Science.gov

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

    PubMed

    Anderson, Kylie L; Congdon, Bradley C

    2013-06-01

    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.

  3. 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

  4. 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.

  5. 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...

  6. 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...

  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. 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...

  10. 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.

  11. 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,…

  12. Accelerating adaptation of natural resource management to address climate change.

    PubMed

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

    2013-02-01

    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.

  13. A WiFi public address system for disaster management.

    PubMed

    Andrade, Nicholas; Palmer, Douglas A; Lenert, Leslie A

    2006-01-01

    The WiFi Bullhorn is designed to assist emergency workers in the event of a disaster situation by offering a rapidly configurable wireless of public address system for disaster sites. The current configuration plays either pre recorded or custom recorded messages and utilizes 802.11b networks for communication. Units can be position anywhere wireless coverage exists to help manage crowds or to recall first responders from dangerous areas.

  14. 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.

  15. Managed Migration: The Caribbean Approach to Addressing Nursing Services Capacity

    PubMed Central

    Salmon, Marla E; Yan, Jean; Hewitt, Hermi; Guisinger, Victoria

    2007-01-01

    Objective To (1) provide a contextual analysis of the Caribbean region with respect to forces shaping the current and emerging nursing workforce picture in the region; (2) discuss country-specific case(s) within the Caribbean; and (3) describe the Managed Migration Program as a potential framework for addressing regional and global nurse migration issues. Principal Findings The Caribbean is in the midst of a crisis of shortages of nurses with an average vacancy rate of 42 percent. Low pay, poor career prospects, and lack of education opportunities are among the reasons nurses resign. Many of these nurses look outside the region for job opportunities in the United Kingdom, Canada, the United States, and other countries. Compounding the situation is the lack of resources to train nurses to fill the vacancies. The Managed Migration Program of the Caribbean is a multilateral, cross-sector, multi-interventional, long-term strategy for developing and maintaining an adequate supply of nurses for the region. Conclusions The Managed Migration Program of the Caribbean has made progress in establishing regional support for addressing the nursing shortage crisis and developing a number of interesting initiatives such as training for export and temporary migration. Recommendations to move the Managed Migration Program of the Caribbean forward focus on advocacy, integration of the program into regional policy decisions, and integration of the program with regional health programming. PMID:17489919

  16. 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

  17. 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

  18. 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…

  19. 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.

  20. 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

  1. 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

  2. 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.

  3. Management of multiple impacted teeth

    PubMed Central

    Bansal, Nidhi; Valiathan, Ashima; Bansal, Kshitij; Parkar, Farhan

    2012-01-01

    An impacted or missing permanent tooth can add significant complications to an otherwise straightforward case. When multiple impacted teeth are present, the case complexity increases further. Developing a treatment sequence, determining appropriate anchorage, and planning and executing sound biomechanics can be a challenge. The following case report illustrates a patient with three retained primary teeth and three impacted permanent canines. After careful treatment planning and extraction of multiple primary teeth;, followed by attempted guided eruption of impacted teeth, the patient finished with a significantly improved functional and aesthetic result. PMID:22557915

  4. 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.

  5. The symptomatic management of multiple sclerosis

    PubMed Central

    Schapiro, Randall T.

    2009-01-01

    The management of multiple sclerosis (MS) revolves around disease management, symptom management, and person management. Of these, symptom management takes up the bulk of the time of the practicing physician. Some symptoms are easily managed whereas others are more difficult. Decisions have often to be made on whether to treat or to wait and watch. This article discusses the varied symptoms of MS and the approaches to management, which involves rehabilitation, pharmacological treatments, and surgical procedures. The skilled physician managing MS should be familiar with the multiple approaches to improving the quality of life of those with MS. After the diagnosis has been established and the decisions regarding treatment approaches have been made, the talk in a typical office appointment for MS usually turns to symptom management. Thus, the majority of management decisions made by the clinician revolve around that important topic. It is symptom management that will determine quality of life for those with MS, It is the basis for improving function, and, up until twenty years ago, it was the only basis for treating MS. Now, however, we can approach treatment by disease management, symptom management, and person management. The MS specialist must be well versed in all three areas. PMID:20182577

  6. 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…

  7. 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

  8. Multiple 3D medical data watermarking for healthcare data management.

    PubMed

    Lee, Suk-Hwan; Kwon, Ki-Ryong

    2011-12-01

    The rapid development of healthcare information management for 3D digital medical libraries, 3D PACS, and 3D medical diagnosis has addressed the security issues pertaining to medical IT technology. This paper presents multiple watermarking schemes for a healthcare information management system for 3D medical image data for the protection, authentication, indexing, and hiding of diagnosis information. The proposed scheme, which is based on POCS watermarking, embeds a robust watermark for a doctor's digital signature and an information retrieval indexing key to the distribution of vertex curvedness; the scheme also embeds a fragile watermark for diagnosis information and an authentication reference message to the vertex distance difference. The multiple embedding process creates three convex sets for robustness, fragileness, and invisibility and projects the 3D medical image data onto these three convex sets alternately and iteratively. Experimental results confirmed that the proposed scheme has the robustness and fragileness to handle various 3D geometric and mesh modifiers simultaneously.

