each location. The isotopic composition of the plant water was used to determine if the was used to compare rainwater use across the different irrigation management practices. Results might suggest changes to the way in which we apply irrigation water that would improve root growth and distribution to enhance the capture of rainfall.

  18. Post-traumatic cervical spondyloptosis: A rare entity with multiple management options.

    PubMed

    Padwal, A; Shukla, D; Bhat, D I; Somanna, S; Devi, B I

    2016-06-01

    Post-traumatic cervical spondyloptosis is a rare condition associated with high energy injuries, and to our knowledge only case reports are available. There are no universally accepted treatment paradigms for these cases and management is individualised according to the case and surgeon preference. We retrospectively analysed our management and clinical outcomes of this condition. From January 2007 to August 2014 we treated eight patients with cervical spondyloptosis at our institute. Only two patients had no neurological deficits; all the remaining patients had partial cord injury. Seven were treated surgically with preoperative traction followed by anterior cervical discectomy and fusion with fixation in three patients, and combined anterior and posterior fusion and fixation in four. Depending on the presence of anterior compression by a disc an anterior first or posterior first approach was advocated. All four combined anterior and posterior fusion and fixation patients needed to be turned more than once (540°). There was no neurological deterioration in any of the patients, as they either improved or remained stable neurologically. Post-traumatic cervical spondyloptosis is a challenging entity to manage. Surgery can be done safely with good clinical and radiological outcome and needs to be tailored to the individual patient. PMID:26922508

  19. Architecture of security management unit for safe hosting of multiple agents

    NASA Astrophysics Data System (ADS)

    Gilmont, Tanguy; Legat, Jean-Didier; Quisquater, Jean-Jacques

    1999-04-01

    In such growing areas as remote applications in large public networks, electronic commerce, digital signature, intellectual property and copyright protection, and even operating system extensibility, the hardware security level offered by existing processors is insufficient. They lack protection mechanisms that prevent the user from tampering critical data owned by those applications. Some devices make exception, but have not enough processing power nor enough memory to stand up to such applications (e.g. smart cards). This paper proposes an architecture of secure processor, in which the classical memory management unit is extended into a new security management unit. It allows ciphered code execution and ciphered data processing. An internal permanent memory can store cipher keys and critical data for several client agents simultaneously. The ordinary supervisor privilege scheme is replaced by a privilege inheritance mechanism that is more suited to operating system extensibility. The result is a secure processor that has hardware support for extensible multitask operating systems, and can be used for both general applications and critical applications needing strong protection. The security management unit and the internal permanent memory can be added to an existing CPU core without loss of performance, and do not require it to be modified.

  20. The value of integrating information from multiple hazards for flood risk analysis and management

    NASA Astrophysics Data System (ADS)

    Castillo-Rodríguez, J. T.; Escuder-Bueno, I.; Altarejos-García, L.; Serrano-Lombillo, A.

    2014-02-01

    This article presents a methodology for estimating flood risk in urban areas integrating pluvial flooding, river flooding and failure of both small and large dams. The first part includes a review of basic concepts on flood risk analysis, evaluation and management. Flood risk analyses may be developed at local, regional and national level, however a general methodology to perform a quantitative flood risk analysis including different flood hazards is still required. The second part describes the proposed methodology, which presents an integrated approach - combining pluvial, river flooding and flooding from dam failure, as applied to a case study: an urban area located downstream of a dam under construction. The methodology enhances the approach developed within the SUFRI project ("Sustainable Strategies of Urban Flood Risk Management to cope with the residual risk", 2009-2011). This article also shows how outcomes from flood risk analysis provide better and more complete information to inform authorities, local entities and the stakeholders involved in decision-making with regard to flood risk management.

  1. Managing self-injection difficulties in patients with relapsing-remitting multiple sclerosis.

    PubMed

    Cox, Darcy; Stone, Jerome

    2006-06-01

    Difficulties with self-injection, including inabillity to self-inject, are common for individuals taking home-administered injectable medications. In relapsing-remitting multiple sclerosis (MS), all of the currently available disease-modifying medications are injectables marketed for self-injection. Problems with self-injection pose a barrier to treatment adherence for many patients. Clinicians at the University of California, San Francisco (UCSF) Multiple Sclerosis Center have developed a number of strategies to help patients who experience anxiety associated with self-injection. These strategies have been empirically tested and found to be effective and easily implemented by mental health professionals and nurses. This article offers case examples and discussion of the principles of the techniques developed at UCSF to remediate patients' difficulties with self-injection. Nurses are most often the healthcare providers responsible for training MS patients in self-injection and monitoring their compliance. Nurses who are familiar with these tools have the opportunity to have a significant positive impact on patient comfort, confidence, and, ultimately, successful long-term adherence to disease-modifying medications. PMID:16817668

  2. Diode laser treatment and clinical management of multiple oral lesions in patients with hereditary haemorrhagic telangiectasia.

    PubMed

    Favia, G; Tempesta, A; Limongelli, L; Suppressa, P; Sabbà, C; Maiorano, E

    2016-05-01

    Hereditary haemorrhagic telangiectasia (HHT) is rare, and characterised by vascular dysplasia that leads to various symptoms including visceral arteriovenous malformations and mucocutaneous telangiectatic lesions. Our aim was to describe the clinical features and options for the treatment of multiple oral lesions, and to illustrate the efficacy of the diode laser in the treatment of early (<2mm) and advanced lesions (2mm or more). We report 24 patients with 1200 oral telangiectatic lesions, which were often associated with regular bleeding (from monthly to daily), superinfection, pain, and swelling, and treated with multiple sessions of laser according to the number and size of the lesions. Early lesions were treated with a single laser impulse in ultrapulsed mode, and advanced lesions with repeated laser impulses in pulsed mode (t-on 200ms/t-off 500ms), at a power of 8W. Early lesions healed completely after laser photocoagulation with no operative or postoperative complications, while advanced lesions improved with a remarkable reduction in size but more discomfort. Protective occlusal plates were sometimes used to reduce the incidence of new lesions caused by dental trauma. The treatment of oral telangiectatic lesions is still being debated, and it is important to improve quality of life for patients. Diode laser surgery could be an effective treatment for oral lesions in those with hereditary haemorrhagic telangiectasia. PMID:26360009

  3. Management of a massive resorptive lesion with multiple perforations in a molar: case report.

    PubMed

    Borkar, Swati; de Noronha de Ataide, Ida

    2015-05-01

    Internal resorption is usually asymptomatic. Large resorption defects may result in penetration of the root dentin leading to perforation. In this case report, we describe the diagnosis and nonsurgical repair of a large resorptive lesion with multiple perforations in a mandibular first molar using cone-beam computed tomographic technology. The 3 different root perforations were located in the mesial root and repaired using Biodentine (Septodont, Saint-Maur des Fossés, France). The mesial root weakened from resorption was reinforced by replacing the lost root dentin with calcium silicate-based cement and placement of a glass fiber post. The 18-month follow-up confirmed remineralization of the osseous defect and asymptomatic function of the tooth. A further follow-up at 43 months revealed retention of the tooth and absence of root fracture. Usually, a tooth with multiple perforations and such a severe tooth material loss would have been destined for extraction. However, with contemporary diagnostic techniques such as cone-beam computed tomography and use of advanced biomaterials and root reinforcement methods, such teeth can be salvaged. PMID:25728818

  4. Multidisciplinary rehabilitation and steroids in the management of multiple sclerosis relapses: a randomized controlled trial

    PubMed Central

    Dackovic, Jelena; Tepavcevic, Darija Kisic; Basuroski, Irena Dujmovic; Mesaros, Sarlota; Pekmezovic, Tatjana; Drulovic, Jelena

    2015-01-01

    Introduction Periodic relapses are one of the main characteristics of multiple sclerosis (MS), from which recovery is often incomplete despite high-dose methylprednisolone (HDMP) treatment. The aim of our study was to evaluate the potential benefits of short-term HDMP combined with multidisciplinary rehabilitation (MDR) in persons with MS in relapse in order to assess whether combination of steroid therapy with MDR is more beneficial than steroid therapy alone. Material and methods This investigation was conducted as a randomized controlled trial. The MS patients were eligible if they had an established diagnosis and relapse requiring application of HDMP. Forty-nine patients were included in the study and randomized to control and treatment groups, and 37 completed the study. High-dose methylprednisolone was administered to all patients. The treatment group additionally underwent an MDR program over a 3-week period. All outcome measures were completed at baseline and 1 and 3 months later. Results The Expanded Disability Status Scale (EDSS) and Functional Independence Measure (FIM) motor scores improved statistically significantly 1 month after HDMP, in both treatment and control groups. During the study period, in the treatment group, a sustained large effect size (ES) was found for both physical and mental composite scores of Multiple Sclerosis Quality of Life-54 (MSQoL-54), while in the controls, a sustained moderate ES was demonstrated only for physical composite score. Conclusions Our findings suggest that MDR improves MS relapse outcome. PMID:27186184

  5. Use of multicriteria decision analysis to address conservation conflicts.

    PubMed

    Davies, A L; Bryce, R; Redpath, S M

    2013-10-01

    Conservation conflicts are increasing on a global scale and instruments for reconciling competing interests are urgently needed. Multicriteria decision analysis (MCDA) is a structured, decision-support process that can facilitate dialogue between groups with differing interests and incorporate human and environmental dimensions of conflict. MCDA is a structured and transparent method of breaking down complex problems and incorporating multiple objectives. The value of this process for addressing major challenges in conservation conflict management is that MCDA helps in setting realistic goals; entails a transparent decision-making process; and addresses mistrust, differing world views, cross-scale issues, patchy or contested information, and inflexible legislative tools. Overall we believe MCDA provides a valuable decision-support tool, particularly for increasing awareness of the effects of particular values and choices for working toward negotiated compromise, although an awareness of the effect of methodological choices and the limitations of the method is vital before applying it in conflict situations. PMID:23869557

  6. Examining occupational stress, sources of stress and stress management strategies through the eyes of management consultants: a multiple correspondence analysis for latent constructs.

    PubMed

    von Humboldt, Sofia; Leal, Isabel; Laneiro, Tito; Tavares, Patrícia

    2013-12-01

    To date, little research has yet focused in broad assessment for management consultancy professionals. This investigation aims to analyse management consultants' self-perceptions of occupational stress (SPoOS), sources of stress (SoS) and stress management strategies (SMS) and to find latent constructs that can work as major determinants in consultants' conceptualization of SPoOS, SoS and SMS. Measures were completed, including demographics and interviews. Complete data were available for 39 management consultants, 53.8% male and aged between 23 and 56 years (M = 38.0; SD = 9.2). The data were subjected to content analysis. Representation of the associations and latent constructs were analysed by a multiple correspondence analysis. Results indicated that 'intellectual disturber' (31.4%) was the most referred SPoOS, 'high workload' (15.1%) was identified as the most prevalent perceived SoS and 'coaching' (19.0%) was the most mentioned SMS. No significant differences between the two gender groups were found regarding the three total scores. SPoOS was explained by a two-factor model: 'organization-oriented' and 'person-oriented'. A three-dimension model formed by 'job concerns', 'organizational constraints' and 'career expectations' was indicated as a best-fit solution for SoS, and SMS was best explained in a three-dimension model by 'group dynamics strategies', 'organizational culture strategies' and 'individual support strategies'. This research makes a unique contribution for a better understanding of what defines SPoOS, SoS and SMS for management consultants. PMID:23401311

  7. The expected and actual communication of health care workers during the management of intrapartum: An interpretive multiple case study

    PubMed Central

    Fawcus, Sue; Korpela, Mikko; De la Harpe, Retha

    2015-01-01

    Background Daily activities within a health care organisation are mediated by information communication processes (ICP) involving multiple health care professionals at different levels of care. Effective perinatal management requires critical information to be accurately communicated. If there is a breakdown in this communication patient safety is at risk for various reasons such as: inadequate critical information, misconception of information and uninformed decisions being made. The purpose of this study was to interpret the complexities around ICP in order to contribute to the effective management of the intrapartum period. Methods Multi method, multiple case study approach was used to understand the ICP during the management of the intrapartum period. During the study, the expected ICP, the actual ICP, the challenges involved and the desired ICP were analysed. Twenty-four in-depth interviews with skilled birth attendants (SBAs) employing observer-as-participant roles, field notes, and document review methods were utilised to gather the data. Thematic analysis was utilised to analyse the data using Atlas TI software. Results The study revealed three subthemes which emerged from the expected ICP, whilst three others that emerged formed the theme actual ICP. The subthemes from the expected ICP included: accessibility of obstetric services, expected referral, recommended tools, expected communication and expected documentation. The theme actual ICP held three emerging subthemes: the handover processes, collaborative information seeking, information communicated and referral processes. Conclusion This study showed that what was expected was not what was actually happening. The requirements of the policies and protocols need to be effectively implemented to improve practice building these into current biomedical guidelines. PMID:26842518

  8. Management of relapsing-remitting multiple sclerosis in Latin America: practical recommendations for treatment optimization.

    PubMed

    Correale, Jorge; Abad, Patricio; Alvarenga, Regina; Alves-Leon, Soniza; Armas, Elizabeth; Barahona, Jorge; Buzó, Ricardo; Corona, Teresa; Cristiano, Edgardo; Gracia, Fernando; Bonitto, Juan García; Macías, Miguel Angel; Soto, Arnoldo; Vizcarra, Darwin; Freedman, Mark S

    2014-04-15

    The Latin American MS Experts' Forum has developed practical recommendations on the initiation and optimization of disease-modifying therapies in patients with relapsing-remitting multiple sclerosis (RRMS). The recommendations reflect the unique epidemiology of MS and the clinical practice environment in Latin American countries. Treatment response may be evaluated according to changes in relapses; progression, as assessed by the Expanded Disability Status Scale and the Timed 25-foot Walk; and lesion number on magnetic resonance imaging. Follow-up assessments are recommended every six months, or annually for stable patients. Cognitive function should be evaluated in all RRMS patients at baseline and annually thereafter. These recommendations are intended to assist clinicians in Latin America in developing a rational approach to treatment selection and sequencing for their RRMS patients. PMID:24607335

  9. Pediatric multiple sclerosis: Conventional first-line treatment and general management.

    PubMed

    Ghezzi, Angelo; Amato, Maria Pia; Makhani, Naila; Shreiner, Teri; Gärtner, Jutta; Tenembaum, Silvia

    2016-08-30

    Many disease-modifying therapies are currently available for adults with relapsing-remitting multiple sclerosis (MS) but none of them has been tested in pediatric MS in randomized placebo-controlled trials. At present, as suggested by observational studies and experts' guidelines, interferon-β and glatiramer acetate continue to be the standard first-line treatments for pediatric MS. Observational studies and some controlled unblinded trials have shown a positive effect of these meditations in reducing relapse rate and delaying disease progression, with an acceptable safety profile. The goal of this article is to provide an overview of current knowledge with regard to safety, tolerability, and efficacy of first-line treatment options for MS in the pediatric age group, with the aim of providing guidance for planning first-line treatment of MS in children and adolescents. PMID:27572869

  10. New approaches in the management of spasticity in multiple sclerosis patients: role of cannabinoids.

    PubMed

    Smith, Paul F

    2010-01-01

    Cannabinoids such as Cannabis-based medicinal extracts (CBMEs) are increasingly being used in the treatment of spasticity associated with multiple sclerosis (MS). They have been shown to have a beneficial effect on spasticity; however, this evidence is largely based on subjective rating scales. Objective measurements using the Ashworth scale have tended to show no significant effect; however, the validity of this scale has been questioned. The available clinical trial data suggest that the adverse side effects associated with using CBMEs are generally mild, such as dry mouth, dizziness, somnolence, nausea and intoxication. However, most of these trials were run over a period of months and it is possible that other adverse side effects could develop with long-term use. There may be reason to be concerned about the use of therapeutic cannabinoids by adolescents, people predisposed to psychosis and pregnant women. PMID:20234785

  11. Management of congenital choanal atresia (CCA) after multiple failures: A Case Report.

    PubMed

    Asma, A; Roslenda, A R; Suraya, A; Saraiza, A B; Aini, A A

    2013-01-01

    Nasal obstruction in neonates is a potentially fatal condition because neonates are obligatory nasal breathers. Bilateral choanal atresia is therefore a neonatal emergency. Several approaches for corrections of choanal atresia are available including the helium laser: YAG. A 5-year-old Chinese girl born with bilateral choanal atresia, had birth asphyxia that required intubation. She underwent multiple surgeries for correction of choanal atresia at other hospitals but failed to improve. She was referred to Universiti Kebangsaan Malaysia Medical Center (UKMMC) after presenting with intermittent respiratory distress and cyanosis following an upper respiratory tract infection. A repeat computed tomography (CT) scan done preoperatively showed complete bony stenosis over the left choana and finding was confirmed by examination under general anesthesia. She underwent endoscopic transnasal removal of left bony atretic plate. There was no intra or postoperative complications. During follow up 10 years later, the airway on both sides remains patent. PMID:23466775

  12. Sea-ice information co-management: Planning for sustainable multiple uses of ice-covered seas in a rapidly changing Arctic

    NASA Astrophysics Data System (ADS)

    Eicken, H.; Lovecraft, A. L.

    2012-12-01

    A thinner, less extensive and more mobile summer sea-ice cover is a major element and driver of Arctic Ocean change. Declining summer sea ice presents Arctic stakeholders with substantial challenges and opportunities from the perspective of sustainable ocean use and derivation of sea-ice or ecosystem services. Sea-ice use by people and wildlife as well as its role as a major environmental hazard focuses the interests and concerns of indigenous hunters and Arctic coastal communities, resource managers and the maritime industry. In particular, rapid sea-ice change and intensifying offshore industrial activities have raised fundamental questions as to how best to plan for and manage multiple and increasingly overlapping ocean and sea ice uses. The western North American Arctic - a region that has seen some of the greatest changes in ice and ocean conditions in the past three decades anywhere in the North - is the focus of our study. Specifically, we examine the important role that relevant and actionable sea-ice information can play in allowing stakeholders to evaluate risks and reconcile overlapping and potentially competing interests. Our work in coastal Alaska suggests that important prerequisites to address such challenges are common values, complementary bodies of expertise (e.g., local or indigenous knowledge, engineering expertise, environmental science) and a forum for the implementation and evaluation of a sea-ice data and information framework. Alongside the International Polar Year 2007-08 and an associated boost in Arctic Ocean observation programs and platforms, there has been a movement towards new governance bodies that have these qualities and can play a central role in guiding the design and optimization of Arctic observing systems. To help further the development of such forums an evaluation of the density and spatial distribution of institutions, i.e., rule sets that govern ocean use, as well as the use of scenario planning and analysis can serve as

  13. Excerpts from keynote address

    SciTech Connect

    Creel, G.C.

    1995-06-01

    Excerpts from the keynote principally address emissions issues in the fossil power industry as related to heat rate improvements. Stack emissions of both sulfur and nitrogen oxides are discussed, and a number of examples are given: (1) PEPCO`s Potomac River Station, and (2) Morgantown station`s NOX reduction efforts. Circulating water emissions are also briefly discussed, as are O & M costs of emission controls.

  14. Holographic content addressable storage

    NASA Astrophysics Data System (ADS)

    Chao, Tien-Hsin; Lu, Thomas; Reyes, George

    2015-03-01

    We have developed a Holographic Content Addressable Storage (HCAS) architecture. The HCAS systems consists of a DMD (Digital Micromirror Array) as the input Spatial Light Modulator (SLM), a CMOS (Complementary Metal-oxide Semiconductor) sensor as the output photodetector and a photorefractive crystal as the recording media. The HCAS system is capable of performing optical correlation of an input image/feature against massive reference data set stored in the holographic memory. Detailed system analysis will be reported in this paper.

  15. The value of integrating information from multiple hazards for flood risk management

    NASA Astrophysics Data System (ADS)

    Castillo-Rodríguez, J. T.; Escuder-Bueno, I.; Altarejos-García, L.; Serrano-Lombillo, A.

    2013-07-01

    This article presents a methodology for estimating flood risk in urban areas integrating pluvial flooding, river flooding and failure of both small and large dams. The first part includes a review of basic concepts and existing methods on flood risk analysis, evaluation and management. Traditionally, flood risk analyses have focused on specific site studies and qualitative or semi-quantitative approaches. However, in this context, a general methodology to perform a quantitative flood risk analysis including different flood hazards was still required. The second part describes the proposed methodology, which presents an integrated approach - combining pluvial, river flooding and dam failure, as applied to a case study: a urban area located downstream a dam under construction. Such methodology represents an upgrade of the methodological piece developed within the SUFRI project. This article shows how outcomes from flood risk analysis provide better and more complete information to inform authorities, local entities and the stakeholders involved on decision-making with regard to flood risk management.

  16. Bedaquiline versus placebo for management of multiple drug-resistant tuberculosis: A systematic review

    PubMed Central

    Charan, Jaykaran; Reljic, Tea; Kumar, Ambuj

    2016-01-01

    Background: Multidrug-resistant tuberculosis (MDR-TB) is associated with significant morbidity and mortality. Bedaquiline is the first drug approved for treating MDR-TB. Objectives: We performed a systematic review and meta-analysis to summarize the totality of all available evidence on the efficacy of bedaquiline for the management of MDR-TB. Materials and Methods: We searched the following PubMed and Cochrane Registry of Clinical Trials. Randomized controlled trials (RCTs) with a parallel design comparing bedaquiline versus any treatment for the management of MDR-TB in adults were eligible for inclusion. Data were pooled under a random effects model. Results: Two trials published as three manuscripts with a total of 207 patients were included. As per the Cochrane risk of bias tool, majority of parameter were labeled as high or unclear risk of bias. Bedaquiline compared with placebo was associated with a statistically significant decrease in time to conversion of positive sputum culture to negative at 8 and 24 weeks with a significant increase in mortality on long-term follow-up. There was no difference in completion rates between bedaquiline and placebo. Conclusion: Bedaquiline is an effective treatment modality for MDR-TB but needs to be balanced against significant mortality. Future Phase 3 RCTs are needed to make a conclusive recommendation. PMID:27127322

  17. Managing Bioenergy Production on Arable Field Margins for Multiple Ecosystem Services: Challenges and Opportunities

    NASA Astrophysics Data System (ADS)

    Ferrarini, Andrea; Serra, Paolo; Amaducci, Stefano; Trevisan, Marco; Puglisi, Edoardo

    2013-04-01

    Growing crops for bioenergy is increasingly viewed as conflicting with food production. However, energy use continues to rise and food production requires fuel inputs, which have increased with intensification. The debate should shift from "food or fuel" to the more challenging target: how the increasing demand for food and energy can be met in the future, particularly when water and land availability will be limited. As for food crops, also for bioenergy crops it is questioned whether it is preferable to manage cultivation to enhance ecosystem services ("land sharing" strategy) or to grow crops with lower ecosystem services but higher yield, thereby requiring less land to meet bioenergy demand ("land sparing" strategy). Energy crop production systems differ greatly in the supply of ecosystem services. The use of perennial biomass (e.g. Switchgrass, Mischantus, Giant reed) for energy production is considered a promising way to reduce net carbon emissions and mitigate climate change. In addition, regulating and supporting ecosystem services could be provided when specific management of bioenergy crops is implemented. The idea of HEDGE-BIOMASS* project is to convert the arable field margins to bioenergy crop production fostering a win-win strategy at landscape level. Main objective of the project is to improve land management to generate environmental benefits and increase farmer income. The various options available in literature for an improved field boundary management are presented. The positive/unknown/negative effects of growing perennial bioenergy crops on field margins will be discussed relatively to the following soil-related ecosystem services: (I) biodiversity conservation and enhancement, (II) soil nutrient cycling, (III) climate regulation (reduction of GHG emissions and soil carbon sequestration/stabilization, (IV) water regulation (filtering and buffering), (V) erosion regulation, (VI) pollination and pest regulation. From the analysis of available

  18. Development of oral immunomodulatory agents in the management of multiple sclerosis

    PubMed Central

    Nicholas, Richard; Giannetti, Paolo; Alsanousi, Ali; Friede, Tim; Muraro, Paolo A

    2011-01-01

    The emergence of oral disease-modifying therapies in multiple sclerosis (MS) will have a significant impact on the evolving scenario of immunomodulatory treatments in MS where current therapies are all injectable. Reducing relapses in trials translates for individuals with MS into a therapeutic aim of stopping future events. Thus the possible absence of any perceived benefits to the individual together with the long disease course, variable outcome, and a younger age group affected in MS makes side effects the major issue. The use of disease-modifying therapies as a whole needs to be placed in the context of a widening therapeutic indication where the use of these therapies is being justified at an increasingly early stage and in pre-MS syndromes such as clinically isolated and radiologically isolated syndromes where no fixed disability is likely to have accumulated. The five oral therapies discussed (cladribine, fingolimod, laquinimod, BG-12, and teriflunomide) have just completed Phase III studies and some have just been licensed. New oral drugs for MS need to be placed within this evolving marketplace where ease of delivery together with efficacy and side effects needs to be balanced against the known issues but also the known long-term safety of standard injectables. PMID:21625416

  19. Sativex in the Management of Multiple Sclerosis-Related Spasticity: Role of the Corticospinal Modulation

    PubMed Central

    Calabrò, Rocco Salvatore; Naro, Antonino; Sessa, Edoardo; D'Aleo, Giangaetano; Leo, Antonino; De Luca, Rosaria; Quartarone, Angelo

    2015-01-01

    Sativex is an emergent treatment option for spasticity in patients affected by multiple sclerosis (MS). This oromucosal spray, acting as a partial agonist at cannabinoid receptors, may modulate the balance between excitatory and inhibitory neurotransmitters, leading to muscle relaxation that is in turn responsible for spasticity improvement. Nevertheless, since the clinical assessment may not be sensitive enough to detect spasticity changes, other more objective tools should be tested to better define the real drug effect. The aim of our study was to investigate the role of Sativex in improving spasticity and related symptomatology in MS patients by means of an extensive neurophysiological assessment of sensory-motor circuits. To this end, 30 MS patients underwent a complete clinical and neurophysiological examination, including the following electrophysiological parameters: motor threshold, motor evoked potentials amplitude, intracortical excitability, sensory-motor integration, and Hmax/Mmax ratio. The same assessment was applied before and after one month of continuous treatment. Our data showed an increase of intracortical inhibition, a significant reduction of spinal excitability, and an improvement in spasticity and associated symptoms. Thus, we can speculate that Sativex could be effective in reducing spasticity by means of a double effect on intracortical and spinal excitability. PMID:25699191

  20. Sativex in the management of multiple sclerosis-related spasticity: role of the corticospinal modulation.

    PubMed

    Russo, Margherita; Calabrò, Rocco Salvatore; Naro, Antonino; Sessa, Edoardo; Rifici, Carmela; D'Aleo, Giangaetano; Leo, Antonino; De Luca, Rosaria; Quartarone, Angelo; Bramanti, Placido

    2015-01-01

    Sativex is an emergent treatment option for spasticity in patients affected by multiple sclerosis (MS). This oromucosal spray, acting as a partial agonist at cannabinoid receptors, may modulate the balance between excitatory and inhibitory neurotransmitters, leading to muscle relaxation that is in turn responsible for spasticity improvement. Nevertheless, since the clinical assessment may not be sensitive enough to detect spasticity changes, other more objective tools should be tested to better define the real drug effect. The aim of our study was to investigate the role of Sativex in improving spasticity and related symptomatology in MS patients by means of an extensive neurophysiological assessment of sensory-motor circuits. To this end, 30 MS patients underwent a complete clinical and neurophysiological examination, including the following electrophysiological parameters: motor threshold, motor evoked potentials amplitude, intracortical excitability, sensory-motor integration, and Hmax/Mmax ratio. The same assessment was applied before and after one month of continuous treatment. Our data showed an increase of intracortical inhibition, a significant reduction of spinal excitability, and an improvement in spasticity and associated symptoms. Thus, we can speculate that Sativex could be effective in reducing spasticity by means of a double effect on intracortical and spinal excitability. PMID:25699191

  1. MicroRNA theragnostics for the clinical management of multiple myeloma.

    PubMed

    Ahmad, N; Haider, S; Jagannathan, S; Anaissie, E; Driscoll, J J

    2014-04-01

    Theragnostics represent cutting-edge, multi-disciplinary strategies that combine diagnostics with therapeutics in order to generate personalized therapies that improve patient outcome. In oncology, the approach is aimed at more accurate diagnosis of cancer, optimization of patient selection to identify those most likely to benefit from a specific therapy and to generate effective therapeutics that enhance patient survival. MicroRNAs (miRNAs) are master regulators of the human genome that orchestrate myriad cellular pathways to control growth during physiologic and pathologic conditions. Compelling evidence shows that miRNA deregulation promotes events linked to tumor initiation, metastasis and drug resistance as seen in multiple myeloma (MM), an invariably fatal hematologic malignancy. miRNAs are readily detected in body fluids, for example, serum, plasma, urine, as well as circulating tumor cells to demonstrate their potential as readily accessible, non-invasive diagnostic and prognostic biomarkers and potential therapeutics. Specific miRNAs are aberrantly expressed early in myelomagenesis and may more readily detect high-risk disease than current methods. Although only recently discovered miRNAs have rapidly advanced from preclinical studies to evaluation in human clinical trials. The development of miRNA theragnostics should provide widely applicable tools for the targeted delivery of personalized medicines to improve the outcome of patients with MM. PMID:24714346

  2. Activity-Dependent and Experience-Driven Myelination Provide New Directions for the Management of Multiple Sclerosis.

    PubMed

    Jensen, Samuel K; Yong, V Wee

    2016-06-01

    Despite an appreciation of the importance of myelination and the consequences of pathological demyelination, the fundamental mechanisms regulating myelination are only now being resolved. Neuronal activity has long been considered a plausible regulatory signal for myelination. However, controversy surrounding its dispensability in certain contexts and the difficulty in determining to what degree it influences myelination has limited its widespread acceptance. Recent studies have shed new light on the role of neuronal activity in regulating oligodendrogenesis and myelination. Further, the dynamics of myelin in adulthood and the association between skilled learning and myelination have become increasingly well characterized. These advances present new considerations for the management of multiple sclerosis and open up new approaches to facilitate remyelination following pathological demyelination. PMID:27113322

  3. Revisiting the management of fatigue in multiple sclerosis in the context of rehabilitation: a narrative review of current evidence.

    PubMed

    Oral, Aydan; Yaliman, Ayşe

    2013-06-01

    Fatigue is one of the most frequently reported symptoms of multiple sclerosis, interfering with functioning and resulting in activity limitations and participation restrictions. Therefore, it is important to manage fatigue in a rehabilitation context considering not only disability associated with impaired functioning but also all the problems relevant to environmental and personal factors as defined in the International Classification of Functioning, Disability and Health (ICF). In addition to pharmacological treatment, there are many rehabilitation interventions with evidence of effectiveness in reducing fatigue and thereby facilitating improvement, particularly in body functions and structures and activities and participation components of the ICF. However, more research is required to provide evidence for effective treatment strategies in overcoming fatigue and related problems, especially in the components of contextual factors of the ICF. PMID:23635795

  4. Application of risk-based multiple criteria decision analysis for selection of the best agricultural scenario for effective watershed management.

    PubMed

    Javidi Sabbaghian, Reza; Zarghami, Mahdi; Nejadhashemi, A Pouyan; Sharifi, Mohammad Bagher; Herman, Matthew R; Daneshvar, Fariborz

    2016-03-01

    Effective watershed management requires the evaluation of agricultural best management practice (BMP) scenarios which carefully consider the relevant environmental, economic, and social criteria involved. In the Multiple Criteria Decision-Making (MCDM) process, scenarios are first evaluated and then ranked to determine the most desirable outcome for the particular watershed. The main challenge of this process is the accurate identification of the best solution for the watershed in question, despite the various risk attitudes presented by the associated decision-makers (DMs). This paper introduces a novel approach for implementation of the MCDM process based on a comparative neutral risk/risk-based decision analysis, which results in the selection of the most desirable scenario for use in the entire watershed. At the sub-basin level, each scenario includes multiple BMPs with scores that have been calculated using the criteria derived from two cases of neutral risk and risk-based decision-making. The simple additive weighting (SAW) operator is applied for use in neutral risk decision-making, while the ordered weighted averaging (OWA) and induced OWA (IOWA) operators are effective for risk-based decision-making. At the watershed level, the BMP scores of the sub-basins are aggregated to calculate each scenarios' combined goodness measurements; the most desirable scenario for the entire watershed is then selected based on the combined goodness measurements. Our final results illustrate the type of operator and risk attitudes needed to satisfy the relevant criteria within the number of sub-basins, and how they ultimately affect the final ranking of the given scenarios. The methodology proposed here has been successfully applied to the Honeyoey Creek-Pine Creek watershed in Michigan, USA to evaluate various BMP scenarios and determine the best solution for both the stakeholders and the overall stream health. PMID:26734840

  5. Content addressable memory project

    NASA Technical Reports Server (NTRS)

    Hall, J. Storrs; Levy, Saul; Smith, Donald E.; Miyake, Keith M.

    1992-01-01

    A parameterized version of the tree processor was designed and tested (by simulation). The leaf processor design is 90 percent complete. We expect to complete and test a combination of tree and leaf cell designs in the next period. Work is proceeding on algorithms for the computer aided manufacturing (CAM), and once the design is complete we will begin simulating algorithms for large problems. The following topics are covered: (1) the practical implementation of content addressable memory; (2) design of a LEAF cell for the Rutgers CAM architecture; (3) a circuit design tool user's manual; and (4) design and analysis of efficient hierarchical interconnection networks.

  6. Bioreactors Addressing Diabetes Mellitus

    PubMed Central

    Minteer, Danielle M.; Gerlach, Jorg C.

    2014-01-01

    The concept of bioreactors in biochemical engineering is a well-established process; however, the idea of applying bioreactor technology to biomedical and tissue engineering issues is relatively novel and has been rapidly accepted as a culture model. Tissue engineers have developed and adapted various types of bioreactors in which to culture many different cell types and therapies addressing several diseases, including diabetes mellitus types 1 and 2. With a rising world of bioreactor development and an ever increasing diagnosis rate of diabetes, this review aims to highlight bioreactor history and emerging bioreactor technologies used for diabetes-related cell culture and therapies. PMID:25160666

  7. Simulating mesoscale coastal evolution for decadal coastal management: A new framework integrating multiple, complementary modelling approaches

    NASA Astrophysics Data System (ADS)

    van Maanen, Barend; Nicholls, Robert J.; French, Jon R.; Barkwith, Andrew; Bonaldo, Davide; Burningham, Helene; Brad Murray, A.; Payo, Andres; Sutherland, James; Thornhill, Gillian; Townend, Ian H.; van der Wegen, Mick; Walkden, Mike J. A.

    2016-03-01

    Coastal and shoreline management increasingly needs to consider morphological change occurring at decadal to centennial timescales, especially that related to climate change and sea-level rise. This requires the development of morphological models operating at a mesoscale, defined by time and length scales of the order 101 to 102 years and 101 to 102 km. So-called 'reduced complexity' models that represent critical processes at scales not much smaller than the primary scale of interest, and are regulated by capturing the critical feedbacks that govern landform behaviour, are proving effective as a means of exploring emergent coastal behaviour at a landscape scale. Such models tend to be computationally efficient and are thus easily applied within a probabilistic framework. At the same time, reductionist models, built upon a more detailed description of hydrodynamic and sediment transport processes, are capable of application at increasingly broad spatial and temporal scales. More qualitative modelling approaches are also emerging that can guide the development and deployment of quantitative models, and these can be supplemented by varied data-driven modelling approaches that can achieve new explanatory insights from observational datasets. Such disparate approaches have hitherto been pursued largely in isolation by mutually exclusive modelling communities. Brought together, they have the potential to facilitate a step change in our ability to simulate the evolution of coastal morphology at scales that are most relevant to managing erosion and flood risk. Here, we advocate and outline a new integrated modelling framework that deploys coupled mesoscale reduced complexity models, reductionist coastal area models, data-driven approaches, and qualitative conceptual models. Integration of these heterogeneous approaches gives rise to model compositions that can potentially resolve decadal- to centennial-scale behaviour of diverse coupled open coast, estuary and inner

  8. Reliability, validity and efficiency of multiple choice question and patient management problem item formats in assessment of clinical competence.

    PubMed

    Norcini, J J; Swanson, D B; Grosso, L J; Webster, G D

    1985-05-01

    Despite a lack of face validity, there continues to be heavy reliance on objective paper-and-pencil measures of clinical competence. Among these measures, the most common item formats are patient management problems (PMPs) and three types of multiple choice questions (MCQs): one-best-answer (A-types); matching questions (M-types); and multiple true/false questions (X-types). The purpose of this study is to compare the reliability, validity and efficiency of these item formats with particular focus on whether MCQs and PMPs measure different aspects of clinical competence. Analyses revealed reliabilities of 0.72 or better for all item formats; the MCQ formats were most reliable. Similarly, efficiency analyses (reliability per unit of testing time) demonstrated the superiority of MCQs. Evidence for validity obtained through correlations of both programme directors' ratings and criterion group membership with item format scores also favoured MCQs. More important, however, is whether MCQs and PMPs measure the same or different aspects of clinical competence. Regression analyses of the scores on the validity measures (programme directors' ratings and criterion group membership) indicated that MCQs and PMPs seem to be measuring predominantly the same thing. MCQs contribute a small unique variance component over and above PMPs, while PMPs make the smallest unique contribution. As a whole, these results indicate that MCQs are more efficient, reliable and valid than PMPs. PMID:4010571

  9. THC and CBD oromucosal spray (Sativex®) in the management of spasticity associated with multiple sclerosis.

    PubMed

    Sastre-Garriga, Jaume; Vila, Carlos; Clissold, Stephen; Montalban, Xavier

    2011-05-01

    People with multiple sclerosis may present with a wide range of disease symptoms during the evolution of the disease; among these, spasticity can have a marked impact on their well-being and quality of life. Symptom control, including spasticity, remains a key management strategy to improve the patient's well-being and functional status. However, available drug therapies for spasticity sometimes have limited benefit and they are often associated with poor tolerability. Sativex is a 1:1 mix of 9-delta-tetrahydrocannabinol and cannabidiol extracted from cloned Cannabis sativa chemovars, which is available as an oromucosal spray. Clinical experience with Sativex in patients with multiple sclerosis is accumulating steadily. Results from randomized, controlled trials have reported a reduction in the severity of symptoms associated with spasticity, leading to a better ability to perform daily activities and an improved perception of patients and their carers regarding functional status when Sativex was added to the current treatment regimen. Adverse events such as dizziness, diarrhea, fatigue, nausea, headache and somnolence occur quite frequently with Sativex, but they are generally of mild-to-moderate intensity and their incidence can be markedly reduced by gradual 'uptitration'. In summary, initial well-controlled studies with Sativex oromucosal spray administered as an add-on to usual therapy have produced promising results and highlight encouraging avenues for future research. PMID:21456949

  10. Multiple Carrying Capacities from a management-oriented perspective to operationalize sustainable tourism in protected areas.