  9. Symptom management in patients with multiple sclerosis.

    PubMed

    Ziemssen, Tjalf

    2011-12-01

    Multiple sclerosis is a complex disease associated with a wide variety of different symptoms that can affect the ability of multiple sclerosis patients to carry out normal activities of daily living. Although a myriad of symptoms can afflict these patients, the most commonly reported include fatigue, mood disorders, changes in cognitive function or memory, sensory changes (numbness, pain, vibrations), motor changes (loss of balance, poor coordination, muscle weakness or stiffness), vision changes (double vision, blurred vision, loss of vision) and bladder or bowel dysfunction. Treatments are available that can help minimise some of these symptoms and relieve patient distress. After the diagnosis has been established and a decision taken regarding initiation of immunomodulatory treatments, the majority of management decisions with which the physician will be confronted will concern symptom management. Whereas some symptoms are relatively easily treated, others are more difficult to manage. Management involves rehabilitation, pharmacological treatments and surgical procedures. Successful symptom management is a key determinant of quality of life for the patient and is the basis for improving physical and psychological function.

  10. Addressing multiple breast cancer risk factors in African-American women.

    PubMed Central

    Stolley, Melinda R.; Fitzgibbon, Marian L.; Wells, Anita; Martinovich, Zoran

    2004-01-01

    This pilot study explored the acceptability and feasibility of and estimated the effectiveness of a weight loss/breast health intervention designed to reduce breast cancer risk in African-American women ages 35-65. The study had a one-group repeated-measures design and took place in a community setting. Forty-four African-American women were recruited, 35 completed the program, and 30 returned for the one-year follow-up. The pilot intervention was three weeks in duration and included twice-weekly exercise classes and weekly active learning seminars that addressed weight loss, breast health, healthy eating, and leading an active life. Measures included those of behavior related to diet, physical activity, and breast health. Satisfaction questionnaires and focus groups were also used to assess acceptability and cultural competency. Statistical analyses included Paired t-tests and Wilcoxon signed ranks tests. Significant results postintervention showed improved physical activity, dietary, and breast health behaviors. Results suggest the acceptability, feasibility, and effectiveness of this comprehensive weight/loss breast health program in reducing multiple breast cancer risk factors among African-American women. PMID:14746356

  11. 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

    ... pricing, which requires address sequencing. For the manual option of Address Sequencing service, customers... 2010 year-to-date only 3 customers have requested this service. USPS recommends that these customers use the electronic option for Address ] Sequencing service which analyzes if a customer's address...

  12. 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.

  13. 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…

  14. 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

  15. 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.

  16. 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.

  17. 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

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

    PubMed

    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

  19. 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

  20. 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…

  1. 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…

  2. 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.

  3. 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

  4. MULTIVARIATE STATISTICAL APPLICATIONS FOR ADDRESSING MULTIPLE STRESSORS IN ECOLOGICAL RISK ASSESSMENTS

    EPA Science Inventory

    Ecological risk managers more and more frequently are asking how specific risk factors act in the environment within the context of the large number of natural stressor amount of variability that always have occurred. They wish to manage for cologically relevant solutions that wi...

  5. Comic Relief: Graduate Students Address Multiple Meanings for Technology Integration with Digital Comic Creation

    ERIC Educational Resources Information Center

    Sockman, Beth Rajan; Sutton, Rhonda; Herrmann, Michele

    2016-01-01

    This study determined the usefulness of digital comic creation with 77 graduate students in a teacher technology course. Students completed an assigned reading and created digital comics that addressed technology integration concerns in the schools and society. Using practical action research, 77 student-created comics were analyzed. The findings…

  6. 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

  7. Managing Multiple Funding Sources and Writing Grant Documents.

    ERIC Educational Resources Information Center

    Brewer, Ernest W.

    1993-01-01

    Successful grants management depends on understanding types of grants and sources of grant funding, writing multiple proposals, and managing and closing out grant projects. Ensuring renewal necessitates adhering to funder requirements, maintaining positive relations, and reporting effectively. (SK)

  8. Addressing parents' concerns: do multiple vaccines overwhelm or weaken the infant's immune system?

    PubMed

    Offit, Paul A; Quarles, Jessica; Gerber, Michael A; Hackett, Charles J; Marcuse, Edgar K; Kollman, Tobias R; Gellin, Bruce G; Landry, Sarah

    2002-01-01

    Recent surveys found that an increasing number of parents are concerned that infants receive too many vaccines. Implicit in this concern is that the infant's immune system is inadequately developed to handle vaccines safely or that multiple vaccines may overwhelm the immune system. In this review, we will examine the following: 1) the ontogeny of the active immune response and the ability of neonates and young infants to respond to vaccines; 2) the theoretic capacity of an infant's immune system; 3) data that demonstrate that mild or moderate illness does not interfere with an infant's ability to generate protective immune responses to vaccines; 4) how infants respond to vaccines given in combination compared with the same vaccines given separately; 5) data showing that vaccinated children are not more likely to develop infections with other pathogens than unvaccinated children; and 6) the fact that infants actually encounter fewer antigens in vaccines today than they did 40 or 100 years ago.

  9. 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.

  10. 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.