    PubMed

    Salerno, Franco; Viviano, Gaetano; Manfredi, Emanuela C; Caroli, Paolo; Thakuri, Sudeep; Tartari, Gianni

    2013-10-15

    This article describes how the concept of Tourism Carrying Capacity (TCC) has shifted from a uni-dimensional approach to incorporating environmental, social and political aspects. This shift is demonstrated by a study of a large, internationally popular protected area used by trekkers, the Mt. Everest Region, where qualitative data collected from visitors was combined with environmental modeling using a participatory framework. Tourist satisfaction showed positive margins for further tourist industry expansion, but current environmental conditions limit growth and further development. Space and time dimensions were also considered. We observed that the limits on growth and further development can be manipulated, with a certain degree of flexibility, through investments and regulatory measures. We hypothesized that TCC can play an important role in the management of protected areas only if it is viewed as a systematic, strategic policy tool within a planning process rather than as a unique, intrinsic number that is not modifiable. We conclude that to translate the strategy into action using standard measures, further investigation is needed to balance the various TCC components as a part of a decision-making framework that includes the integration of different cultural approaches and policy needs. PMID:23728182

  11. Acceptance of spent nuclear fuel in multiple element sealed canisters by the Federal Waste Management System

    SciTech Connect

    Not Available

    1990-03-01

    This report is one of a series of eight prepared by E.R. Johnson Associates, Inc. (JAI) under ORNL's contract with DOE's OCRWM Systems Integration Program and in support of the Annual Capacity Report (ACR) Issue Resolution Process. The report topics relate specifically to the list of high priority technical waste acceptance issues developed jointly by DOE and a utility-working group. JAI performed various analyses and studies on each topic to serve as starting points for further discussion and analysis leading eventually to finalizing the process by which DOE will accept spent fuel and waste into its waste management system. The eight reports are concerned with the conditions under which spent fuel and high level waste will be accepted in the following categories: (1) failed fuel; (2) consolidated fuel and associated structural parts; (3) non-fuel-assembly hardware; (4) fuel in metal storage casks; (5) fuel in multi-element sealed canisters; (6) inspection and testing requirements for wastes; (7) canister criteria; (8) spent fuel selection for delivery; and (9) defense and commercial high-level waste packages. 14 refs., 27 figs.

  12. Supporting self-managed leisure engagement and communication in post-coma persons with multiple disabilities.

    PubMed

    Lancioni, Giulio E; Singh, Nirbhay N; O'Reilly, Mark F; Sigafoos, Jeff; Belardinelli, Marta Olivetti; Buonocunto, Francesca; D'Amico, Fiora; Navarro, Jorge; Lanzilotti, Crocifissa; Denitto, Floriana; De Tommaso, Marina; Megna, Marisa

    2015-03-01

    Post-coma persons affected by extensive motor impairment and lack of speech, with or without disorders of consciousness, need special support to manage leisure engagement and communication. These two studies extended research efforts aimed at assessing basic technology-aided programs to provide such support. Specifically, Study I assessed a program for promoting independent stimulation choice in four post-coma persons who combined motor and speech disabilities with disorders of consciousness (i.e., were rated between the minimally conscious state and the emergence from such state). Study II assessed a program for promoting independent television operation and basic communication in three post-coma participants who, contrary to those involved in Study I, did not have disorders of consciousness (i.e., had emerged from a minimally conscious state). The results of the studies were largely positive with substantial levels of independent stimulation choice and access for the participants of Study I and independent television operation and communication for the participants of Study II. The results were analyzed in relation to previous data in the area and in terms of their implications for daily contexts dealing with these persons. PMID:25546297

  13. Multiple attractors of host-parasitoid models with integrated pest management strategies: eradication, persistence and outbreak.

    PubMed

    Tang, Sanyi; Xiao, Yanni; Cheke, Robert A

    2008-03-01

    Host-parasitoid models including integrated pest management (IPM) interventions with impulsive effects at both fixed and unfixed times were analyzed with regard to host-eradication, host-parasitoid persistence and host-outbreak solutions. The host-eradication periodic solution with fixed moments is globally stable if the host's intrinsic growth rate is less than the summation of the mean host-killing rate and the mean parasitization rate during the impulsive period. Solutions for all three categories can coexist, with switch-like transitions among their attractors showing that varying dosages and frequencies of insecticide applications and the numbers of parasitoids released are crucial. Periodic solutions also exist for models with unfixed moments for which the maximum amplitude of the host is less than the economic threshold. The dosages and frequencies of IPM interventions for these solutions are much reduced in comparison with the pest-eradication periodic solution. Our results, which are robust to inclusion of stochastic effects and with a wide range of parameter values, confirm that IPM is more effective than any single control tactic. PMID:18215410

  14. Addressing Environmental Health Inequalities.

    PubMed

    Gouveia, Nelson

    2016-01-01

    Environmental health inequalities refer to health hazards disproportionately or unfairly distributed among the most vulnerable social groups, which are generally the most discriminated, poor populations and minorities affected by environmental risks. Although it has been known for a long time that health and disease are socially determined, only recently has this idea been incorporated into the conceptual and practical framework for the formulation of policies and strategies regarding health. In this Special Issue of the International Journal of Environmental Research and Public Health (IJERPH), "Addressing Environmental Health Inequalities-Proceedings from the ISEE Conference 2015", we incorporate nine papers that were presented at the 27th Conference of the International Society for Environmental Epidemiology (ISEE), held in Sao Paulo, Brazil, in 2015. This small collection of articles provides a brief overview of the different aspects of this topic. Addressing environmental health inequalities is important for the transformation of our reality and for changing the actual development model towards more just, democratic, and sustainable societies driven by another form of relationship between nature, economy, science, and politics. PMID:27618906

  15. Advances in the management of multiple sclerosis spasticity: experiences from recent studies and everyday clinical practice.

    PubMed

    Pozzilli, Carlo

    2013-12-01

    Although spasticity of varying severity affects up to 80% of patients with multiple sclerosis (MS) during the course of their disease, the symptom is often overlooked and undertreated. Despite the availability of oral antispasticity treatments (baclofen, tizanidine and others), approximately one-third of MS patients in Europe and the USA experience moderate or severe nonfocalized spasticity. At present, a thorough clinical evaluation of MS-related spasticity that takes into account the patient's own perception of spasms, spasticity-related pain and other associated symptoms is not common in daily neurological practice. Some of the usual spasticity scales, such as the Ashworth and modified Ashworth scales, reflect the observer's measurement of spasticity at a particular point in time. Herbal (smoked) cannabis has long been recognized as a possible option for relief of spasticity and neuropathic pain, but pertinent concerns about psychoactive effects and addiction risk have prevented its common use. An innovative method of benefiting from the mode of action of cannabinoids while limiting their drawbacks is to reduce peak plasma levels of 9-delta-tetrahydrocannabinol and counteract psychoactivity with higher than naturally occurring proportions of a second cannabinoid, cannabidiol. Sativex® oromucosal spray (1:1 ratio of 9-delta-tetrahydrocannabinol/cannabidiol) has recently been approved in a number of EU countries and elsewhere for use in patients with MS-related spasticity who are resistant to treatment with other antispasticity medications. In clinical trials, Sativex provided initial relief of spasticity symptoms within the first 4 weeks of treatment (trial period) in up to about half of patients resistant to other available oral antispasticity medications and demonstrated clinically significant improvement in spasticity (30% or higher reduction from baseline) in three-quarters of the initial responders. Adverse events were limited mainly to mild or moderate

  16. Content addressable memory project

    NASA Technical Reports Server (NTRS)

    Hall, Josh; Levy, Saul; Smith, D.; Wei, S.; Miyake, K.; Murdocca, M.

    1991-01-01

    The progress on the Rutgers CAM (Content Addressable Memory) Project is described. The overall design of the system is completed at the architectural level and described. The machine is composed of two kinds of cells: (1) the CAM cells which include both memory and processor, and support local processing within each cell; and (2) the tree cells, which have smaller instruction set, and provide global processing over the CAM cells. A parameterized design of the basic CAM cell is completed. Progress was made on the final specification of the CPS. The machine architecture was driven by the design of algorithms whose requirements are reflected in the resulted instruction set(s). A few of these algorithms are described.

  17. Bax: Addressed to kill.

    PubMed

    Renault, Thibaud T; Manon, Stéphen

    2011-09-01

    The pro-apoptototic protein Bax (Bcl-2 Associated protein X) plays a central role in the mitochondria-dependent apoptotic pathway. In healthy mammalian cells, Bax is essentially cytosolic and inactive. Following a death signal, the protein is translocated to the outer mitochondrial membrane, where it promotes a permeabilization that favors the release of different apoptogenic factors, such as cytochrome c. The regulation of Bax translocation is associated to conformational changes that are under the control of different factors. The evidences showing the involvement of different Bax domains in its mitochondrial localization are presented. The interactions between Bax and its different partners are described in relation to their ability to promote (or prevent) Bax conformational changes leading to mitochondrial addressing and to the acquisition of the capacity to permeabilize the outer mitochondrial membrane. PMID:21641962

  18. Multiple Sclerosis

    PubMed Central

    Hashimoto, S.A.; Jiwa, Theresa I.

    1991-01-01

    Successful management of patients with multiple sclerosis depends upon the involvement of the family physician. All contacts with either a multiple sclerosis clinic or a neurologist should be made at the instigation of the family practitioner. Constant contact with the family physician ensures that the individual receives proper care. While specialty care is needed for many of the symptoms, psychosocial problems are dealt with best by the individual's own family physician. PMID:21229090

  19. Long-term water quality and biological responses to multiple best management practices in Rock Creek, Idaho

    USGS Publications Warehouse

    Maret, T.R.; MacCoy, D.E.; Carlisle, D.M.

    2008-01-01

    Water quality and macroinvertebrate assemblage data from 1981 to 2005 were assessed to evaluate the water quality and biological responses of a western trout stream to the implementation of multiple best management practices (BMPs) on irrigated cropland. Data from Rock Creek near Twin Falls, Idaho, a long-term monitoring site, were assembled from state and federal sources to provide the evaluation. Seasonal loads of the nonpoint source pollutants suspended sediment (SS), total phosphorus (TP), and nitrate-nitrite (NN) were estimated using a regression model with time-series streamflow data and constituent concentrations. Trends in the macroinvertebrate assemblages were evaluated using a number of biological metrics and nonmetric multidimensional scaling ordination. Regression analysis found significant annual decreases in TP and SS flow-adjusted concentrations during the BMP implementation period from 1983 to 1990 of about 7 and 10%, respectively. These results are coincident with the implementation of multiple BMPs on about 75% of the irrigated cropland in the watershed. Macroinvertebrate assemblages during this time also responded with a change in taxa composition resulting in improved biotic index scores. Taxon specific TP and SS optima, empirically derived from a large national dataset, predicted a decrease in SS concentrations of about 37% (52 to 33 mg/l) and a decrease in TP concentrations of about 50% (0.20 to 0.10 mg/l) from 1981 to 1987. Decreasing trends in TP, SS, and NN pollutant loads were primarily the result of naturally low streamflow conditions during the BMP post-implementation period from 1993 to 2005. Trends in macroinvertebrate responses during 1993 to 2005 were confounded by the introduction of the New Zealand mudsnail (Potamopyrgus antipodarum), which approached densities of 100,000 per m 2 in riffle habitat. The occurrence of this invasive species appears to have caused a major shift in composition and function of the macroinvertebrate

  20. Development and Feasibility of an Evidence-Based Patient Education Program for Managing Fatigue in Multiple Sclerosis

    PubMed Central

    Feddersen, Lena Katharina; Lau, Stephanie; Köpke, Sascha; Moss-Morris, Rona; Heesen, Christoph; Pöttgen, Jana

    2016-01-01

    Background: Multiple sclerosis (MS) is an inflammatory and neurodegenerative disease of the central nervous system. Fatigue is a common and disabling symptom, often causing decreased quality of life, social withdrawal, and unemployment. We developed and studied the feasibility of a cognitive-behavioral group intervention to manage fatigue in MS. We aimed to integrate the concepts of cognitive-behavioral therapy and evidence-based patient information. Methods: We conducted patient interviews and a focus group to assess patients' interest in and need for fatigue self-management training and developed the program accordingly. The program consists of six 90-minute modules, which were structured with the use of moderation cards, helping to guarantee treatment fidelity. The program was tested on three pilot groups (N = 16) in a rehabilitation center. Fatigue, depression, and coping self-efficacy were assessed at baseline and after the intervention. Acceptance and general satisfaction with the program were also evaluated. Results: Patient interviews elicited different characteristics of fatigue, suggesting that patients had different requirements. The program was very acceptable to patients. Pre-post assessments of the pilot study showed significantly improved scores on the Coping Self-Efficacy Scale (P = .013) but not on the Fatigue Scale for Motor and Cognitive Functions and the 30-item Inventory of Depressive Symptomatology. Conclusions: These preliminary results suggest that this program is a feasible cognitive-behavioral group training program that may improve coping self-efficacy and has the potential to subsequently reduce fatigue. The next step is evaluation of the program in a randomized controlled trial. PMID:27252600

  1. The Health Action Process Approach as a Motivational Model of Dietary Self-Management for People with Multiple Sclerosis: A Path Analysis

    ERIC Educational Resources Information Center

    Chiu, Chung-Yi; Lynch, Ruth Torkelson; Chan, Fong; Rose, Lindsey

    2012-01-01

    The main objective of this study was to evaluate the health action process approach (HAPA) as a motivational model for dietary self-management for people with multiple sclerosis (MS). Quantitative descriptive research design using path analysis was used. Participants were 209 individuals with MS recruited from the National MS Society and a…

  2. The Part-Time Student Role: Implications for the Emotional Experience of Managing Multiple Roles amongst Hong Kong Public Health Nurses.

    ERIC Educational Resources Information Center

    Shiu, Ann Tak-Ying

    1999-01-01

    Nine public-health nurses studying part time and 11 other nurses sampled their mood states randomly over seven days. The part-time student role created additional strain for nurses with children. The stress of managing multiple roles was greatest when both work and nonwork role responsibilities were heavy. (SK)

  3. Addressing the municipal market

    SciTech Connect

    Mullin, R.

    1993-05-12

    Most municipalities employ simple, fairly inexpensive water treatment regimes, which is why some large industrial treatment firms stay away from the municipal market, despite rapid growth in the sector. Of the $625 million/year spent for US wastewater treatment, 46% is for municipalities, up 14.5% from 1987. Waste treatment in general grew by 12% in that period, according to Kline Co. (Fairfield, NJ). Some of the challenges facing municipalities in the Clean Water Act reauthorization bills are metals-contaminated sediments and storm water containment and treatment. Bill Tullos, business manager for chlor-alkali at Elf Atochem North America, does not foresee a phaseout of chlorine-based products used as disinfectant in drinking water treatment by municipalities, or as a wastewater treatment in municipal and industrial use. [open quotes]Alternatives are not as effective and are more expensive,[close quotes] says Tullos. [open quotes]There was some promise with ozone, but unfortunately it tends to tear apart your corrosion and scale inhibitors. Chlorine also provides residual protection from contamination all along the water line system.[close quotes] Tullos adds that the formation of tetrahydromethane-one of the problems of using chlorine-based products-can be avoided by screening out the hydrocarbons first and then adding chlorine.

  4. International Myeloma Working Group guidelines for the management of multiple myeloma patients ineligible for standard high-dose chemotherapy with autologous stem cell transplantation.

    PubMed

    Palumbo, A; Sezer, O; Kyle, R; Miguel, J S; Orlowski, R Z; Moreau, P; Niesvizky, R; Morgan, G; Comenzo, R; Sonneveld, P; Kumar, S; Hajek, R; Giralt, S; Bringhen, S; Anderson, K C; Richardson, P G; Cavo, M; Davies, F; Bladé, J; Einsele, H; Dimopoulos, M A; Spencer, A; Dispenzieri, A; Reiman, T; Shimizu, K; Lee, J H; Attal, M; Boccadoro, M; Mateos, M; Chen, W; Ludwig, H; Joshua, D; Chim, J; Hungria, V; Turesson, I; Durie, B G M; Lonial, S

    2009-10-01

    In 2005, the first guidelines were published on the management of patients with multiple myeloma (MM). An expert panel reviewed the currently available literature as the basis for a set of revised and updated consensus guidelines for the diagnosis and management of patients with MM who are not eligible for autologous stem cell transplantation. Here we present recommendations on the diagnosis, treatment of newly diagnosed non-transplant-eligible patients and the management of complications occurring during induction therapy among these patients. These guidelines will aid the physician in daily clinical practice and will ensure optimal care for patients with MM. PMID:19494840

  5. A formative evaluation of customized pamphlets to promote physical activity and symptom self-management in women with multiple sclerosis.

    PubMed

    Plow, Matthew; Bethoux, Francois; Mai, Kimloan; Marcus, Bess

    2014-10-01

    Inactivity is a prevalent problem in the population affected with multiple sclerosis (MS). Thus, there is a need to develop and test physical activity (PA) interventions that can be widely disseminated. We conducted a formative evaluation as part of a randomized controlled trial of a pamphlet-based PA intervention among 30 women with MS. Pamphlets were customized to sub-sets of participants who shared similar symptoms and barriers to PA. Mixed methods were used to examine the intervention's influence on self-efficacy, social support, processes of change and stages of change placement, as well as explore participants' perceived barriers, motivators and strategies for engaging in a PA program. Results indicated that the intervention group significantly improved stages of change placement (F = 16.64, P < 0.01) and social support (F = 4.08, P = 0.05) in comparison to the control group. Fatigue, pain and lack of time were the commonly cited barriers to engage in the PA program; whereas the pamphlets, phone calls and action planning were cited as motivators. Participants used fatigue management strategies, enlisted social support and modified their environment to routinely engage in the PA program. Strategies were identified to improve the PA intervention in future research. PMID:24989822

  6. A formative evaluation of customized pamphlets to promote physical activity and symptom self-management in women with multiple sclerosis

    PubMed Central

    Plow, Matthew; Bethoux, Francois; Mai, Kimloan; Marcus, Bess

    2014-01-01

    Inactivity is a prevalent problem in the population affected with multiple sclerosis (MS). Thus, there is a need to develop and test physical activity (PA) interventions that can be widely disseminated. We conducted a formative evaluation as part of a randomized controlled trial of a pamphlet-based PA intervention among 30 women with MS. Pamphlets were customized to sub-sets of participants who shared similar symptoms and barriers to PA. Mixed methods were used to examine the intervention’s influence on self-efficacy, social support, processes of change and stages of change placement, as well as explore participants’ perceived barriers, motivators and strategies for engaging in a PA program. Results indicated that the intervention group significantly improved stages of change placement (F = 16.64, P < 0.01) and social support (F = 4.08, P = 0.05) in comparison to the control group. Fatigue, pain and lack of time were the commonly cited barriers to engage in the PA program; whereas the pamphlets, phone calls and action planning were cited as motivators. Participants used fatigue management strategies, enlisted social support and modified their environment to routinely engage in the PA program. Strategies were identified to improve the PA intervention in future research. PMID:24989822

  7. Post Pregnancy Severe Spinal Osteoporosis with Multiple Vertebral Fractures and Kyphoscoliosis in a Multigravida: A Rare Case with Management

    PubMed Central

    Hadgaonkar, Shailesh; Bhatt, Hrutvij; Shyam, Ashok; Sancheti, Parag

    2015-01-01

    Osteoporosis associated with pregnancy and lactation is a less commonly known condition and often overlooked. The prevalence, exact aetiology and its pathogenesis are unknown. It is commonly seen in first three months after delivery in primigravida. It is often undiagnosed because of it not suspected n and X-rays and densitometry are avoided if possible during pregnancy and lactation. If missed, it can lead to osteoporotic fractures and disability. In this paper, we report a case of a 24-year-old multigravida 4 months after pregnancy with multiple vertebral compression fractures and kyphoscoliosis. Her metabolic workup was normal but bone densitometry revealed severe osteoporosis of the dorso-lumbar spine. Immediate weaning and antiresorptives like bisphosphonates and teriparatide are used as first line drugs to manage postpartum spinal osteoporosis. Our patient presented at 4 month lactation and did not want to wean her infant, so she was treated with total contact orthosis and took vitamin D and calcium. The pain was relieved within 3 months but there was no improvement in bone density. After eight months when the infant was weaned, she was treated with teriparatide. After one year of teriparatide therapy, there were no new fractures and densitometry scores improved. PMID:26240726

  8. Design of Experiments with Multiple Independent Variables: A Resource Management Perspective on Complete and Reduced Factorial Designs

    PubMed Central

    Collins, Linda M.; Dziak, John J.; Li, Runze

    2009-01-01

    An investigator who plans to conduct experiments with multiple independent variables must decide whether to use a complete or reduced factorial design. This article advocates a resource management perspective on making this decision, in which the investigator seeks a strategic balance between service to scientific objectives and economy. Considerations in making design decisions include whether research questions are framed as main effects or simple effects; whether and which effects are aliased (confounded) in a particular design; the number of experimental conditions that must be implemented in a particular design and the number of experimental subjects the design requires to maintain the desired level of statistical power; and the costs associated with implementing experimental conditions and obtaining experimental subjects. In this article four design options are compared: complete factorial, individual experiments, single factor, and fractional factorial designs. Complete and fractional factorial designs and single factor designs are generally more economical than conducting individual experiments on each factor. Although relatively unfamiliar to behavioral scientists, fractional factorial designs merit serious consideration because of their economy and versatility. PMID:19719358

  9. Optimizing therapeutics in the management of patients with multiple sclerosis: a review of drug efficacy, dosing, and mechanisms of action

    PubMed Central

    Damal, Kavitha; Stoker, Emily; Foley, John F

    2013-01-01

    Multiple sclerosis (MS) is a debilitating neurological disorder that affects nearly 2 million adults, mostly in the prime of their youth. An environmental trigger, such as a viral infection, is hypothesized to initiate the abnormal behavior of host immune cells: to attack and damage the myelin sheath surrounding the neurons of the central nervous system. While several other pathways and disease triggers are still being investigated, it is nonetheless clear that MS is a heterogeneous disease with multifactorial etiologies that works independently or synergistically to initiate the aberrant immune responses to myelin. Although there are still no definitive markers to diagnose the disease or to cure the disease per se, research on management of MS has improved many fold over the past decade. New disease-modifying therapeutics are poised to decrease immune inflammatory responses and consequently decelerate the progression of MS disease activity, reduce the exacerbations of MS symptoms, and stabilize the physical and mental status of individuals. In this review, we describe the mechanism of action, optimal dosing, drug administration, safety, and efficacy of the disease-modifying therapeutics that are currently approved for MS therapy. We also briefly touch upon the new drugs currently under investigation, and discuss the future of MS therapeutics. PMID:24324326

  10. Addressing neurological disorders with neuromodulation.

    PubMed

    Oluigbo, Chima O; Rezai, Ali R

    2011-07-01

    Neurological disorders are becoming increasingly common in developed countries as a result of the aging population. In spite of medications, these disorders can result in progressive loss of function as well as chronic physical, cognitive, and emotional disability that ultimately places enormous emotional and economic on the patient, caretakers, and the society in general. Neuromodulation is emerging as a therapeutic option in these patients. Neuromodulation is a field, which involves implantable devices that allow for the reversible adjustable application of electrical, chemical, or biological agents to the central or peripheral nervous system with the objective of altering its functioning with the objective of achieving a therapeutic or clinically beneficial effect. It is a rapidly evolving field that brings together many different specialties in the fields of medicine, materials science, computer science and technology, biomedical, and neural engineering as well as the surgical or interventional specialties. It has multiple current and emerging indications, and an enormous potential for growth. The main challenges before it are in the need for effective collaboration between engineers, basic scientists, and clinicians to develop innovations that address specific problems resulting in new devices and clinical applications. PMID:21193369

  11. 41 CFR 101-26.203 - Activity address codes.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 41 Public Contracts and Property Management 2 2010-07-01 2010-07-01 true Activity address codes... PROGRAM 26.2-Federal Requisitioning System § 101-26.203 Activity address codes. To obtain items through the FEDSTRIP system, each ordering activity is required to have an activity address code. The...

  12. 41 CFR 105-53.120 - Address and telephone numbers.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... numbers. 105-53.120 Section 105-53.120 Public Contracts and Property Management Federal Property... FUNCTIONS General § 105-53.120 Address and telephone numbers. The Office of the Administrator; Office of..., however, the mailing address is Washington, DC 20406. The telephone number for the above addresses is...

  13. 41 CFR 105-53.120 - Address and telephone numbers.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... numbers. 105-53.120 Section 105-53.120 Public Contracts and Property Management Federal Property... FUNCTIONS General § 105-53.120 Address and telephone numbers. The Office of the Administrator; Office of..., however, the mailing address is Washington, DC 20406. The telephone number for the above addresses is...

  14. National Multiple Sclerosis Society

    MedlinePlus

    Home - National Multiple Sclerosis Society Skip to navigation Skip to content Menu Navigation National Multiple Sclerosis Society Sign In In Your Area ... DIAGNOSED IN 2009 You Can Live Well with MS A healthy diet, regular exercise, stress management and ...

  15. 2014 ASHG Awards and Addresses

    PubMed Central

    2015-01-01

    Each year at the annual meeting of The American Society of Human Genetics (ASHG), addresses are given in honor of The Society and a number of award winners. A summary of each of these addresses is given below. On the following pages, we have printed the presidential address and the addresses for the William Allan Award, the Curt Stern Award, and the Victor A. McKusick Leadership Award. Webcasts of these addresses, as well as those of many other presentations, can be found at http://www.ashg.org.

  16. 2013 ASHG Awards and Addresses

    PubMed Central

    2014-01-01

    Each year at the annual meeting of The American Society of Human Genetics (ASHG), addresses are given in honor of The Society and a number of award winners. A summary of each of these addresses is given below. On the following pages, we have printed the Presidential Address and the addresses for the William Allan Award, the Curt Stern Award, and the Victor A. McKusick Leadership Award. Webcasts of these addresses, as well as those of many other presentations, can be found at http://www.ashg.org.

  17. Addressing Risks to Advance Mental Health Research

    PubMed Central

    Iltis, Ana S.; Misra, Sahana; Dunn, Laura B.; Brown, Gregory K.; Campbell, Amy; Earll, Sarah A.; Glowinski, Anne; Hadley, Whitney B.; Pies, Ronald; DuBois, James M.

    2015-01-01

    Objective Risk communication and management are essential to the ethical conduct of research, yet addressing risks may be time consuming for investigators and institutional review boards (IRBs) may reject study designs that appear too risky. This can discourage needed research, particularly in higher risk protocols or those enrolling potentially vulnerable individuals, such as those with some level of suicidality. Improved mechanisms for addressing research risks may facilitate much needed psychiatric research. This article provides mental health researchers with practical approaches to: 1) identify and define various intrinsic research risks; 2) communicate these risks to others (e.g., potential participants, regulatory bodies, society); 3) manage these risks during the course of a study; and 4) justify the risks. Methods As part of a National Institute of Mental Health (NIMH)-funded scientific meeting series, a public conference and a closed-session expert panel meeting were held on managing and disclosing risks in mental health clinical trials. The expert panel reviewed the literature with a focus on empirical studies and developed recommendations for best practices and further research on managing and disclosing risks in mental health clinical trials. IRB review was not required because there were no human subjects. The NIMH played no role in developing or reviewing the manuscript. Results Challenges, current data, practical strategies, and topics for future research are addressed for each of four key areas pertaining to management and disclosure of risks in clinical trials: identifying and defining risks, communicating risks, managing risks during studies, and justifying research risks. Conclusions Empirical data on risk communication, managing risks, and the benefits of research can support the ethical conduct of mental health research and may help investigators better conceptualize and confront risks and to gain IRB approval. PMID:24173618

  18. The Invisible Work of Personal Health Information Management Among People With Multiple Chronic Conditions: Qualitative Interview Study Among Patients and Providers

    PubMed Central

    Witteman, Holly O; Hafeez, Baria; Provencher, Thierry; Van de Graaf, Mary; Wei, Esther

    2015-01-01

    Background A critical problem for patients with chronic conditions who see multiple health care providers is incomplete or inaccurate information, which can contribute to lack of care coordination, low quality of care, and medical errors. Objective As part of a larger project on applications of consumer health information technology (HIT) and barriers to its use, we conducted a semistructured interview study with patients with multiple chronic conditions (MCC) with the objective of exploring their role in managing their personal health information. Methods Semistructured interviews were conducted with patients and providers. Patients were eligible if they had multiple chronic conditions and were in regular care with one of two medical organizations in New York City; health care providers were eligible if they had experience caring for patients with multiple chronic conditions. Analysis was conducted from a grounded theory perspective, and recruitment was concluded when saturation was achieved. Results A total of 22 patients and 7 providers were interviewed; patients had an average of 3.5 (SD 1.5) chronic conditions and reported having regular relationships with an average of 5 providers. Four major themes arose: (1) Responsibility for managing medical information: some patients perceived information management and sharing as the responsibility of health care providers; others—particularly those who had had bad experiences in the past—took primary responsibility for information sharing; (2) What information should be shared: although privacy concerns did influence some patients’ perceptions of sharing of medical data, decisions about what to share were also heavily influenced by their understanding of health and disease and by the degree to which they understood the health care system; (3) Methods and tools varied: those patients who did take an active role in managing their records used a variety of electronic tools, paper tools, and memory; and (4

  19. Continuous insulin therapy versus multiple insulin injections in the management of type 1 diabetes: a longitutinal study

    PubMed Central

    Ribeiro, Maria Estela Bellini; Liberatore, Raphael Del Roio; Custodio, Rodrigo; Martinelli, Carlos Eduardo

    2016-01-01

    Abstract Objective: To compare multiple doses of insulin and continuous insulin infusion therapy as treatment for type 1 diabetes mellitus. Methods: 40 patients with type 1 diabetes mellitus (21 female) with ages between 10 and 20 years (mean=14.2) and mean duration of diabetes of 7 years used multiple doses of insulin for at least 6 months and after that, continuous insulin infusion therapy for at least 6 months. Each one of the patients has used multiple doses of insulin and continuous insulin infusion therapy. For analysis of HbA1c, mean glycated hemoglobin levels (mHbA1c) were obtained during each treatment period (multiple doses of insulin and continuous insulin infusion therapy period). Results: Although mHbA1c levels were lower during continuous insulin infusion therapy the difference was not statistically significant. During multiple doses of insulin, 14.2% had mHbA1c values below 7.5% vs. 35.71% while on continuous insulin infusion therapy; demonstrating better glycemic control with the use of continuous insulin infusion therapy. During multiple doses of insulin, 15–40 patients have severe hypoglycemic events versus 5–40 continuous insulin infusion therapy. No episodes of ketoacidosis events were recorded. Conclusions: This is the first study with this design comparing multiple doses of insulin and continuous insulin infusion therapy in Brazil showing no significant difference in HbA1c; hypoglycemic events were less frequent during continuous insulin infusion therapy than during multiple doses of insulin and the percentage of patients who achieved a HbA1c less than 7.5% was greater during continuous insulin infusion therapy than multiple doses of insulin therapy. PMID:26826879

  20. Management of Side Effects of Novel Therapies for Multiple Myeloma: Consensus Statements Developed by the International Myeloma Foundation’s Nurse Leadership Board

    PubMed Central

    Bertolotti, Page; Bilotti, Elizabeth; Colson, Kathleen; Curran, Kathleen; Doss, Deborah; Faiman, Beth; Gavino, Maria; Jenkins, Bonnie; Lilleby, Kathy; Love, Ginger; Mangan, Patricia A.; McCullagh, Emily; Miceli, Teresa; Miller, Kena; Rogers, Kathryn; Rome, Sandra; Sandifer, Stacey; Smith, Lisa C.; Tariman, Joseph D.; Westphal, Jeanne

    2014-01-01

    Nurses play an essential role in managing the care of patients with multiple myeloma, who require education and support to receive and adhere to optimal therapy. The International Myeloma Foundation created a Nurse Leadership Board comprised of oncology nurses from leading cancer centers and community practices. An assessment survey identified the need for specific recommendations for managing key side effects of novel antimyeloma agents. Myelosuppression, thromboembolic events, peripheral neuropathy, steroid toxicities, and gastrointestinal side effects were selected for the first consensus statements. The board developed recommendations for healthcare providers in any medical setting, including grading of side-effect toxicity and strategies for managing the side effects in general, with specific recommendations pertaining to the novel agents. PMID:18490252

  1. 41 CFR 105-53.120 - Address and telephone numbers.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 41 Public Contracts and Property Management 3 2013-07-01 2013-07-01 false Address and telephone numbers. 105-53.120 Section 105-53.120 Public Contracts and Property Management Federal Property Management Regulations System (Continued) GENERAL SERVICES ADMINISTRATION 53-STATEMENT OF ORGANIZATION...

  2. 41 CFR 105-53.120 - Address and telephone numbers.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 41 Public Contracts and Property Management 3 2014-01-01 2014-01-01 false Address and telephone numbers. 105-53.120 Section 105-53.120 Public Contracts and Property Management Federal Property Management Regulations System (Continued) GENERAL SERVICES ADMINISTRATION 53-STATEMENT OF ORGANIZATION...

  3. The interactive web-based program MSmonitor for self-management and multidisciplinary care in multiple sclerosis: utilization and valuation by patients

    PubMed Central

    Jongen, Peter Joseph; Sinnige, Ludovicus G; van Geel, Björn M; Verheul, Freek; Verhagen, Wim I; van der Kruijk, Ruud A; Haverkamp, Reinoud; Schrijver, Hans M; Baart, Jacoba C; Visser, Leo H; Arnoldus, Edo P; Gilhuis, Herman Jacobus; Pop, Paul; Booy, Monique; Heerings, Marco; Kool, Anton; van Noort, Esther

    2016-01-01

    Background MSmonitor is an interactive web-based program for self-management and integrated, multidisciplinary care in multiple sclerosis. Methods To assess the utilization and valuation by persons with multiple sclerosis, we held an online survey among those who had used the program for at least 1 year. We evaluated the utilization and meaningfulness of the program’s elements, perceived use of data by neurologists and nurses, and appreciation of care, self-management, and satisfaction. Results Fifty-five persons completed the questionnaire (estimated response rate 40%). The Multiple Sclerosis Impact Profile (MSIP), Medication and Adherence Inventory, Activities Diary, and electronic consultation (e-consult) were used by 40%, 55%, 47%, and 44% of respondents and were considered meaningful by 83%, 81%, 54%, and 88%, respectively. During out-patient consultations, nurses reportedly used the MSmonitor data three to six times more frequently than neurologists. As to nursing care, more symptoms were dealt with (according to 54% of respondents), symptoms were better discussed (69%), and the overall quality of care had improved (60%) since the use of the program. As to neurological care, these figures were 24%, 31%, and 27%, respectively. In 46% of the respondents, the insight into their symptoms and disabilities had increased since the use of the program; the MSIP, Activities Diary, and e-consult had contributed most to this improvement. The overall satisfaction with the program was 3.5 out of 5, and 73% of the respondents would recommend the program to other persons with multiple sclerosis. Conclusion A survey among persons with multiple sclerosis using the MSmonitor program showed that the MSIP, Medication and Adherence Inventory, Activities Diary, and e-consult were frequently used and that the MSIP, Medication and Adherence Inventory, and e-consult were appreciated the most. Moreover, the quality of nursing care, but not so neurological care, had improved, which

  4. Use of Multiple Methodologies for Developing a Customer-Oriented Model of Total Quality Management in Higher Education

    ERIC Educational Resources Information Center

    Sahney, Sangeeta

    2016-01-01

    Purpose: Educational institutes must embrace the principles of total quality management (TQM) if they seek to remain competitive, and survive and succeed in the long run. An educational institution must embrace the principles of quality management and incorporate them into all of their activities. Starting with a theoretical background, the paper…

  5. The interactive web-based program MSmonitor for self-management and multidisciplinary care in multiple sclerosis: concept, content, and pilot results

    PubMed Central

    Jongen, Peter Joseph; Sinnige, Ludovicus G; van Geel, Björn M; Verheul, Freek; Verhagen, Wim I; van der Kruijk, Ruud A; Haverkamp, Reinoud; Schrijver, Hans M; Baart, J Coby; Visser, Leo H; Arnoldus, Edo P; Gilhuis, H Jacobus; Pop, Paul; Booy, Monique; Lemmens, Wim; Donders, Rogier; Kool, Anton; van Noort, Esther

    2015-01-01

    Background There is a growing need to offer persons with multiple sclerosis (PwMS) possibilities for self-management and to integrate multidisciplinary health data. In 2009–2014 we developed a patient-reported outcome based, interactive, web-based program (MSmonitor) for (self-)monitoring, self-management and integrated, multidisciplinary care in MS. Methods The notions underlying the MSmonitor concept and the program’s elements are described. We analyze MSmonitor’s role in the self-management of fatigue by retrospective comparison of fatigue and health-related quality of life (HRQoL) before and after usage of specific elements of MSmonitor, and by a correlative analysis between frequency of usage and fatigue change. Results After a step-wise development the program comprises six validated questionnaires: Multiple Sclerosis Impact Profile, Modified Fatigue Impact Scale-5 items (MFIS-5), Hospital Anxiety and Depression Scale, Multiple Sclerosis Quality of Life-54 items, and the 8-item Leeds Multiple Sclerosis Quality of Life (LMSQoL) questionnaires; two inventories: Medication and Adherence Inventory, Miction Inventory; two diaries: Activities Diary, Miction Diary; and two functionalities: e-consult and personal e-logbook. The program is now used in 17 hospitals by 581 PwMS and their neurologists, MS nurses, physical therapists, rehabilitative doctors, continence nurses, and family doctors. Those PwMS (N=105) who used the LMSQoL and MFIS-5 questionnaires at least twice in a period of up to 6 months, showed improved HRQoL (P<0.026). In the subgroup (N=56) who had also used the Activities Diary twice or more, the frequency of diary usage correlated modestly with the degree of fatigue improvement (r=0.292; P=0.028). Conclusion MSmonitor is an interactive web-based program for self-management and integrated care in PwMS. Pilot data suggest that the repeated use of the short MFIS-5 and LMSQoL questionnaires is associated with an increase in HRQoL, and that a

  6. Name-Based Address Mapping for Virtual Private Networks

    NASA Astrophysics Data System (ADS)

    Surányi, Péter; Shinjo, Yasushi; Kato, Kazuhiko

    IPv4 private addresses are commonly used in local area networks (LANs). With the increasing popularity of virtual private networks (VPNs), it has become common that a user connects to multiple LANs at the same time. However, private address ranges for LANs frequently overlap. In such cases, existing systems do not allow the user to access the resources on all LANs at the same time. In this paper, we propose name-based address mapping for VPNs, a novel method that allows connecting to hosts through multiple VPNs at the same time, even when the address ranges of the VPNs overlap. In name-based address mapping, rather than using the IP addresses used on the LANs (the real addresses), we assign a unique virtual address to each remote host based on its domain name. The local host uses the virtual addresses to communicate with remote hosts. We have implemented name-based address mapping for layer 3 OpenVPN connections on Linux and measured its performance. The communication overhead of our system is less than 1.5% for throughput and less than 0.2ms for each name resolution.