  11. Childhood Obesity Prevention and Treatment Research (COPTR): interventions addressing multiple influences in childhood and adolescent obesity.

    PubMed

    Pratt, Charlotte A; Boyington, Josephine; Esposito, Layla; Pemberton, Victoria L; Bonds, Denise; Kelley, Melinda; Yang, Song; Murray, David; Stevens, June

    2013-11-01

    This paper is the first of five papers in this issue that describes a new research consortium funded by the National Institutes of Health. It describes the design characteristics of the Childhood Obesity Prevention and Treatment Research (COPTR) trials and common measurements across the trials. The COPTR Consortium is conducting interventions to prevent obesity in pre-schoolers and treat overweight or obese 7-13 year olds. Four randomized controlled trials will enroll a total of 1700 children and adolescents (~50% female, 70% minorities), and will test innovative multi-level and multi-component interventions in multiple settings involving primary care physicians, parks and recreational centers, family advocates, and schools. For all the studies, the primary outcome measure is body mass index; secondary outcomes, moderators and mediators of intervention include diet, physical activity, home and neighborhood influences, and psychosocial factors. COPTR is being conducted collaboratively among four participating field centers, a coordinating center, and NIH project offices. Outcomes from COPTR have the potential to enhance our knowledge of interventions to prevent and treat childhood obesity.

  12. 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.

  13. 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

  14. Addressing Stability Robustness, Period Uncertainties, and Startup of Multiple-Period Repetitive Control for Spacecraft Jitter Mitigation

    NASA Astrophysics Data System (ADS)

    Ahn, Edwin S.

    Repetitive Control (RC) is a relatively new form of control that seeks to converge to zero tracking error when executing a periodic command, or when executing a constant command in the presence of a periodic disturbance. The design makes use of knowledge of the period of the disturbance or command, and makes use of the error observed in the previous period to update the command in the present period. The usual RC approaches address one period, and this means that potentially they can simultaneously address DC or constant error, the fundamental frequency for that period, and all harmonics up to Nyquist frequency. Spacecraft often have multiple sources of periodic excitation. Slight imbalance in reaction wheels used for attitude control creates three disturbance periods. A special RC structure was developed to allow one to address multiple unrelated periods which is referred to as Multiple-Period Repetitive Control (MPRC). MPRC in practice faces three main challenges for hardware implementation. One is instability due to model errors or parasitic high frequency modes, the second is degradation of the final error level due to period uncertainties or fluctuations, and the third is bad transients due to issues in startup. Regarding these three challenges, the thesis develops a series of methods to enhance the performance of MPRC or to assist in analyzing its performance for mitigating optical jitter induced by mechanical vibration within the structure of a spacecraft testbed. Experimental analysis of MPRC shows contrasting advantages over existing adaptive control algorithms, such as Filtered-X LMS, Adaptive Model Predictive Control, and Adaptive Basis Method, for mitigating jitter within the transmitting beam of Laser Communication (LaserCom) satellites.

  15. 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

  16. 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

  17. 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

  18. 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

    ... Bureau of Land Management Notice of Relocation/Change of Address for the Bureau of Land Management, Office of Pipeline Monitoring, Alaska State Office AGENCY: Bureau of Land Management, Interior. ACTION: Notice. SUMMARY: The Bureau of Land Management (BLM), Office of Pipeline Monitoring, located at 411...

  19. 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

  20. Service learning in a pediatric weight management program to address childhood obesity.

    PubMed

    Kuo, Fengyi; Goebel, Laurie A; Satkamp, Nicole; Beauchamp, Rachel; Kurrasch, Julie M; Smith, Asia R; Maguire, Julia M

    2013-04-01

    This paper describes an inter-professional service learning collaboration and reflects benefits and considerations when incorporating a family-oriented approach in the community-based pediatric weight management program. Because obesity has tremendous consequences on a nation's health and economy, a pediatrician in a community health network has utilized an inter-professional team to implement a pediatric weight management program targeting children between the ages of 8 and 15 years. The team incorporates a culturally sensitive curriculum using a family-oriented approach for obesity prevention and intervention. Physicians, registered dietitians, occupational therapists, nurse practitioners, and mental health professionals assist participants in adopting a healthier lifestyle by addressing physical and psychosocial issues related to obesity, developing a nutrition plan, making healthier food choices, and finding fun ways to be more physically active. Graduate occupational therapy students work closely with the team members to assist delivery of interactive activities and behavior intervention.

  1. Management of the multiple organ donor.

    PubMed

    Grebenik, C R; Hinds, C J

    1987-07-01

    The need for cadaveric organs for transplantation is increasing. This article provides guidelines for the identification of potential organ donors and suggests suitable principles of management. The physiological changes after brain death are briefly reviewed.