  7. Chemical Priming of Plants Against Multiple Abiotic Stresses: Mission Possible?

    PubMed

    Savvides, Andreas; Ali, Shawkat; Tester, Mark; Fotopoulos, Vasileios

    2016-04-01

    Crop plants are subjected to multiple abiotic stresses during their lifespan that greatly reduce productivity and threaten global food security. Recent research suggests that plants can be primed by chemical compounds to better tolerate different abiotic stresses. Chemical priming is a promising field in plant stress physiology and crop stress management. We review here promising chemical agents such as sodium nitroprusside, hydrogen peroxide, sodium hydrosulfide, melatonin, and polyamines that can potentially confer enhanced tolerance when plants are exposed to multiple abiotic stresses. The challenges and opportunities of chemical priming are addressed, with the aim to boost future research towards effective application in crop stress management. PMID:26704665

  8. A Formative Evaluation of Customized Pamphlets to Promote Physical Activity and Symptom Self-Management in Women with Multiple Sclerosis

    ERIC Educational Resources Information Center

    Plow, Matthew; Bethoux, Francois; Mai, Kimloan; Marcus, Bess

    2014-01-01

    Inactivity is a prevalent problem in the population affected with multiple sclerosis (MS). Thus, there is a need to develop and test physical activity (PA) interventions that can be widely disseminated. We conducted a formative evaluation as part of a randomized controlled trial of a pamphlet-based PA intervention among 30 women with MS. Pamphlets…

  9. Managing Teacher Leave and Absence in South African Rural Schools: Implications for Supporting Schools in Contexts of Multiple-Deprivation

    ERIC Educational Resources Information Center

    Moletsane, Relebohile; Juan, Andrea; Prinsloo, Cas; Reddy, Vijay

    2015-01-01

    Research increasingly points to the negative impacts of teacher absence from school on access to schooling and success in learning in schools, in particular in schools in areas of multiple-deprivation (including rural schools). South African schools are no exception. In this regard, like any other employer, the South African Department of Basic…

  10. Multiple Myeloma Symptoms

    MedlinePlus

    ... it is multiple myeloma . Stay on top of discoveries, trials, research and more. Click here to sign up for the MMRF Newsletter First name Last name E-mail address CLOSE News & Press Multiple Myeloma Knowledge Center Privacy Policy Donor Privacy Policy Terms of ...

  11. Multiple muscle tear after fall on buttock-role of conservative management and exercise for early recovery and return to play

    PubMed Central

    Adhau, Rajesh; Angrish, Piyush; Ahuja, Ashok; Sandhu, Avtar Singh

    2014-01-01

    Summary Background: to describe role of alternative management as an approach to management and rehabilitation of multiple hip muscles tears by the use of 1 RM (Repetition Maximum) testing and hip muscle strengthening program along with the use of sports specific drills for rehabilitation and recovery. There is very limited literature describing multiple hip muscle tears and the conservative management of the same. 1RM testing and strengthening of hip muscles is an approach that is able to help in the return to sports of an athlete without surgical intervention. Methods: the patient, is a 21-year-old male hockey player who presented with pain right buttock, right lower leg and a limp on the right side while walking. Physical examination revealed a positive Trendelenburg sign both in stance and gait phase. Hip rotational movements showed a normal range of motion, there was a severe pain in the right buttock on movements which he described at 8/10 on VAS (Visual Analogue Scale). Strength assessment revealed weakness of the right hip flexors and extensors and also of the abductor and external hip rotator muscles. Treatment protocol followed was based on 1 RM testing of muscles and hip strengthening exercises and sports specific drills. Results: following the intervention, the patient reported pain at 0/10 VAS while doing all activities and also showed good muscle control with no limp. Conclusions: this highlights an alternative protocol for treating multiple hip muscle tears and illustrates the importance of 1 RM testing as a part of examination and sports medicine intervention. PMID:25332927

  12. Forest management and economics

    SciTech Connect

    Buongiorno, J.; Gilless, J.K.

    1987-01-01

    This volume provides a survey of quantitative methods, guiding the reader through formulation and analysis of models that address forest management problems. The authors use simple mathematics, graphics, and short computer programs to explain each method. Emphasizing applications, they discuss linear, integer, dynamic, and goal programming; simulation; network modeling; and econometrics, as these relate to problems of determining economic harvest schedules in even-aged and uneven-aged forests, the evaluation of forest policies, multiple-objective decision making, and more.

  13. 27 CFR 478.52 - Change of address.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 3 2013-04-01 2013-04-01 false Change of address. 478.52....52 Change of address. (a) Licensees may during the term of their current license remove their... for denial in accordance with § 478.71. (Approved by the Office of Management and Budget under...

  14. 27 CFR 478.52 - Change of address.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 3 2014-04-01 2014-04-01 false Change of address. 478.52....52 Change of address. (a) Licensees may during the term of their current license remove their... for denial in accordance with § 478.71. (Approved by the Office of Management and Budget under...

  15. 27 CFR 478.52 - Change of address.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 3 2010-04-01 2010-04-01 false Change of address. 478.52....52 Change of address. (a) Licensees may during the term of their current license remove their... for denial in accordance with § 478.71. (Approved by the Office of Management and Budget under...

  16. 41 CFR 109-26.203 - Activity address codes.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false Activity address codes...-PROCUREMENT SOURCES AND PROGRAM 26.2-Federal Requisitioning System § 109-26.203 Activity address codes. (a) DOE field organizations designated by OCMA are responsible for processing routine activity...

  17. The multiple market-exposure of waste management companies: A case study of two Swedish municipally owned companies

    SciTech Connect

    Corvellec, Herve; Bramryd, Torleif

    2012-09-15

    Highlights: Black-Right-Pointing-Pointer Swedish municipally owned waste management companies are active on political, material, technical, and commercial markets. Black-Right-Pointing-Pointer These markets differ in kind and their demands follow different logics. Black-Right-Pointing-Pointer These markets affect the public service, processing, and marketing of Swedish waste management. Black-Right-Pointing-Pointer Articulating these markets is a strategic challenge for Swedish municipally owned waste management. - Abstract: This paper describes how the business model of two leading Swedish municipally owned solid waste management companies exposes them to four different but related markets: a political market in which their legitimacy as an organization is determined; a waste-as-material market that determines their access to waste as a process input; a technical market in which these companies choose what waste processing technique to use; and a commercial market in which they market their products. Each of these markets has a logic of its own. Managing these logics and articulating the interrelationships between these markets is a key strategic challenge for these companies.

  18. Motivation and drives in bottom-up developments in natural hazards management: multiple-use of adaptation strategies in Austria

    NASA Astrophysics Data System (ADS)

    Thaler, Thomas; Fuchs, Sven

    2015-04-01

    Losses from extreme hydrological events, such as recently experienced in Europe have focused the attention of policymakers as well as researchers on vulnerability to natural hazards. In parallel, the context of changing flood risks under climate and societal change is driving transformation in the role of the state in responsibility sharing and individual responsibilities for risk management and precaution. The new policy agenda enhances the responsibilities of local authorities and private citizens in hazard management and reduces the role of central governments. Within the objective is to place added responsibility on local organisations and citizens to determine locally-based strategies for risk reduction. A major challenge of modelling adaptation is to represent the complexity of coupled human-environmental systems and particularly the feedback loops between environmental dynamics and human decision-making processes on different scales. This paper focuses on bottom-up initiatives to flood risk management which are, by definition, different from the mainstream. These initiatives are clearly influenced (positively or negatively) by a number of factors, where the combination of these interdependences can create specific conditions that alter the opportunity for effective governance arrangements in a local scheme approach. In total, this study identified six general drivers which encourage the implementation of flood storages, such as direct relation to recent major flood frequency and history, the initiative of individual stakeholders (promoters), political pressures from outside (e.g. business companies, private households) and a strong solidarity attitude of municipalities and the stakeholders involved. Although partnership approach may be seen as an 'optimal' solution for flood risk management, in practice there are many limitations and barriers in establishing these collaborations and making them effective (especially in the long term) with the consequences

  19. Successful multiple-step management of intravenous leiomyomatosis diagnosed after episode of acute abdominal pain: Case report and review of literature

    PubMed Central

    Efthimiadis, Christoforos; Petousis, Stamatios; Grigoriou, Marios; Ioannidis, Aristeidis; Tzouveleki, Ioanna; Margioula-Siarkou, Chrysoula; Kalogiannidis, Ioannis

    2015-01-01

    Introduction We present the case of a 37-year old woman diagnosed with intravenous leiomyomatosis (IVL) that was managed uneventfully with multiple-step management. Presentation of case A 37-year-old woman was admitted because of acute abdominal pain. Emergency Computed Tomography demonstrated a big pelvic mass 5 × 15 cm of heterogenous composition intaking the contrast agent. Total hysterectomy with salpingoophorectomy was proposed to patient, however, patient expressed her will for fertility preservation and gave consent only for the resection of a single ovary. Laparotomy revealed the presence of myoma, multiple lesions of potential adenomyosis and cordon-shaped formations arising from uterus and extending mainly to left ovary. Final histological diagnosis was intravenous leiomyomatosis (IVL). MRI angiography revealed the presence of residual lesions in inferior vena cava. Laparoscopic resection was performed one month after laparotomy and left ovary was resected without complications. Venovenous bypass was finally performed three months later from initial surgery. The process was significantly labored, resulted in the successful resection of intravenous lesions but was complicated intraoperatively by right kidney rupture. After a follow-up of 33 months, case remains uncomplicated without signs or symptoms of potential recurrence. Discussion Intravenous leiomyomatosis represents a rare clinical entity histologically bening but clinically aggressive. No consensus exists regarding the optimal management, especially in cases with initial will for fertility preservation. Conclusion IVL represents a rare clinical entity often presenting difficulties in diagnosis and optimal treatment. Large case-series studies should be encouraged to assess the optimal management. PMID:26282558

  20. Prevention and Management of Infusion-Associated Reactions in the Comparison of Alemtuzumab and Rebif® Efficacy in Multiple Sclerosis (CARE-MS) Program

    PubMed Central

    Namey, Marie; Meyer, Cathy; Mayer, Lori; Oyuela, Pedro; Margolin, David H.; Rizzo, Marco

    2015-01-01

    Background: Alemtuzumab is a humanized monoclonal antibody approved in several countries for treatment of relapsing-remitting multiple sclerosis (RRMS). This report summarizes the experience with infusion-associated reactions (IARs) in two phase 3 trials of alemtuzumab in RRMS and examines skilled nursing interventions in IAR prevention and management. Methods: In the Comparison of Alemtuzumab and Rebif® Efficacy in Multiple Sclerosis (CARE-MS) studies, patients with RRMS (treatment naive [CARE-MS I] or with inadequate response [defined as at least one relapse] to previous therapy [CARE-MS II]) received intravenous infusions of alemtuzumab 12 mg/day on 5 consecutive days at baseline and on 3 consecutive days 12 months later. Patients were monitored for IARs during and after each infusion. An IAR was defined as any adverse event occurring during any infusion or within 24 hours after infusion. Results: The IARs affected 90.1% of patients receiving alemtuzumab. The most common IARs were headache, rash, pyrexia, nausea, and flushing; most were mild to moderate in severity. Management of IARs consisted of infusion interruption or rate reduction, pharmacologic therapies, and continual patient education and support. Medication administration before and during alemtuzumab infusion reduced IAR severity. Forty-five of 972 alemtuzumab-treated patients (4.6%) required interruption of the first treatment course (ie, infusions did not occur on consecutive days); of these, 24 (53.3%) were still able to complete the first and second full treatment courses. Conclusions: Nurses played an invaluable role in the detection and management of IARs in the CARE-MS studies. Best practices for management of IARs associated with alemtuzumab include patient and caregiver education, medication to lessen IAR severity, infusion monitoring, and discharge planning. PMID:26300705

  1. Clinical vocabulary as a boundary object in multidisciplinary care management of multiple chemical sensitivity, a complex and chronic condition

    PubMed Central

    Sampalli, Tara; Shepherd, Michael; Duffy, Jack

    2011-01-01

    Background: Research has shown that accurate and timely communication between multidisciplinary clinicians involved in the care of complex and chronic health conditions is often challenging. The domain knowledge for these conditions is heterogeneous, with poorly categorized, unstructured, and inconsistent clinical vocabulary. The potential of boundary object as a technique to bridge communication gaps is explored in this study. Methods: A standardized and controlled clinical vocabulary was developed as a boundary object in the domain of a complex and chronic health condition, namely, multiple chemical sensitivity, to improve communication among multidisciplinary clinicians. A convenience sample of 100 patients with a diagnosis of multiple chemical sensitivity, nine multidisciplinary clinicians involved in the care of patients with multiple chemical sensitivity, and 36 clinicians in the community participated in the study. Results: Eighty-two percent of the multidisciplinary and inconsistent vocabulary was standardized using the Systematized Nomenclature of Medicine – Clinical Terms (SNOMED® CT as a reference terminology. Over 80% of the multidisciplinary clinicians agreed on the overall usefulness of having a controlled vocabulary as a boundary object. Over 65% of clinicians in the community agreed on the overall usefulness of the vocabulary. Conclusion: The results from this study are promising and will be further evaluated in the domain of another complex chronic condition, ie, chronic pain. The study was conducted as a preliminary analysis for developing a boundary object in a heterogeneous domain of knowledge. PMID:21594060

  2. AN INTEGRATED FRAMEWORK FOR WATERSHED ASSESSMENT AND MANAGEMENT

    EPA Science Inventory

    Watershed approaches to water quality management have become popular, because they can address multiple point and non-point sources and the influences of land use. Developing technically-sound watershed management strategies can be challenging due to the need to 1) account for mu...

  3. Addressable parallel cavity-based quantum memory

    NASA Astrophysics Data System (ADS)

    Vetlugin, Anton N.; Sokolov, Ivan V.

    2014-09-01

    We elaborate theoretically a model of addressable parallel cavity-based quantum memory for light able to store multiple transverse spatial modes of the input light signal of finite duration and, at the same time, a time sequence of the signals by side illumination. Having in mind possible applications for, e.g., quantum repeaters, we reveal the addressability of our memory, that is, its handiness for the read-out on demand of a given transverse quantized signal mode and of a given signal from the time sequence. The addressability is achieved by making use of different spatial configurations of pump wave during the write-in and the readout. We also demonstrate that for the signal durations of the order of few cavity decay times, better efficiency is achieved when one excites the cavity with zero light-matter coupling and finally performs fast excitation transfer from the intracavity field to the collective spin. On the other hand, the light-matter coupling control in time, based on dynamical impedance matching, allows to store and retrieve time restricted signals of the on-demand smooth time shape.

  4. Matching Alternative Addresses: a Semantic Web Approach

    NASA Astrophysics Data System (ADS)

    Ariannamazi, S.; Karimipour, F.; Hakimpour, F.

    2015-12-01

    Rapid development of crowd-sourcing or volunteered geographic information (VGI) provides opportunities for authoritatives that deal with geospatial information. Heterogeneity of multiple data sources and inconsistency of data types is a key characteristics of VGI datasets. The expansion of cities resulted in the growing number of POIs in the OpenStreetMap, a well-known VGI source, which causes the datasets to outdate in short periods of time. These changes made to spatial and aspatial attributes of features such as names and addresses might cause confusion or ambiguity in the processes that require feature's literal information like addressing and geocoding. VGI sources neither will conform specific vocabularies nor will remain in a specific schema for a long period of time. As a result, the integration of VGI sources is crucial and inevitable in order to avoid duplication and the waste of resources. Information integration can be used to match features and qualify different annotation alternatives for disambiguation. This study enhances the search capabilities of geospatial tools with applications able to understand user terminology to pursuit an efficient way for finding desired results. Semantic web is a capable tool for developing technologies that deal with lexical and numerical calculations and estimations. There are a vast amount of literal-spatial data representing the capability of linguistic information in knowledge modeling, but these resources need to be harmonized based on Semantic Web standards. The process of making addresses homogenous generates a helpful tool based on spatial data integration and lexical annotation matching and disambiguating.

  5. Quantifying the Implications of Different Land Users' Priorities in the Management of Boreal Multiple-Use Forests

    NASA Astrophysics Data System (ADS)

    Horstkotte, Tim; Lind, Torgny; Moen, Jon

    2016-04-01

    In the management of natural resources, conflicting interests and objectives among different stakeholders often need to be considered. Here, we examine how two contrasting management scenarios of boreal forests in northern Sweden differ in their consequences on forest structural composition and the economic gains at harvest. Management strategies prioritize either (i) forest characteristics that promote grazing resources for reindeer herded by the indigenous Sámi, or (ii) timber production as practiced in Sweden today. When prioritizing reindeer grazing, forest stands develop a higher abundance of older age classes with larger trees and lower stem density, which reduces harvest and revenue levels by approximately 20 % over a 100-year period. The differences between these strategies illustrate the complexity in finding a trade-off for coexistence between industrial land users and other livelihoods that share the same landscape. Political support and institutional solutions are necessary to initiate changes in policy in finding such trade-offs in the management of environmental resources and thereby influence the optimal distribution of costs and benefits between different actors.

  6. Quantifying the Implications of Different Land Users' Priorities in the Management of Boreal Multiple-Use Forests.

    PubMed

    Horstkotte, Tim; Lind, Torgny; Moen, Jon

    2016-04-01

    In the management of natural resources, conflicting interests and objectives among different stakeholders often need to be considered. Here, we examine how two contrasting management scenarios of boreal forests in northern Sweden differ in their consequences on forest structural composition and the economic gains at harvest. Management strategies prioritize either (i) forest characteristics that promote grazing resources for reindeer herded by the indigenous Sámi, or (ii) timber production as practiced in Sweden today. When prioritizing reindeer grazing, forest stands develop a higher abundance of older age classes with larger trees and lower stem density, which reduces harvest and revenue levels by approximately 20% over a 100-year period. The differences between these strategies illustrate the complexity in finding a trade-off for coexistence between industrial land users and other livelihoods that share the same landscape. Political support and institutional solutions are necessary to initiate changes in policy in finding such trade-offs in the management of environmental resources and thereby influence the optimal distribution of costs and benefits between different actors. PMID:26645074

  7. Management Relevance of Benthic Biogeography at Multiple Scales in Coastal Waters of the Northeast U.S.

    EPA Science Inventory

    Continuing pressures from human activities harm the health of ocean ecosystems, particularly near the coast. Traditional management practices operating on one use sector at a time have not resulted in healthy oceans that can sustainably provide the ecosystem services humans want ...

  8. Scripted Collaboration in Serious Gaming for Complex Learning: Effects of Multiple Perspectives when Acquiring Water Management Skills

    ERIC Educational Resources Information Center

    Hummel, Hans G. K.; van Houcke, Jasper; Nadolski, Rob J.; van der Hiele, Tony; Kurvers, Hub; Lohr, Ansje

    2011-01-01

    This paper examines how learning outcomes from playing serious games can be enhanced by including scripted collaboration in the game play. We compared the quality of advisory reports, that students in the domain of water management had to draw up for an authentic case problem, both before and after collaborating on the problem with (virtual) peer…

  9. Versions to Address Business Process Flexibility Issue

    NASA Astrophysics Data System (ADS)

    Chaâbane, Mohamed Amine; Andonoff, Eric; Bouaziz, Rafik; Bouzguenda, Lotfi

    This paper contributes to address an important issue in business process management: the Business Process (BP) flexibility issue. First, it defends that versions are an interesting solution to deal with both a priori (when designing BPs) and a posteriori (when executing BPs) flexibility. It also explains why previous contributions about versions of BPs are incomplete, and need to be revisited. Then, the paper presents a meta-model for BP versions, which combines five perspectives -the functional, process, informational, organizational and operation perspectives- for BP modelling, and which allows a comprehensive description of versionalized BPs.

  10. Multiple sclerosis.

    PubMed

    Files, Daniel Kane; Jausurawong, Tani; Katrajian, Ruba; Danoff, Robert

    2015-06-01

    Multiple sclerosis (MS) is a chronic, debilitating disease that can have devastating effects. Presentation varies widely in symptoms, pace, and progression. In addition to a thorough history and physical examination, diagnostic tools required to diagnose MS and exclude other diagnoses include MRI, evoked potential testing, and cerebrospinal fluid analysis. Although the disease is not curable presently, quality of life can be improved by minimizing the frequency and severity of disease burden. Disease modification, symptom management, preservation of function, and treatment of psychosocial issues are paramount to enhance the quality of life for the patient affected with MS. PMID:25979578

  11. Responding to health care reform: how managed health care providers can manage major change overload.

    PubMed

    Gilmartin, J J

    1994-02-01

    Multiple pressures for clinical, administrative, economical, and political change face providers today. To cope with a changing society and health care delivery system, change management skills have become essential for survival. However, implementing and managing organizational change demands a level of expertise that is, unfortunately, not readily found in many managed health care organizations. In this article, the author addresses the importance for providers to understand the process of change implementation. PMID:10132445

  12. The part-time student role: implications for the emotional experience of managing multiple roles amongst Hong Kong public health nurses.

    PubMed

    Shiu, A T

    1999-04-01

    The study investigated the contribution of the added part-time student role on the emotional experience of managing multiple roles of Hong Kong public health nurses (PHNs) who have children by comparing PHNs with and without the part-time student role. The research design employed the experience sampling method. Convenience sampling was used to recruit 20 subjects of which nine were undertaking part-time degree programmes. A watch was worn that gave a signal at six random times each day for 7 days to complete an experience sampling diary. PHNs on average responded to 34 signals (80%) and therefore completed 34 diaries, which collected data on work, college-work and family juggling and their effects on mood states. Results indicate that PHNs with an added part-time student role, although having fewer juggling occasions and higher emotional spouse support, had fewer family-related activities as well as a lower positive effect and a higher negative effect than PHNs without this role. These results suggest that taking up an added part-time student role creates additional role strain to nurses with children, and lend support to the argument that the stress of managing multiple roles is greatest and benefits least when work and non-work role responsibilities are both heavy. PMID:10578828

  13. Addressing Phonological Questions with Ultrasound

    ERIC Educational Resources Information Center

    Davidson, Lisa

    2005-01-01

    Ultrasound can be used to address unresolved questions in phonological theory. To date, some studies have shown that results from ultrasound imaging can shed light on how differences in phonological elements are implemented. Phenomena that have been investigated include transitional schwa, vowel coalescence, and transparent vowels. A study of…

  14. Communities Address Barriers to Connectivity.

    ERIC Educational Resources Information Center

    Byers, Anne

    1996-01-01

    Rural areas lag behind urban areas in access to information technologies. Public institutions play a critical role in extending the benefits of information technologies to those who would not otherwise have access. The most successful rural telecommunications plans address barriers to use, such as unawareness of the benefits, technophobia, the…

  15. Keynote Address: Rev. Mark Massa

    ERIC Educational Resources Information Center

    Massa, Mark S.

    2011-01-01

    Rev. Mark S. Massa, S.J., is the dean and professor of Church history at the School of Theology and Ministry at Boston College. He was invited to give a keynote to begin the third Catholic Higher Education Collaborative Conference (CHEC), cosponsored by Boston College and Fordham University. Fr. Massa's address posed critical questions about…

  16. State of the Lab Address

    ScienceCinema

    King, Alex

    2013-03-01

    In his third-annual State of the Lab address, Ames Laboratory Director Alex King called the past year one of "quiet but strong progress" and called for Ames Laboratory to continue to build on its strengths while responding to changing expectations for energy research.

  17. State of the Lab Address

    SciTech Connect

    King, Alex

    2010-01-01

    In his third-annual State of the Lab address, Ames Laboratory Director Alex King called the past year one of "quiet but strong progress" and called for Ames Laboratory to continue to build on its strengths while responding to changing expectations for energy research.

  18. Randomized controlled trial of a teleconference fatigue management plus physical activity intervention in adults with multiple sclerosis: rationale and research protocol

    PubMed Central

    2012-01-01

    Background Chronic fatigue and inactivity are prevalent problems among individuals with multiple sclerosis (MS) and may independently or interactively have detrimental effects on quality of life and ability to participate in life roles. However, no studies to date have systematically evaluated the benefits of an intervention for both managing fatigue and promoting physical activity in individuals with MS. This study involves a randomized controlled trial to examine the effectiveness of a telehealth intervention that supports individuals with MS in managing fatigue and increasing physical activity levels. Methods/Design A randomly-allocated, three-parallel group, time-series design with a social support program serving as the control group will be used to accomplish the purpose of the study. Our goal is to recruit 189 ambulatory individuals with MS who will be randomized into one of three telehealth interventions: (1) a contact-control social support intervention, (2) a physical activity-only intervention, and (3) a physical activity plus fatigue management intervention. All interventions will last 12 weeks and will be delivered entirely over the phone. Our hypothesis is that, in comparison to the contact-control condition, both the physical activity-only intervention and the physical activity plus fatigue management intervention will yield significant increases in physical activity levels as well as improve fatigue and health and function, with the physical activity plus fatigue management intervention yielding significantly larger improvements. To test this hypothesis, outcome measures will be administered at Weeks 1, 12, and 24. Primary outcomes will be the Fatigue Impact Scale, the Godin Leisure-Time Exercise Questionnaire (GLTEQ), and Actigraph accelerometers. Secondary outcomes will include the SF-12 Survey, Mental Health Inventory, Multiple Sclerosis Impact Scale, the Community Participation Indicator, and psychosocial constructs (e.g., self

  19. Managing multiple funding streams and agendas to achieve local and global health and research objectives: lessons from the field

    PubMed Central

    Holmes, Charles B.; Sikazwe, Izukanji; Raelly, Roselyne; Freeman, Bethany; Wambulawae, Inonge; Silwizya, Geoffrey; Topp, Stephanie; Chilengi, Roma; Henostroza, German; Kapambwe, Sharon; Simbeye, Darius; Sibajene, Sheila; Chi, Harmony; Godfrey, Katy; Chi, Benjamin; Moore, Carolyn Bolton

    2014-01-01

    Multiple funding sources provide research and program implementation organizations a broader base of funding and facilitate synergy, but also entail challenges that include varying stakeholder expectations, unaligned grant cycles, and highly variable reporting requirements. Strong governance and strategic planning are essential to ensure alignment of goals and agendas. Systems to track budgets and outputs as well as procurement and human resources are required. A major goal is to transition leadership and operations to local ownership. This article details successful approaches used by the newly independent non-governmental organization, the Centre for Infectious Disease Research in Zambia (CIDRZ). PMID:24321983

  20. How is environmental conflict addressed by SIA?

    SciTech Connect

    Barrow, C.J.

    2010-09-15

    The fields of Environmental Conflict Management (ECM), Environmental Conflict Resolution (ECR), and Peace and Conflict Impact Assessment (PCIA) have become well established; however, as yet there has not been much use of Social Impact Assessment (SIA) to manage environmental conflicts. ECM, ECR and PCIA are mainly undertaken when problems are advanced or, more likely, have run their course (post-conflict). This paper examines how conflict is addressed by SIA and whether there is potential to develop it for more proactive assessment of conflicts (pre-conflict or while things develop). SIA has the potential to identify and clarify the cause(s) of environmental and natural resources conflicts, and could possibly enable some avoidance or early mitigation. A promising approach may be for 'conflict-aware' SIA to watch for critical conflict stages or thresholds and to monitor stakeholders. Effective conflict-aware SIA might also significantly contribute to efforts to achieve sustainable development.

  1. From left bundle branch block to Icelandic whales: the multiple perils of atrial fibrillation management in the elderly.

    PubMed

    Fumagalli, Stefano; Boni, Serena; Gabbai, Debbie; Giannini, Ilaria; Tarantini, Francesca; Marchionni, Niccolò

    2016-06-01

    We present the case of an elderly woman which demonstrates how AF therapy in aged individuals is particularly challenging for the presence of complex conditions. The rhythm- or the rate control strategy must be carefully chosen based on individual risk profile. Oral anticoagulant therapy must be wisely managed to maximize benefits-in terms of stroke and dementia control-and to reduce complications. PMID:26319529

  2. Relative contribution of soil, management and traits to co-variations of multiple ecosystem properties in grasslands.

    PubMed

    Gos, Pierre; Loucougaray, Grégory; Colace, Marie-Pascale; Arnoldi, Cindy; Gaucherand, Stéphanie; Dumazel, Daphné; Girard, Lucie; Delorme, Sarah; Lavorel, Sandra

    2016-04-01

    Ecological intensification promotes the better use of ecosystem functioning for agricultural production and as a provider of additional regulation and cultural services. We investigated the mechanisms underpinning potential ecological intensification of livestock production in the Vercors mountains (France). We quantified the variations in seven ecosystem properties associated with key ecosystem services: above-ground biomass production at first harvest, fodder digestibility, plant species richness, soil organic matter content, soil carbon content, total microbial biomass and soil bacteria:fungi ratio across 39 grassland plots representing varying management types and intensity. Our analyses confirmed joint effects of management, traits and soil abiotic parameters on variations in ecosystem properties, with the combination of management and traits being most influential. The variations explained by traits were consistent with the leaf economics spectrum model and its implications for ecosystem functioning. The observed independence between ecosystem properties relevant to production (forage biomass, digestibility and nutrient turnover) on the one hand and soil stocks (organic matter, carbon and microbial stocks) on the other hand suggests that an intensification of fodder production might be compatible with the preservation of the soil capital. We highlight that appropriate choices regarding various practices, such as the first date of grazing or mowing being dependent on soil moisture, have important consequences on a number of ecosystem properties relevant for ecosystem services and may influence biodiversity patterns. Such avenues for ecological intensification should be considered as part of further landscape- and farm-scale analyses of the relationships between farm functioning and ecosystem services. PMID:26830292

  3. Management Relevance of Benthic Biogeography at Multiple Scales in Coastal Waters of the Northeast U.S.

    NASA Astrophysics Data System (ADS)

    Hale, Stephen S.; Coté, Melville P.; Tedesco, Mark A.; Searfoss, Renee

    2013-04-01

    Continuing pressures from human activities have harmed the health of ocean ecosystems, particularly those near the coast. Current management practices that operate on one sector at a time have not resulted in healthy oceans that can sustainably provide the ecosystem services humans want and need. Now, adoption of ecosystem-based management (EBM) and coastal and marine spatial planning (CMSP) as foundational principles for ocean management in the United States should result in a more holistic approach. Recent marine biogeographical studies and benthic habitat mapping using satellite imagery, large-scale monitoring programs, ocean observation systems, acoustic and video techniques, landscape ecology, geographic information systems, integrated databases, and ecological modeling provide information that can support EBM, make CMSP ecologically meaningful, and contribute to planning for marine biodiversity conservation. Examples from coastal waters along the northeast coast of the United States from Delaware Bay to Passamaquoddy Bay, Maine, illustrate how benthic biogeography and bottom seascape diversity information is a useful lens through which to view EBM and CMSP in nearshore waters. The focus is on benthic communities, which are widely used in monitoring programs and are sensitive to many stresses from human activities.

  4. [Multiple apheresis].

    PubMed

    Coffe, C

    2007-05-01

    Multiple apheresis makes it possible to obtain at least two labile blood components from a single donor using a cell separator. It can be either multicomponent apheresis leading to the preparation of at least two different blood component types or red blood cell apheresis providing two identical red blood cell concentrates. These techniques available in addition to whole blood donation, are modifying collection strategies in many Etablissements Français du Sang and will contribute to improve stock logistics in the future. In areas with insufficient stock, these procedures will help achieve blood component self-sufficiency. The author first describes the principle underlying different--current or future--techniques as well as their advantages and drawbacks. He finally addresses the potential impact of these processes on the evolution of blood collection and the advantages to be gained. PMID:17521944

  5. The Quality of Pre-hospital Circulatory Management in Patients With Multiple Trauma Referred to the Trauma Center of Shahid Beheshti Hospital in Kashan, Iran, in the First Six Months of 2013

    PubMed Central

    Maghaminejad, Farzaneh; Adib-Hajbaghery, Mohsen

    2016-01-01

    Background Circulatory management is a critical issue in pre-hospital transportation phase of multiple trauma patients. However, the quality of this important care did not receive enough attention. Objectives The aim of this study was to investigate the quality of pre-hospital circulatory management in patients with multiple trauma. Patients and Methods This was a cross-sectional study conducted in 2013. The study population consisted of all patients with multiple trauma who had been transferred by emergency medical services (EMS) to the central trauma department in Kashan Shahid Beheshti medical center, Kashan, Iran. We recruited a convenience sample of 400 patients with multiple trauma. Data were collected using the circulatory assessment questionnaire and controlling hemorrhage (CAQCH) that were designed by the researchers and were described by using frequency tabulations, central tendency measures, and variability indices. The chi-square test was used to analyze the data. Results The study sample consisted of 263 males (75.2%); 57.75% had lower levels of education and 28.75% were workers. The most common mechanism of trauma was traffic accident (85.4%). We found that the quality of circulatory management was unfavorable in 61% of the cases. A significant relationship was observed between the quality of circulatory management and type of trauma and staff’s employment status. Conclusions The quality of pre-hospital circulatory management provided to patients with multiple trauma was unfavorable. Therefore, establishment of in-service training programs on circulatory management is recommended. PMID:27556056

  6. Managing multiple myeloma: the emerging role of novel therapies and adapting combination treatment for higher risk settings.

    PubMed

    Richardson, Paul G; Laubach, Jacob; Mitsiades, Constantine S; Schlossman, Robert; Hideshima, Teru; Redman, Katherine; Chauhan, Dharminder; Ghobrial, Irene M; Munshi, Nikhil; Anderson, Kenneth C

    2011-09-01

    Novel therapies have transformed the treatment paradigm for multiple myeloma with significant improvements in survival now seen in both younger and older patients. Nonetheless, the disease is heterogeneous and high-risk patients in particular continue to have poor outcome. Moreover, the disease remains incurable. Efforts to refine risk stratification and disease characteristics continue with the use of cytogenetics, enhanced imaging techniques and other new technologies, such as genomics. The integration of novel therapies into induction therapy, consolidation and maintenance continues to evolve, and the appropriate use of combination strategies including proteasome inhibition and immunomodulatory treatment is emerging as a platform with application across the disease spectrum. Despite these advances, resistance to novel agents occurs and so the identification of new targets and the recognition of clonal heterogeneity are especially important as improvements to current treatment strategies are developed, with the goal of further improving patient outcome. PMID:21732930

  7. The effectiveness of a self-management occupational therapy intervention on activity performance in individuals with multiple sclerosis-related fatigue: a randomized-controlled trial.

    PubMed

    Kos, Daphne; Duportail, Marijke; Meirte, Jill; Meeus, Mira; D'hooghe, Marie B; Nagels, Guy; Willekens, Barbara; Meurrens, Tom; Ilsbroukx, Stephan; Nijs, Jo

    2016-09-01

    Purpose to evaluate the effectiveness of an individual self-management occupational therapy intervention program (SMOoTh) versus relaxation on the performance of and satisfaction with relevant daily activities in individuals with multiple sclerosis (MS)-related fatigue. in a single-blind randomized-controlled trial, 31 patients with MS (SMOoTh: n=17, relaxation: n=14) were randomly allocated to three individual sessions focusing on pacing, prioritizing, ergonomics, and self-management (SMOoTh) or on stress management and relaxation (relaxation). Outcomes (blind assessor): Canadian Occupational Performance Measure (COPM) (primary), Modified Fatigue Impact Scale, Checklist Individual Strength and Short-Form Health Measure. COPM improved in the SMOoTh and relaxation group after the intervention and 3 months later (COPM performance: F=13.1, P=0.001 and COPM satisfaction: F=10.4, P=0.001); nonsignificant group differences showed a trend in favor of SMOoTh. Modified Fatigue Impact Scale, Checklist Individual Strength, and most of the Short-Form Health Measure subscales did not change. Clinically relevant changes in COPM performance scores were found in 71 and 27% of patients in the SMOoTh versus the relaxation group. Both interventions seem to be feasible approaches to improve performance of and satisfaction with relevant daily activities in people with MS, with a sustained effect after 3 months. Neither program altered change fatigue (impact) or quality of life. Future studies with larger sample sizes are needed. PMID:27182847

  8. The management of multiple sclerosis by reference centers in south of Italy: a 2011 survey on health demands and needs in Campania region.