  2. Multiple system modelling of waste management.

    PubMed

    Eriksson, Ola; Bisaillon, Mattias

    2011-12-01

    Due to increased environmental awareness, planning and performance of waste management has become more and more complex. Therefore waste management has early been subject to different types of modelling. Another field with long experience of modelling and systems perspective is energy systems. The two modelling traditions have developed side by side, but so far there are very few attempts to combine them. Waste management systems can be linked together with energy systems through incineration plants. The models for waste management can be modelled on a quite detailed level whereas surrounding systems are modelled in a more simplistic way. This is a problem, as previous studies have shown that assumptions on the surrounding system often tend to be important for the conclusions. In this paper it is shown how two models, one for the district heating system (MARTES) and another one for the waste management system (ORWARE), can be linked together. The strengths and weaknesses with model linking are discussed when compared to simplistic assumptions on effects in the energy and waste management systems. It is concluded that the linking of models will provide a more complete, correct and credible picture of the consequences of different simultaneous changes in the systems. The linking procedure is easy to perform and also leads to activation of project partners. However, the simulation procedure is a bit more complicated and calls for the ability to run both models.

  3. 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

  4. Web-Based Geospatial Tools to Address Hazard Mitigation, Natural Resource Management, and Other Societal Issues

    USGS Publications Warehouse

    Hearn,, Paul P.

    2009-01-01

    Federal, State, and local government agencies in the United States face a broad range of issues on a daily basis. Among these are natural hazard mitigation, homeland security, emergency response, economic and community development, water supply, and health and safety services. The U.S. Geological Survey (USGS) helps decision makers address these issues by providing natural hazard assessments, information on energy, mineral, water and biological resources, maps, and other geospatial information. Increasingly, decision makers at all levels are challenged not by the lack of information, but by the absence of effective tools to synthesize the large volume of data available, and to utilize the data to frame policy options in a straightforward and understandable manner. While geographic information system (GIS) technology has been widely applied to this end, systems with the necessary analytical power have been usable only by trained operators. The USGS is addressing the need for more accessible, manageable data tools by developing a suite of Web-based geospatial applications that will incorporate USGS and cooperating partner data into the decision making process for a variety of critical issues. Examples of Web-based geospatial tools being used to address societal issues follow.

  5. 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

  6. Multiple system modelling of waste management

    SciTech Connect

    Eriksson, Ola; Bisaillon, Mattias

    2011-12-15

    Highlights: > Linking of models will provide a more complete, correct and credible picture of the systems. > The linking procedure is easy to perform and also leads to activation of project partners. > The simulation procedure is a bit more complicated and calls for the ability to run both models. - Abstract: Due to increased environmental awareness, planning and performance of waste management has become more and more complex. Therefore waste management has early been subject to different types of modelling. Another field with long experience of modelling and systems perspective is energy systems. The two modelling traditions have developed side by side, but so far there are very few attempts to combine them. Waste management systems can be linked together with energy systems through incineration plants. The models for waste management can be modelled on a quite detailed level whereas surrounding systems are modelled in a more simplistic way. This is a problem, as previous studies have shown that assumptions on the surrounding system often tend to be important for the conclusions. In this paper it is shown how two models, one for the district heating system (MARTES) and another one for the waste management system (ORWARE), can be linked together. The strengths and weaknesses with model linking are discussed when compared to simplistic assumptions on effects in the energy and waste management systems. It is concluded that the linking of models will provide a more complete, correct and credible picture of the consequences of different simultaneous changes in the systems. The linking procedure is easy to perform and also leads to activation of project partners. However, the simulation procedure is a bit more complicated and calls for the ability to run both models.

  7. 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.

  8. 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.

  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. Approaches and incentives to implement integrated pest management that addresses regional and environmental issues.

    PubMed

    Brewer, Michael J; Goodell, Peter B

    2012-01-01

    Agricultural, environmental, and social and policy interests have influenced integrated pest management (IPM) from its inception. The first 50 years of IPM paid special attention to field-based management and market-driven decision making. Concurrently, IPM strategies became available that were best applied both within and beyond the bounds of individual fields and that also provided environmental benefits. This generated an incentives dilemma for farmers: selecting IPM activities for individual fields on the basis of market-based economics versus selecting IPM activities best applied regionally that have longer-term benefits, including environmental benefits, that accrue to the broader community as well as the farmer. Over the past several decades, public-supported incentives, such as financial incentives available to farmers from conservation programs for farms, have begun to be employed to encourage use of conservation techniques, including strategies with IPM relevance. Combining private investments with public support may effectively address the incentives dilemma when advanced IPM strategies are used regionally and provide public goods such as those benefiting resource conservation. This review focuses on adaptation of IPM to these broader issues, on transitions of IPM from primarily individual field-based decision making to coordinated community decision making, and on the form of partnerships needed to gain long-lasting regional and environmental benefits.

  11. 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.

  12. 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.

  13. Managing large online classes across multiple locations.

    PubMed

    Egea, Kathy; Zelmer, A C Lynn

    2004-01-01

    We now have many different ways of delivering educational offerings, hopefully tailored to the educational environments and student characteristics. Programs vary based on country of origin and delivery location, organisational structures, development and delivery technologies, and the business arrangements made between providers and agents/students. At Central Queensland University (CQU) we deliver the same courses domestically and internationally, often with more than 1000 students per offering, several times per year across 14 campuses located thousands of kilometers apart using face-to-face and/or virtual mode. The students are a mix of Australian distance and on campus plus international on campus. This chapter builds on the CQU experience managing these large classes, particularly within the Faculty of Informatics and Communication, using an evolving mix of technologies. The economic realities of tertiary education require providers to focus on servicing international markets, including an emphasis on student preferences for language of instruction, preferred location (campus or distance delivery) and mode of instruction. Educational delivery requires development and delivery teamwork, maintenance of consistency (quality) in terms of offerings and assessment, appropriate use of technology and cultural awareness.

  14. 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

  15. 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…

  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. 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

  18. Current Concepts in Orthopedic Management of Multiple Trauma

    PubMed Central

    Kucukdurmaz, Fatih; Alijanipour, Pouya

    2015-01-01

    Multiple trauma patients frequently present challenging clinical scenarios with musculoskeletal injuries being the most common indications for surgical procedures in these patients. Despite our substantial knowledge, a universally approved objective definition for “multiple trauma” is yet to be delineated. Several controversial aspects of economics, pathophysiology, animal models, diagnosis, management and outcome of patients with multiple trauma have recently been explored and although some progress has been made, it seems that the available evidence is still inconclusive in some occasions. This manuscript revisits several current concepts of multiple trauma that have been the focus of recent investigation. We aim to provide the reader with an updated perspective based on the most recently published literature in the field of multiple trauma. PMID:26312111

  19. 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.

  20. Addressing occupational factors in the management of low back pain: implications for physical therapist practice.

    PubMed

    Shaw, William S; Main, Chris J; Johnston, Venerina

    2011-05-01

    There is mounting evidence that occupational factors influence the extent of sickness absence following an episode of low back pain, but there have been limited efforts to integrate the identification and management of occupational factors into the routine practice of physical therapists. Systematic reviews suggest that a client's report of heavy physical demands, inability to modify job tasks, work stress, lack of organizational support, job dissatisfaction, poor expectations for resuming usual work, and fear of reinjury are indications of significant barriers to returning to work. Recommended strategies for evaluating and addressing occupational factors are explored with respect to the physical therapist's role in client assessment, development of activity and lifestyle recommendations, therapeutic exercise, communication with other providers, and summary reports. Primary recommendations include: (1) administration of self-report questionnaires to assess a client's perspective of physical job demands, (2) client-centered interviewing to highlight individual return-to-work concerns, (3) early discussions with clients about possible job modifications, and (4) incorporation of clients' workplace concerns in progress reports and summaries. These strategies may improve low back pain outcomes by encouraging effective communication with key stakeholders and by developing clients' ability to resolve obstacles to returning to work. PMID:21451096

  1. Effective Management of Multiple Roles: Family and Work.

    ERIC Educational Resources Information Center

    Texas Tech Univ., Lubbock. Home Economics Curriculum Center.

    A facilitator's manual and participant materials (adult and student) are provided for a program designed to help students, teachers, and people in business and industry to learn effective skills for managing multiple roles and how to apply those skills in balancing work and family issues. The facilitator's manual contains information on project…

  2. Optimization of landscape services under uncoordinated management by multiple landowners.

    PubMed

    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

  3. Diagnosis and Management of Multiple Sclerosis in Children

    PubMed Central

    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

  4. Evaluation of Dairy Effluent Management Options Using Multiple Criteria Analysis

    NASA Astrophysics Data System (ADS)

    Hajkowicz, Stefan A.; Wheeler, Sarah A.

    2008-04-01

    This article describes how options for managing dairy effluent on the Lower Murray River in South Australia were evaluated using multiple criteria analysis (MCA). Multiple criteria analysis is a framework for combining multiple environmental, social, and economic objectives in policy decisions. At the time of the study, dairy irrigation in the region was based on flood irrigation which involved returning effluent to the river. The returned water contained nutrients, salts, and microbial contaminants leading to environmental, human health, and tourism impacts. In this study MCA was used to evaluate 11 options against 6 criteria for managing dairy effluent problems. Of the 11 options, the MCA model selected partial rehabilitation of dairy paddocks with the conversion of remaining land to other agriculture. Soon after, the South Australian Government adopted this course of action and is now providing incentives for dairy farmers in the region to upgrade irrigation infrastructure and/or enter alternative industries.

  5. Evaluation of dairy effluent management options using multiple criteria analysis.

    PubMed

    Hajkowicz, Stefan A; Wheeler, Sarah A

    2008-04-01

    This article describes how options for managing dairy effluent on the Lower Murray River in South Australia were evaluated using multiple criteria analysis (MCA). Multiple criteria analysis is a framework for combining multiple environmental, social, and economic objectives in policy decisions. At the time of the study, dairy irrigation in the region was based on flood irrigation which involved returning effluent to the river. The returned water contained nutrients, salts, and microbial contaminants leading to environmental, human health, and tourism impacts. In this study MCA was used to evaluate 11 options against 6 criteria for managing dairy effluent problems. Of the 11 options, the MCA model selected partial rehabilitation of dairy paddocks with the conversion of remaining land to other agriculture. Soon after, the South Australian Government adopted this course of action and is now providing incentives for dairy farmers in the region to upgrade irrigation infrastructure and/or enter alternative industries.

  6. 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.