    PubMed

    de Waure, Chiara; Di Nardo, Francesco; Mazzucco, Walter; Nedovic, Darko; Battaglia, Mario Alberto; Busillo, Vincenzo; Di Iorio, Walter; Gallo, Antonio; Lanzillo, Roberta; Lombardi, Emilio; Maniscalco, Giorgia Teresa; Orefice, Giuseppe; Petracca, Maria; Romano, Felice; Sinisi, Leonardo; Spadera, Anna Pia; Spitaleri, Daniele; Vivo, Pasquale; Ricciardi, Walter

    2016-02-01

    This cross-sectional study has investigated the diagnostic and therapeutic management of patients suffering from multiple sclerosis (MS) in the Campania Region (Italy). A survey involving all the reference centers for MS in Campania Region was conducted from March to August 2011. Centers responded to a web-administered questionnaire on management and clinical characteristics of MS patients. In the study period, 3263 patients (mean age 37 years, 66 % females) accessed the centers. Patients received a first diagnosis of MS in 161 cases (4.9 %). About 37 % of the subjects without a previous diagnosis came to the centers on their own initiative. All patients underwent a complete neurological examination and expanded disability status scale. The other most common investigations were magnetic resonance imaging (44.0 %) and evoked potentials (22.1 %). The number of treated patients was 2797 (87.1 %). The most used drugs were interferon β and glatiramer acetate. The time between diagnosis and initiation of therapy exceeded 6 months in 32 % of cases. Second-line drugs were under-used: 16 % of patients who might benefit from them show high clinical and radiological disease activity despite treatment with immunomodulant drugs. The MS care management of the surveyed centers showed consistent margins for improvement in 2011. Even though these data do not represent the current situation, they can be used to monitor improvements in MS care. PMID:26439919

  9. Design of oral agents for the management of multiple sclerosis: benefit and risk assessment for dimethyl fumarate

    PubMed Central

    Nicholas, Jacqueline Ann; Boster, Aaron Lee; Imitola, Jaime; O’Connell, Colleen; Racke, Michael Karl

    2014-01-01

    Dimethyl fumarate (DMF) is the most recent oral disease-modifying therapy approved by the US Food and Drug Administration and is indicated for the treatment of relapsing forms of multiple sclerosis (MS). Prior to approval for use in MS, DMF and its active metabolite, monomethyl fumarate, had been used for decades as two of the fumaric acid esters in Fumaderm®, a medication used in Europe for the treatment of psoriasis. The unique mechanism of action of DMF remains under evaluation; however, it has been shown to act through multiple pathways leading to shifts away from the Th1 proinflammatory response to the less inflammatory Th2 response. Preliminary data suggest that DMF may induce neuroprotective effects in central nervous system white matter, although further studies are needed to demonstrate these effects on inflammatory demyelination. The DMF Phase III clinical trials demonstrated its efficacy with regard to a reduction in the annualized relapse rate and reductions in new or enlarging T2 lesions and numbers of gadolinium-enhancing lesions on magnetic resonance imaging. DMF has a well-defined safety profile, given the experience with its use in the treatment of psoriasis, and more recently from the DMF clinical trials program and post-marketing era for treatment of MS. The safety profile and oral mode of administration of DMF place it as an attractive first-line therapy option for the treatment of relapsing forms of MS. Long-term observational studies will be needed to determine the effects of DMF on progression of disability in MS. PMID:25045248

  10. The effects of multiple beneficial management practices on hydrology and nutrient losses in a small watershed in the Canadian prairies.

    PubMed

    Li, Sheng; Elliott, Jane A; Tiessen, Kevin H D; Yarotski, James; Lobb, David A; Flaten, Don N

    2011-01-01

    Most beneficial management practices (BMPs) recommended for reducing nutrient losses from agricultural land have been established and tested in temperate and humid regions. Previous studies on the effects of these BMPs in cold-climate regions, especially at the small watershed scale, are rare. In this study, runoff and water quality were monitored from 1999 to 2008 at the outlets of two subwatersheds in the South Tobacco Creek watershed in Manitoba, Canada. Five BMPs-a holding pond below a beef cattle overwintering feedlot, riparian zone and grassed waterway management, grazing restriction, perennial forage conversion, and nutrient management-were implemented in one of these two subwatersheds beginning in 2005. We determined that >80% of the N and P in runoff at the outlets of the two subwatersheds were lost in dissolved forms, ≈ 50% during snowmelt events and ≈ 33% during rainfall events. When all snowmelt- and rainfall-induced runoff events were considered, the five BMPs collectively decreased total N (TN) and total P (TP) exports in runoff at the treatment subwatershed outlet by 41 and 38%, respectively. The corresponding reductions in flow-weighted mean concentrations (FWMCs) were 43% for TN and 32% for TP. In most cases, similar reductions in exports and FWMCs were measured for both dissolved and particulate forms of N and P, and during both rainfall and snowmelt-induced runoff events. Indirect assessment suggests that retention of nutrients in the holding pond could account for as much as 63 and 57%, respectively, of the BMP-induced reductions in TN and TP exports at the treatment subwatershed outlet. The nutrient management BMP was estimated to have reduced N and P inputs on land by 36 and 59%, respectively, in part due to the lower rates of nutrient application to fields converted from annual crop to perennial forage. Overall, even though the proportional contributions of individual BMPs were not directly measured in this study, the collective reduction

  11. The novel use of heart transplantation for the management of a case with multiple complications after acute myocardial infarction.

    PubMed

    Cinq-Mars, Alexandre; Veilleux, Simon-Pierre; Voisine, Pierre; Dagenais, François; O'Connor, Kim; Bernier, Mathieu; Sénéchal, Mario

    2015-06-01

    Rupture of the interventricular septum after myocardial infarction (MI) is an uncommon but serious complication, usually leading to congestive heart failure and cardiogenic shock. Surgical repair is usually the only definitive treatment for these patients because medical management is associated with a 30-day mortality approaching 100%. However with conventional surgical repair, operative mortality rates range from 33% to 53%. Furthermore, outcomes in patients with posterior ventricular septal defect (VSD) have been reported to have mortality rates up to 86%. Therefore, alternative treatment should be considered to improve management of this mechanical complication. We report the case of a 63-year-old man in whom VSD developed after an inferior MI. The patient presented with shortness of breath and a recent ST-elevation inferior MI. Transthoracic echocardiography revealed a 50% left ventricular ejection fraction with mild-moderate right ventricular dysfunction. A posterior VSD (diameter ≥ 12 mm), moderate ischemic mitral regurgitation (MR), and a posterior pseudoaneurysm were also seen. The operative risk was considered to be too high for VSD repair because the surgery would have to include bypass grafting, mitral valve replacement, and pseudoaneurysm correction. Consequently, an urgent heart transplantation was considered the best option. The patient underwent heart transplantation 9 days after initial symptoms, and the recovery was unremarkable. To achieve a definitive optimal treatment, we propose that patients with posterior VSD with significant MR or pseudoaneurysm, or both, should be considered as heart transplant candidates. PMID:25921863

  12. Technology and the Data Management Challenge.

    ERIC Educational Resources Information Center

    Hansen, Sean; Ashbrook, Michael

    2000-01-01

    The Workforce Investment Act of 1998 (WIA) clearly identifies community colleges as integral players in creating a high quality workforce. With multiple funding streams, greater local control over system design, and a mandate for universal access, community colleges must be able to address the client tracking and data management challenges that…

  13. SIG: Multiple Views on Safety-Critical Automation: Aircraft, Autonomous Vehicles, Air Traffic Management and Satellite Ground Segments Perspectives

    NASA Technical Reports Server (NTRS)

    Feary, Michael; Palanque, Philippe; Martinie, Célia; Tscheligi, Manfred

    2016-01-01

    This SIG focuses on the engineering of automation in interactive critical systems. Automation has already been studied in a number of (sub-) disciplines and application fields: design, human factors, psychology, (software) engineering, aviation, health care, games. One distinguishing feature of the area we are focusing on is that in the field of interactive critical systems properties such as reliability, dependability, fault tolerance are as important as usability, user experience or overall acceptance issues. The SIG targets at two problem areas: first the engineering of the user interaction with (partly-) autonomous systems: how to design, build and assess autonomous behavior, especially in cases where there is a need to represent on the user interface both autonomous and interactive objects. An example of such integration is the representation of an unmanned aerial vehicle (UAV) (where no direct interaction is possible), together with aircrafts (that have to be instructed by an air traffic controller to avoid the UAV). Second the design and engineering of user interaction in general for autonomous objects/systems (for example a cruise control in a car or an autopilot in an aircraft). The goal of the SIG is to raise interest in the CHI community on the general aspects of automation and to identify a community of researchers and practitioners interested in those increasingly prominent issues of interfaces towards (semi)-autonomous systems. The expected audience should be interested in addressing the issues of integration of mainly unconnected research domains to formulate a new joint research agenda.

  14. How can we exploit above–belowground interactions to assist in addressing the challenges of food security?

    PubMed Central

    Orrell, Peter; Bennett, Alison E.

    2013-01-01

    Can above–belowground interactions help address issues of food security? We address this question in this manuscript, and review the intersection of above–belowground interactions and food security. We propose that above–belowground interactions could address two strategies identified by Godfray etal. (2010): reducing the Yield Gap, and Increasing Production Limits. In particular, to minimize the difference between potential and realized production (The Yield Gap) above–belowground interactions could be manipulated to reduce losses to pests and increase crop growth (and therefore yields). To Increase Production Limits we propose two mechanisms: utilizing intercropping (which uses multiple aspects of above–belowground interactions) and breeding for traits that promote beneficial above–belowground interactions, as well as breeding mutualistic organisms to improve their provided benefit. As a result, if they are managed correctly, there is great potential for above–belowground interactions to contribute to food security. PMID:24198821

  15. Cadmium contamination in American lobster, Homarus americanus, near a coastal lead smelter: use of multiple linear regression for management

    SciTech Connect

    Uthe, J.F.; Scott, D.P.; Chou, C.L.

    1987-04-01

    In 1980 cadmium (Cd) concentrations in digestive gland from American Lobster (Homarus americanus), captured at Belledune Harbour, New Brunswick, Canada were found to range 47.6-372 mg/kg wet weight. Since the digestive gland is commonly eaten the harbor fishery was closed. The adjacent area was decreed a controlled fishery zone. The cadmium source was a lead smelter on the harbor shore. The company installed an aqueous effluent treatment plant and improved handling procedures within the plant area. Aqueous Cd discharges were subsequently reduced by more than 95%. Cadmium levels in lobsters have been monitored annually since 1980 by sampling in early spring, immediately after the lobsters emerged from their overwintering locations. The results from the 1981-1985 monitoring program were used to model the system, analyze the data and predict the years in which certain changes to the management plan might be implemented.

  16. Spack: the Supercomputing Package Manager

    2013-11-09

    The HPC software ecosystem is growing larger and more complex, but software distribution mechanisms have not kept up with this trend. Tools, Libraries, and applications need to run on multiple platforms and build with multiple compliers. Increasingly, packages leverage common software components, and building any one component requires building all of its dependencies. In HPC environments, ABI-incompatible interfaces (likeMPI), binary-incompatible compilers, and cross-compiled environments converge to make the build process a combinatoric nightmare. This obstaclemore » deters many users from adopting useful tools, and others waste countless hours building and rebuilding tools. Many package managers exist to solve these problems for typical desktop environments, but none suits the unique needs of supercomputing facilities or users. To address these problems, we have Spack, a package manager that eases the task of managing software for end-users, across multiple platforms, package versions, compilers, and ABI incompatibilities.« less

  17. Spack: the Supercomputing Package Manager

    SciTech Connect

    Gamblin, T.

    2013-11-09

    The HPC software ecosystem is growing larger and more complex, but software distribution mechanisms have not kept up with this trend. Tools, Libraries, and applications need to run on multiple platforms and build with multiple compliers. Increasingly, packages leverage common software components, and building any one component requires building all of its dependencies. In HPC environments, ABI-incompatible interfaces (likeMPI), binary-incompatible compilers, and cross-compiled environments converge to make the build process a combinatoric nightmare. This obstacle deters many users from adopting useful tools, and others waste countless hours building and rebuilding tools. Many package managers exist to solve these problems for typical desktop environments, but none suits the unique needs of supercomputing facilities or users. To address these problems, we have Spack, a package manager that eases the task of managing software for end-users, across multiple platforms, package versions, compilers, and ABI incompatibilities.

  18. Inter-Model Diagnostics for Two Snow Models Across Multiple Western U.S. Locations and Implications for Management

    NASA Astrophysics Data System (ADS)

    Houle, E. S.; Livneh, B.; Kasprzyk, J. R.

    2014-12-01

    In the western United States, water resource management is increasingly reliant on numerical modeling of hydrological processes, namely snow accumulation and ablation. We seek to advance a framework for providing model diagnostics for such systems by combining an improved understanding of model structural differences (i.e., conceptual vs. physically based) and parameter sensitivities. The two snow models used in this study are SNOW-17, a conceptual degree-day model, and the Variable Infiltration Capacity (VIC) snow model, which is physically based and solves the full water and energy balances. To better understand the performance of these models, several approaches will be used. For the conceptual model, global sensitivity analysis methods (e.g., Sobol' and Method of Morris), and a multi-objective calibration will be applied to identify important parameters and show calibrated parameter values. For the physically based model, we will contribute a novel exploration of some parameters that can be adjusted within the model, including the liquid water holding capacity, the density of newly fallen snow, and the snow roughness. Additionally, the VIC model will be run with explicit radiation inputs at selected sites. For each model run, snow sensitivities and errors (i.e., snow water equivalent results) will be translated into estimated changes in annual water yield for the study areas. Accurately predicting water yield is essential for water management, and it is used here as a practical measure to determine the importance of model parameter sensitivity and calibration. The analysis will be conducted across a range of snow-dominated locations representing a variety of climates across the western United States (e.g. continental, maritime, alpine).

  19. The use of molecular-based risk stratification and pharmacogenomics for outcome prediction and personalized therapeutic management of multiple myeloma

    PubMed Central

    Johnson, Sarah K.; Heuck, Christoph J.; Albino, Anthony P.; Qu, Pingping; Zhang, Qing; Barlogie, Bart

    2015-01-01

    Despite improvement in therapeutic efficacy, multiple myeloma (MM) remains incurable with a median survival of approximately 10 years. Gene-expression profiling (GEP) can be used to elucidate the molecular basis for resistance to chemotherapy through global assessment of molecular alterations that exist at diagnosis, after therapeutic treatment and that evolve during tumor progression. Unique GEP signatures associated with recurrent chromosomal translocations and ploidy changes have defined molecular classes with differing clinical features and outcomes. When compared to other stratification systems the GEP70 test remained a significant predictor of outcome, reduced the number of patients classified with a poor prognosis, and identified patients at increased risk of relapse despite their standard clinico-pathologic and genetic findings. GEP studies of serial samples showed that risk increases over time, with relapsed disease showing GEP shifts toward a signature of poor outcomes. GEP signatures of myeloma cells after therapy were prognostic for event-free and overall survival and thus may be used to identify novel strategies for overcoming drug resistance. This brief review will focus on the use of GEP of MM to define high-risk myeloma, and elucidate underlying mechanisms that are beginning to change clinical decision-making and inform drug design. PMID:22002477

  20. Addressing the workforce pipeline challenge

    SciTech Connect

    Leonard Bond; Kevin Kostelnik; Richard Holman

    2006-11-01

    A secure and affordable energy supply is essential for achieving U.S. national security, in continuing U.S. prosperity and in laying the foundations to enable future economic growth. To meet this goal the next generation energy workforce in the U.S., in particular those needed to support instrumentation, controls and advanced operations and maintenance, is a critical element. The workforce is aging and a new workforce pipeline, to support both current generation and new build has yet to be established. The paper reviews the challenges and some actions being taken to address this need.

  1. Addressing the Special Education Crisis

    ERIC Educational Resources Information Center

    Amprey, Walter G.

    2005-01-01

    In the author's past work as a superintendent, and in his current capacity as an educational consultant, he has seen hundreds of dollars (per special education student) wasted in unnecessary costs and lost funding opportunities resulting from out-of-date, ineffective management systems. In addition to the fiscal implications, this imposes…

  2. Long-lasting intestinal bleeding in an old patient with multiple mucosal vascular abnormalities and Glanzmann's thrombasthenia: 3-year pharmacological management.

    PubMed

    Coppola, A; De Stefano, V; Tufano, A; Nardone, G; Amoriello, A; Cerbone, A M; Di Minno, G

    2002-09-01

    A 75-year-old woman with Glanzmann's thrombasthenia was admitted because of persistent melaena. Endoscopic examination showed multiple angiodysplastic lesions, with active bleeding in small and large bowel. Electro-coagulation of some lesions, octreotide, conjugated oestrogens and selective embolization of jejunal vessels did not change transfusion requirements. After 8 month-transfusions, ethinylestradiol + norethisterone in association with octreotide was started, leading to no transfusion over the following 9 months. Bleeding recurred after withdrawing octreotide and substituting ethinylestradiol + norgestrel for the ethinylestradiol + norethisterone combination. Re-introduction of octreotide did not improve bleeding; however, a reduction of transfusion requirement was observed when the ethinylestradiol + norethisterone pill was re-administered. The association of octreotide and of an oestrogen-progesterone combination was helpful in the difficult management of recurrent bleeding in this patient with diffuse gastrointestinal vascular abnormalities and a severe condition predisposing to bleeding. PMID:12270009

  3. Multiple mandibular fractures. Treatment outlines.

    PubMed

    Elia, Giovanni; Franco, Elena; Clauser, Luigi C

    2016-02-01

    Multiple mandibular comminuted fractures usually occur in high energy traumas. The authors describe the management and treatment of multiple mandibular fractures in a young patient after a suicide attempt. PMID:26862697

  4. Coupled simulation-optimization model for coastal aquifer management using genetic programming-based ensemble surrogate models and multiple-realization optimization

    NASA Astrophysics Data System (ADS)

    Sreekanth, J.; Datta, Bithin

    2011-04-01

    Approximation surrogates are used to substitute the numerical simulation model within optimization algorithms in order to reduce the computational burden on the coupled simulation-optimization methodology. Practical utility of the surrogate-based simulation-optimization have been limited mainly due to the uncertainty in surrogate model simulations. We develop a surrogate-based coupled simulation-optimization methodology for deriving optimal extraction strategies for coastal aquifer management considering the predictive uncertainty of the surrogate model. Optimization models considering two conflicting objectives are solved using a multiobjective genetic algorithm. Objectives of maximizing the pumping from production wells and minimizing the barrier well pumping for hydraulic control of saltwater intrusion are considered. Density-dependent flow and transport simulation model FEMWATER is used to generate input-output patterns of groundwater extraction rates and resulting salinity levels. The nonparametric bootstrap method is used to generate different realizations of this data set. These realizations are used to train different surrogate models using genetic programming for predicting the salinity intrusion in coastal aquifers. The predictive uncertainty of these surrogate models is quantified and ensemble of surrogate models is used in the multiple-realization optimization model to derive the optimal extraction strategies. The multiple realizations refer to the salinity predictions using different surrogate models in the ensemble. Optimal solutions are obtained for different reliability levels of the surrogate models. The solutions are compared against the solutions obtained using a chance-constrained optimization formulation and single-surrogate-based model. The ensemble-based approach is found to provide reliable solutions for coastal aquifer management while retaining the advantage of surrogate models in reducing computational burden.