  7. 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…

  8. Management of Fatigue in Persons with Multiple Sclerosis

    PubMed Central

    Khan, Fary; Amatya, Bhasker; Galea, Mary

    2014-01-01

    Fatigue is one of the most common symptoms of multiple sclerosis. Despite advances in pharmacological and non-pharmacological treatment, fatigue continues to be the disabling symptom in persons with MS (pwMS), affecting almost 80% of pwMS. In current practice, both pharmacological and non-pharmacological interventions are used in combination, encompassing a multi-disciplinary approach. The body of research investigating the effect of these interventions is growing. This review systematically evaluated the existing evidence on the effectiveness and safety of different interventions currently applied for the management of fatigue in person with multiple sclerosis in improving patient outcomes, to guide treating clinicians. PMID:25309504

  9. Current management of relapsing-remitting multiple sclerosis.

    PubMed

    Sedal, L; Wilson, I B; McDonald, E A

    2014-10-01

    Multiple sclerosis was without effective disease-modifying therapy for many years. The introduction of the injectable therapies (interferon and glatiramer acetate) some 20 years ago was considered a major advance. Recent years have heralded a revolution in treatment options with the introduction of intravenous natalizumab and, even more recently, three oral agents. We are currently in a period of determining the best use of these therapies to ensure prevention of disease progression while maintaining patient safety. Despite these new treatments, there are still many patients living with disability as a result of multiple sclerosis and significant attention must be given to symptomatic management. PMID:25302718

  10. 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…

  11. Long-term management of patients with multiple sclerosis.

    PubMed

    Weightman, Cherie

    2006-07-01

    This article explores the challenges of long-term case management for patients who have multiple sclerosis (MS). Currently there is scant research into district nursing input into long-term management of patients who have MS. Until now the role of the community nurses has been confined to palliation or terminal care, focusing on the more physical manifestations of MS. The contemporary role of district nurse is going to evolve to include proactive approaches. Governmental initiatives demand proactive services, and place emphasis on self-care for patients with MS. Themes that emerge from this article relate to the pre-existing skills--such as managing patients with complex needs and the advanced assessment skills--that will be required to achieve this. What is clear is that community nurses already possess many of the prerequisite skills needed for long-term management, and they should not be daunted by this prospect.

  12. 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

  13. 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.

  14. Progress Addressing Safeguards Capability Development Needs through Educational Outreach and Knowledge Management

    SciTech Connect

    Leek, K. M.; Seward, Amy M.; Dickman, Deborah A.; Toomey, Charles J.; Greenfield, Bryce A.; Mathews, Caroline E.; Fishbone, L.; Graham, T.; Rosenthal, Michael; Ward, B.

    2010-11-08

    This paper describes the NGSI Human Capital Development Program's domestic and international activities, and offers specific case studies to exemplify the outcomes and progress achieved in this area over the past several years. The paper highlights the importance of a sustained effort to address the human dimension of safeguards and nonproliferation and to address critical work force issues in the U.S. and abroad.

  15. 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.

  16. A New Standard-Based Polynomial Interpolation (SBPIn) Method to Address Gel-to-Gel Variability for the Comparison of Multiple Denaturing Gradient Gel Electrophoresis Profile Matrices

    PubMed Central

    Valentín-Vargas, Alexis; Chorover, Jon; Maier, Raina M.

    2013-01-01

    The Standard-Based Polynomial Interpolation (SBPIn) method is a new simple three-step protocol proposed to address common gel-to-gel variations for the comparison of sample profiles across multiple DGGE gels. The advantages of this method include no requirement for additional software or modification of the standard DGGE protocol. PMID:23234884

  17. 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

  18. 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.

  19. 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.

  20. 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.

  1. 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

  2. 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…

  3. 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…

  4. Managing the Facilities Portfolio: New Book Addresses Elimination of $60 Billion Problem.

    ERIC Educational Resources Information Center

    Rush, Sean; And Others

    1991-01-01

    This excerpt from "Managing the Facilities Portfolio: A Practical Approach to Institutional Renewal and Deferred Maintenance" offers higher education business officers a conceptual framework comprising four steps: (1) establish baseline; (2) estimate needs; (3) compare model alternatives; and (4) report to management. (DB)

  5. 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…

  6. Managing chronic sorrow: experiences of patients with multiple sclerosis.

    PubMed

    Isaksson, Ann-Kristin; Ahlström, Gerd

    2008-06-01

    The goals of this study were to describe the ways in which patients with multiple sclerosis (MS) manage chronic sorrow and to apply this information to the theoretical model of chronic sorrow. This descriptive study involved 38 participants with MS who were experiencing chronic sorrow. Using the theoretical model of chronic sorrow, we applied content analysis to participants' accounts of how they attempted to manage this sorrow. The findings showed that discomfort resulted from ineffective management of chronic sorrow, reflecting the vulnerability these patients experience and the lack of understanding of their needs and appropriate support from family, friends, and healthcare personnel. In some cases, however, the losses and emotional distress caused by MS were managed effectively, which led to increased comfort through personal growth and a greater appreciation of life, greater confidence, and hope for the future. The theoretical model was valuable in helping to describe participants' patterns of managing chronic sorrow. Healthcare personnel should acknowledge chronic sorrow as one aspect of psychological distress in MS. Knowledge of patients' experiences of chronic sorrow should be included in the education for neuroscience nurses. Furthermore, it is necessary to develop support interventions for patients with chronic sorrow and their families.

  7. 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.

  8. Legal issues to address when managing clinical information across Europe: the ECIT case study (www.ECIT.info).

    PubMed

    Lawford Davies, James; Jenkins, Julian

    2005-01-01

    This paper identifies issues which will need to be addressed in pursuing the aims and objectives of the European Classification of Infertility Taskforce (ECIT), namely: to establish classification codes for infertility management; to improve the consistency of infertility information collection by specialist centres, particularly but not exclusively by computerised systems; to use these codes to enable the transfer of infertility information from specialist centres to national infertility data registries; to develop a Grid linking the data held in European infertility data registries; to use Grid processing to mine the data in the European infertility data registries to optimise patient management improving the effectiveness of treatment and reducing the risk.

  9. 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

  10. Managing Multiple Vacancies: Ten Library Directors' Suggestions for Expediting Multiple Searches and Mitigating the Effects on Staff

    ERIC Educational Resources Information Center

    Munde, Gail

    2008-01-01

    Many libraries have a disaster plan for collections and facilities, but few libraries have a plan to address the strategic or practical implications of multiple vacancies. Much has been written about the search process, but little about the considerations involved in multiple search situations.

  11. Bone disease in multiple myeloma: pathophysiology and management.

    PubMed

    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.

  12. 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

  13. Management of fatigue in patients with multiple sclerosis.

    PubMed

    Zifko, Udo A

    2004-01-01

    As long as no causal treatment is available for multiple sclerosis (MS), and as long as only some patients with MS respond to immunomodulators, symptomatic treatment is of paramount importance. Fatigue is the most common symptom of MS and is associated with a reduced quality of life. It is described as the worst symptom of their disease by 50-60% of patients. The first step in managing MS-related fatigue is identifying and eliminating any secondary causes. Primary fatigue syndrome can be alleviated with drug treatment in many cases. Modafinil has been shown to be effective in some studies, and amantadine is an alternative for patients who do not respond to or cannot tolerate modafinil. The nonpharmacological management of fatigue in MS includes inpatient rehabilitation and aerobic endurance exercise. This article describes the pathophysiology, diagnosis and treatment of MS-related fatigue--the most common symptom of MS.

  14. 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…

  15. "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...

  16. 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…

  17. Addressable micropatterning of multiple proteins and cells by microscope projection photolithography based on a protein friendly photoresist.

    PubMed

    Kim, Miju; Choi, Jong-Cheol; Jung, Hong-Ryul; Katz, Joshua S; Kim, Min-Gon; Doh, Junsang

    2010-07-20

    We report a new method for the micropatterning of multiple proteins and cells with micrometer-scale precision. Microscope projection photolithography based on a new protein-friendly photoresist, poly(2,2-dimethoxy nitrobenzyl methacrylate-r-methyl methacrylate-r-poly(ethylene glycol) methacrylate) (PDMP), was used for the fabrication of multicomponent protein/cell arrays. Microscope projection lithography allows precise registration between multiple patterns as well as facile fabrication of microscale features. Thin films of PDMP became soluble in near-neutral physiological buffer solutions upon UV exposure and exhibited excellent resistance to protein adsorption and cell adhesion. By harnessing advantages in microscope projection photolithography and properties of PDMP thin films, we could successfully fabricate protein arrays composed of multiple proteins. Furthermore, we could extend this method for the patterning of two different types of immune cells for the potential study of immune cell interactions. This technique will in general be useful for protein chip fabrication and high-throughput cell-cell communication study.

  18. 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

  19. 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.

  20. 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

  1. 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

  2. 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

  3. 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.

  4. 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.

  5. An integrated approach for addressing uncertainty in the delineation of groundwater management areas.

    PubMed

    Sousa, Marcelo R; Frind, Emil O; Rudolph, David L

    2013-05-01

    Uncertainty is a pervasive but often poorly understood factor in the delineation of wellhead protection areas (WHPAs), which can discourage water managers and practitioners from relying on model results. To make uncertainty more understandable and thereby remove a barrier to the acceptance of models in the WHPA context, we present a simple approach for dealing with uncertainty. The approach considers two spatial scales for representing uncertainty: local and global. At the local scale, uncertainties are assumed to be due to heterogeneities, and a capture zone is expressed in terms of a capture probability plume. At the global scale, uncertainties are expressed through scenario analysis, using a limited number of physically realistic scenarios. The two scales are integrated by using the precautionary principle to merge the individual capture probability plumes corresponding to the different scenarios. The approach applies to both wellhead protection and the mitigation of contaminated aquifers, or in general, to groundwater management areas. An example relates to the WHPA for a supply well located in a complex glacial aquifer system in southwestern Ontario, where we focus on uncertainty due to the spatial distributions of recharge. While different recharge scenarios calibrate equally well to the same data, they result in different capture probability plumes. Using the precautionary approach, the different plumes are merged into two types of maps delineating groundwater management areas for either wellhead protection or aquifer mitigation. The study shows that calibrations may be non-unique, and that finding a "best" model on the basis of the calibration fit may not be possible.

  6. 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.

  7. 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.