  5. Beyond anaemia management: evolving role of erythropoietin therapy in neurological disorders, multiple myeloma and tumour hypoxia models.

    PubMed

    Boogaerts, Marc; Mittelman, Moshe; Vaupel, Peter

    2005-01-01

    Recombinant human erythropoietin (epoetin) has become the standard of care in the treatment of anaemia resulting from cancer and its treatment, and chronic kidney disease. The discovery that erythropoietin and its receptor are located in regions outside the erythropoietic system has led to interest in the potential role of epoetin in other tissues, such as the central nervous system. Animal studies have shown that systemically applied epoetin can cross the blood-brain barrier, where it reduces tissue injury associated with stroke, blunt trauma and experimental autoimmune encephalomyelitis. Pilot studies in humans have shown that epoetin treatment given within 8 h of stroke reduces infarct size and results in a significantly better outcome when compared with placebo treatment. Studies also suggest that epoetin has the potential to improve cognitive impairment associated with adjuvant chemotherapy in patients with cancer. Anaemia is a major factor causing tumour hypoxia, a condition that can promote changes within neoplastic cells that further tumour survival and malignant progression and also reduces the effectiveness of several anticancer therapies including radiotherapy and oxygen-dependent cytotoxic agents. Use of epoetin to prevent or correct anaemia has the potential to reduce tumour hypoxia and improve treatment outcome. Several therapeutic studies in anaemic animals with experimental tumours have shown a beneficial effect of epoetin on delaying tumour growth. Furthermore, clinical observations in patients with multiple myeloma and animal studies have suggested that epoetin has an antimyeloma effect, mediated via the immune system through activation of CD8+ T cells. Therefore, the role of epoetin may go well beyond that of increasing haemoglobin levels in anaemic patients, although additional studies are required to confirm these promising results. PMID:16244507

  6. Upstream to downstream: a multiple-assessment-point approach for targeting non-point-source priority management areas at large watershed scale

    NASA Astrophysics Data System (ADS)

    Chen, L.; Zhong, Y.; Wei, G.; Shen, Z.

    2014-04-01

    The identification of priority management areas (PMAs) is essential for the control of non-point-source (NPS) pollution, especially for a large-scale watershed. However, previous studies have typically focused on small-scale catchments adjacent to specific assessment points; thus, the interactions between multiple river points remain poorly understood. In this study, a multiple-assessment-point PMA (MAP-PMA) framework was proposed by integrating the upstream sources and the downstream transport aspects of NPS pollution. Daning River watershed was taken as a case study in this paper, which has demonstrated that the integration of the upstream input changes was vital for the final PMAs map, especially for downstream areas. Contrary to conventional wisdom, this research recommended that the NPS pollutants could be best controlled among the upstream high-level PMAs when protecting the water quality of the entire watershed. The MAP-PMA framework provided a more cost-effective tool for the establishment of conservation practices, especially for a large-scale watershed.

  7. Testing for multiple invasion routes and source populations for the invasive brown treesnake (Boiga irregularis) on Guam: implications for pest management

    USGS Publications Warehouse

    Richmond, Jonathan Q.; Wood, Dustin A.; Stanford, James W.; Fisher, Robert N.

    2014-01-01

    The brown treesnake (Boiga irregularis) population on the Pacific island of Guam has reached iconic status as one of the most destructive invasive species of modern times, yet no published works have used genetic data to identify a source population. We used DNA sequence data from multiple genetic markers and coalescent-based phylogenetic methods to place the Guam population within the broader phylogeographic context of B. irregularis across its native range and tested whether patterns of genetic variation on the island are consistent with one or multiple introductions from different source populations. We also modeled a series of demographic scenarios that differed in the effective size and duration of a population bottleneck immediately following the invasion on Guam, and measured the fit of these simulations to the observed data using approximate Bayesian computation. Our results exclude the possibility of serial introductions from different source populations, and instead verify a single origin from the Admiralty Archipelago off the north coast of Papua New Guinea. This finding is consistent with the hypothesis thatB. irregularis was accidentally transported to Guam during military relocation efforts at the end of World War II. Demographic model comparisons suggest that multiple snakes were transported to Guam from the source locality, but that fewer than 10 individuals could be responsible for establishing the population. Our results also provide evidence that low genetic diversity stemming from the founder event has not been a hindrance to the ecological success of B. irregularis on Guam, and at the same time offers a unique ‘genetic opening’ to manage snake density using classical biological approaches.

  8. Presidential address: imagination trumps knowledge.

    PubMed

    Moore, Frederick A

    2010-12-01

    Multiple organ failure (MOF) emerged 30 years ago and became our research focus. Over the years, we have proposed a series of cartoons that rallied multidisciplinary translational research teams around common themes to generate "win-win" hypotheses that when tested (right or wrong) have advanced our understanding of MOF. MOF has a bimodal trajectory, and the gut plays a role in both trajectories. Early MOF occurs because of excessive proinflammation (ie, systemic inflammatory response syndrome [SIRS]), and early gut ischemia-reperfusion can amplify SIRS and contribute to the early fulminant SIRS-MOF trajectory. Fortunately, most patients survive early SIRS, but some develop excessive anti-inflammation (ie, compensatory anti-inflammatory response syndrome). The gut also plays a role in this late indolent compensatory anti-inflammatory response syndrome-MOF trajectory. Multiple factors cause progressive gut dysfunction such that the gut (an important immunologic organ) worsens compensatory anti-inflammatory response syndrome and becomes the reservoir for pathogens and toxins that cause late sepsis. PMID:21146000

  9. Addressing Common Student Errors with Classroom Voting in Multivariable Calculus

    ERIC Educational Resources Information Center

    Cline, Kelly; Parker, Mark; Zullo, Holly; Stewart, Ann

    2012-01-01

    One technique for identifying and addressing common student errors is the method of classroom voting, in which the instructor presents a multiple-choice question to the class, and after a few minutes for consideration and small group discussion, each student votes on the correct answer, often using a hand-held electronic clicker. If a large number…

  10. Addressing the Needs of Students with Rett Syndrome.

    ERIC Educational Resources Information Center

    Katsiyannis, Antonis; Ellenburg, Jennifer S.; Acton, Olivia M.; Torrey, Gregory

    2001-01-01

    This article discusses symptoms of students with Rett Syndrome, a disability in females characterized by the development of multiple specific deficits following a period of normal functioning after birth. Specific interventions for students with Rett syndrome are provided and address communication, stereotypic movements, self-injurious behaviors,…

  11. POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, multiple myeloma and skin changes) with cranial vault plasmocytoma and the role of surgery in its management: a case report

    PubMed Central

    2013-01-01

    Introduction POEMS syndrome (an acronym of polyneuropathy, organomegaly, endocrinopathy, multiple myeloma and skin changes) is a paraneoplastic disorder related to an underlying plasma cell dyscrasia. The development of such a syndrome is rare and its association with calvarial plasmocytoma is even less common, with only two previous reported cases. We describe, in detail, an unusual presentation of cranial plasmocytoma associated with POEMS syndrome and briefly discuss the possible role of surgery in the management of this disease. Case presentation We present the case of a 45-year-old Caucasian man who was admitted to our department presenting with progressive weakness in his lower limbs, enlarged lymph nodes and a large mass on the scalp with intense bone erosion. POEMS criteria were present and pathological studies confirmed a Castleman’s variant plasmocytoma. Clinical status improved noticeably after the excision of the plasmocytoma and the treatment was completed with radiotherapy and steroid pulse therapy. Conclusion Cranial vault plasmocytoma and its association with POEMS syndrome are rare conditions with few previously reported cases. Although the role of surgery is not clearly defined in POEMS syndrome guidelines, the fact that there seems to be a better prognosis and clinical outcome when surgery is used as a part of the management in POEMS syndrome with cranial vault plasmocytoma is worth discussing. PMID:24139142

  12. Management of Newly Diagnosed Symptomatic Multiple Myeloma: updated Mayo Stratification of Myeloma and Risk-Adapted Therapy (mSMART) Consensus Guidelines

    PubMed Central

    Kumar, Shaji K.; Mikhael, Joseph R.; Buadi, Francis K.; Dingli, David; Dispenzieri, Angela; Fonseca, Rafael; Gertz, Morie A.; Greipp, Philip R.; Hayman, Suzanne R.; Kyle, Robert A.; Lacy, Martha Q.; Lust, John A.; Reeder, Craig B.; Roy, Vivek; Russell, Stephen J.; Short, Kristen E. Detweiler; Stewart, A. Keith; Witzig, Thomas E.; Zeldenrust, Steven R.; Dalton, Robert J.; Rajkumar, S. Vincent; Bergsagel, P. Leif

    2009-01-01

    Multiple myeloma is a malignant plasma cell neoplasm that affects more than 20,000 people each year and is the second most common hematologic malignancy. It is part of a spectrum of monoclonal plasma cell disorders, many of which do not require active therapy. During the past decade, considerable progress has been made in our understanding of the disease process and factors that influence outcome, along with development of new drugs that are highly effective in controlling the disease and prolonging survival without compromising quality of life. Identification of well-defined and reproducible prognostic factors and introduction of new therapies with unique modes of action and impact on disease outcome have for the first time opened up the opportunity to develop risk-adapted strategies for managing this disease. Although these risk-adapted strategies have not been prospectively validated, enough evidence can be gathered from existing randomized trials, subgroup analyses, and retrospective studies to develop a working framework. This set of recommendations represents such an effort—the development of a set of consensus guidelines by a group of experts to manage patients with newly diagnosed disease based on an interpretation of the best available evidence. PMID:19955246

  13. Role of reservoir simulation in development and management of complexly-faulted, multiple-reservoir Dulang field, offshore Malaysia: Holistic strategies

    SciTech Connect

    Sonrexa, K.; Aziz, A.; Solomon, G.J.; Bandal, M.; Embong, M.K.; Wahir, H.

    1995-10-01

    The Dulang field, discovered in 1981, is a major oil filed located offshore Malaysia in the Malay Basin. The Dulang Unit Area constitutes the central part of this exceedingly heterogeneous field. The Unit Area consists of 19 stacked shaly sandstone reservoirs which are divided into about 90 compartments with multiple fluid contacts owing to severe faulting. Current estimated put the Original-Oil-In-Place (OOIP) in the neighborhood of 700 million stock tank barrels (MMSTB). Production commenced in March 1991 and the current production is more than 50,000 barrels of oil per day (BOPD). In addition to other more conventional means, reservoir simulation has been employed form the very start as a vital component of the overall strategy to develop and manage this challenging field. More than 10 modeling studies have been completed by Petronas Carigali Sdn. Bhd. (Carigali) at various times during the short life of this field thus far. To add to that, Esso Production Malaysia Inc. (EPMI) has simultaneously conducted a number of independent studies. These studies have dealt with undersaturated compartments as well as those with small and large gas caps. They have paved the way for improved reservoir characterization, optimum development planning and prudent production practices. This paper discusses the modeling approaches and highlights the crucial role these studies have played on an ongoing basis in the development and management of the complexly-faulted, multi-reservoir Dulang Unit Area.

  14. Use of Vacuum-assisted closure in management of open abdominal wound with multiple enterocutaneous fistulae during chemotherapy: A case report

    PubMed Central

    Fujino, Shiki; Miyoshi, Norikatsu; Ohue, Masayuki; Noura, Shingo; Fukata, Tadafumi; Yagi, Toshiya; Fujiwara, Yoshiyuki; Yano, Masahiko

    2015-01-01

    Introduction Vacuum-assisted closure (VAC) is useful for treating complex wounds because it promotes granulation. In the present report, a successful case of VAC used for an open abdominal wound with enterocutaneous fistulae after multiple intestinal perforations during chemotherapy is described. Presentation of case A 73-year-old man was admitted to our hospital with severe abdominal pain. He underwent surgical resection for ascending colon cancer 4 years ago and was administered chemotherapy with bevacizumab for recurrence. Physical examination and computed tomography revealed perforation of the intestine, and an emergency operation was performed. Following this procedure, other intestinal perforations occurred, resulting in an open abdominal wound at postoperative day (POD) 10. To isolate enteric contents and promote granulation, VAC was applied to the abdominal wound with enterocutaneous fistulae. Oral intake started at POD 21 and the wound size became smaller. Further, an ostomy bag was directly attached to the most oral perforation site. The patient recovered from life-threatening events without severe infection and was transferred to another hospital close to his home at POD 180. Discussion Gastrointestinal perforation is known to be one of the fatal adverse events of bevacizumab. In this case four gastrointestinal perforations were observed. Isolation of enteric contents is important to heal the wound and VAC is an effective therapy for the management of open abdominal wounds even with enterocutaneous fistulae. Conclusion Innovative VAC use for the management of open abdominal wounds can improve the nutritional status and overall wound healing of the patient. PMID:26599504

  15. Addressing viral resistance through vaccines

    PubMed Central

    Laughlin, Catherine; Schleif, Amanda; Heilman, Carole A

    2015-01-01

    Antimicrobial resistance is a serious healthcare concern affecting millions of people around the world. Antiviral resistance has been viewed as a lesser threat than antibiotic resistance, but it is important to consider approaches to address this growing issue. While vaccination is a logical strategy, and has been shown to be successful many times over, next generation viral vaccines with a specific goal of curbing antiviral resistance will need to clear several hurdles including vaccine design, evaluation and implementation. This article suggests that a new model of vaccination may need to be considered: rather than focusing on public health, this model would primarily target sectors of the population who are at high risk for complications from certain infections. PMID:26604979

  16. Addressing failures in exascale computing

    SciTech Connect

    Snir, Marc; Wisniewski, Robert W.; Abraham, Jacob A.; Adve, Sarita; Bagchi, Saurabh; Balaji, Pavan; Belak, Jim; Bose, Pradip; Cappello, Franck; Carlson, William; Chien, Andrew A.; Coteus, Paul; Debardeleben, Nathan A.; Diniz, Pedro; Engelmann, Christian; Erez, Mattan; Saverio, Fazzari; Geist, Al; Gupta, Rinku; Johnson, Fred; Krishnamoorthy, Sriram; Leyffer, Sven; Liberty, Dean; Mitra, Subhasish; Munson, Todd; Schreiber, Robert; Stearly, Jon; Van Hensbergen, Eric

    2014-05-01

    We present here a report produced by a workshop on “Addressing Failures in Exascale Computing” held in Park City, Utah, August 4–11, 2012. The charter of this workshop was to establish a common taxonomy about resilience across all the levels in a computing system; discuss existing knowledge on resilience across the various hardware and software layers of an exascale system; and build on those results, examining potential solutions from both a hardware and software perspective and focusing on a combined approach. The workshop brought together participants with expertise in applications, system software, and hardware; they came from industry, government, and academia; and their interests ranged from theory to implementation. The combination allowed broad and comprehensive discussions and led to this document, which summarizes and builds on those discussions.

  17. Light addressable photoelectrochemical cyanide sensor

    SciTech Connect

    Licht, S.; Myung, N.; Sun, Y.

    1996-03-15

    A sensor is demonstrated that is capable of spatial discrimination of cyanide with use of only a single stationary sensing element. Different spatial regions of the sensing element are light activated to reveal the solution cyanide concentration only at the point of illumination. In this light addressable photoelectrochemical (LAP) sensor the sensing element consists of an n-CdSe electrode immersed in solution, with the open-circuit potential determined under illumination. In alkaline ferro-ferri-cyanide solution, the open-circuit photopotential is highly responsive to cyanide, with a linear response of (120 mV) log [KCN]. LAP detection with a spatial resolution of {+-}1 mm for cyanide detection is demonstrated. The response is almost linear for 0.001-0.100 m cyanide with a resolution of 5 mV. 38 refs., 7 figs., 1 tab.

  18. Addressing Failures in Exascale Computing

    SciTech Connect

    Snir, Marc; Wisniewski, Robert; Abraham, Jacob; Adve, Sarita; Bagchi, Saurabh; Balaji, Pavan; Belak, J.; Bose, Pradip; Cappello, Franck; Carlson, Bill; Chien, Andrew; Coteus, Paul; DeBardeleben, Nathan; Diniz, Pedro; Engelmann, Christian; Erez, Mattan; Fazzari, Saverio; Geist, Al; Gupta, Rinku; Johnson, Fred; Krishnamoorthy, Sriram; Leyffer, Sven; Liberty, Dean; Mitra, Subhasish; Munson, Todd; Schreiber, Rob; Stearley, Jon; Van Hensbergen, Eric

    2014-01-01

    We present here a report produced by a workshop on Addressing failures in exascale computing' held in Park City, Utah, 4-11 August 2012. The charter of this workshop was to establish a common taxonomy about resilience across all the levels in a computing system, discuss existing knowledge on resilience across the various hardware and software layers of an exascale system, and build on those results, examining potential solutions from both a hardware and software perspective and focusing on a combined approach. The workshop brought together participants with expertise in applications, system software, and hardware; they came from industry, government, and academia, and their interests ranged from theory to implementation. The combination allowed broad and comprehensive discussions and led to this document, which summarizes and builds on those discussions.

  19. Remediation tradeoffs addressed with simulated annealing optimization

    SciTech Connect

    Rogers, L. L., LLNL

    1998-02-01

    Escalation of groundwater remediation costs has encouraged both advances in optimization techniques to balance remediation objectives and economics and development of innovative technologies to expedite source region clean-ups. We present an optimization application building on a pump-and-treat model, yet assuming a prior removal of different portions of the source area to address the evolving management issue of more aggressive source remediation. Separate economic estimates of in-situ thermal remediation are combined with the economic estimates of the subsequent optimal pump-and-treat remediation to observe tradeoff relationships of cost vs. highest remaining contamination levels (hot spot). The simulated annealing algorithm calls the flow and transport model to evaluate the success of a proposed remediation scenario at a U.S.A. Superfund site contaminated with volatile organic compounds (VOCs).

  20. Evaluating local indirect addressing in SIMD proc essors

    NASA Technical Reports Server (NTRS)

    Middleton, David; Tomboulian, Sherryl

    1989-01-01

    In the design of parallel computers, there exists a tradeoff between the number and power of individual processors. The single instruction stream, multiple data stream (SIMD) model of parallel computers lies at one extreme of the resulting spectrum. The available hardware resources are devoted to creating the largest possible number of processors, and consequently each individual processor must use the fewest possible resources. Disagreement exists as to whether SIMD processors should be able to generate addresses individually into their local data memory, or all processors should access the same address. The tradeoff is examined between the increased capability and the reduced number of processors that occurs in this single instruction stream, multiple, locally addressed, data (SIMLAD) model. Factors are assembled that affect this design choice, and the SIMLAD model is compared with the bare SIMD and the MIMD models.