  8. "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…

  9. 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

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

    USGS Publications Warehouse

    Kowalski, Kurt P.

    2016-06-30

    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.

  11. Water demand management in Yemen and Jordan: addressing power and interests.

    PubMed

    Zeitoun, Mark; Allan, Tony; Al Aulaqi, Nasser; Jabarin, Amer; Laamrani, Hammou

    2012-01-01

    This paper investigates the extent to which entrenched interests of stakeholder groups both maintain water use practice, and may be confronted. The focus is on the agricultural sectors of Yemen and Jordan, where water resource policymakers face resistance in their attempts to reduce water use to environmentally sustainable levels through implementation of water demand management (WDM) activities. Some farmers in both countries that have invested in irrigated production of high-value crops (such as qat and bananas) benefit from a political economy that encourages increased rather than reduced water consumption. The resultant over-exploitation of water resources affects groups in unequal measures. Stakeholder analysis demonstrates that the more ‘powerful’ groups (chiefly the large landowners and the political elites, as well as the ministries of irrigation over which they exert influence) are generally opposed to reform in water use, while the proponents of WDM (e.g. water resource managers, environmental ministries and NGOs, and the international donor community) are found to have minimal influence over water use policy and decisionmaking. Efforts and ideas attempted by this latter group to challenge the status quo are classified here as either (a) influencing or (b) challenging the power asymmetry, and the merits and limits of both approaches are discussed. The interpretation of evidence suggests current practice is likely to endure, but may be more effectively challenged if a long-term approach is taken with an awareness of opportunities generated by windows of opportunity and the participation of ‘overlap groups’. PMID:22413173

  12. 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.

  13. Water demand management in Yemen and Jordan: addressing power and interests.

    PubMed

    Zeitoun, Mark; Allan, Tony; Al Aulaqi, Nasser; Jabarin, Amer; Laamrani, Hammou

    2012-01-01

    This paper investigates the extent to which entrenched interests of stakeholder groups both maintain water use practice, and may be confronted. The focus is on the agricultural sectors of Yemen and Jordan, where water resource policymakers face resistance in their attempts to reduce water use to environmentally sustainable levels through implementation of water demand management (WDM) activities. Some farmers in both countries that have invested in irrigated production of high-value crops (such as qat and bananas) benefit from a political economy that encourages increased rather than reduced water consumption. The resultant over-exploitation of water resources affects groups in unequal measures. Stakeholder analysis demonstrates that the more ‘powerful’ groups (chiefly the large landowners and the political elites, as well as the ministries of irrigation over which they exert influence) are generally opposed to reform in water use, while the proponents of WDM (e.g. water resource managers, environmental ministries and NGOs, and the international donor community) are found to have minimal influence over water use policy and decisionmaking. Efforts and ideas attempted by this latter group to challenge the status quo are classified here as either (a) influencing or (b) challenging the power asymmetry, and the merits and limits of both approaches are discussed. The interpretation of evidence suggests current practice is likely to endure, but may be more effectively challenged if a long-term approach is taken with an awareness of opportunities generated by windows of opportunity and the participation of ‘overlap groups’.

  14. Novel therapeutics in multiple sclerosis management: clinical applications.

    PubMed

    Leist, Thomas; Hunter, Samuel F; Kantor, Daniel; Markowitz, Clyde

    2014-01-01

    Multiple sclerosis (MS) affects an estimated 300,000 individuals in the United States. No cure exists and although there is a lack of consensus on management, strategies to modify disease course are available. These strategies involve initiating disease-modifying therapies that have been found to slow disease progression and prevent disability symptoms, thereby improving function for MS patients. The overall goal of early disease management is to intervene prior to irreversible neuronal destruction in order to delay disability progression and improve quality of life. Maintaining a lower level of disability for a longer period of time postpones and ultimately attempts to prevent reaching a level of immobility and irreversible disability. However, due to the complex nature of disease and its unique, individual patient course, no patient can be treated alike and no patient responds to therapy similarly. Therefore, MS research is continuous in its evolution of therapeutic development, focusing on neuroprotective effects and agents with distinctive mechanisms of action allowing for unique safety and efficacy profiles. Investigations include novel oral agents and monoclonal antibodies. Many of the approved agents also are continually being investigated in order to evaluate comparative data, the most appropriate means of implementing subsequent therapy upon failure, responsiveness to therapeutic agent when switched, and long-term safety and efficacy. This multimedia webcast educational activity will cover the current state of MS science, current therapies in MS, emerging treatments in clinical trials for MS as well as differences between physicians in diagnosis and management of MS and their evolving practices.

  15. 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

  16. 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

  17. 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

  18. 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

  19. 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

    2014-02-25

    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.

  20. 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

  1. Phylogenetic relationships within the lizard clade Xantusiidae: using trees and divergence times to address evolutionary questions at multiple levels.

    PubMed

    Noonan, Brice P; Pramuk, Jennifer B; Bezy, Robert L; Sinclair, Elizabeth A; de Queiroz, Kevin; Sites, Jack W

    2013-10-01

    Xantusiidae (night lizards) is a clade of small-bodied, cryptic lizards endemic to the New World. The clade is characterized by several features that would benefit from interpretation in a phylogenetic context, including: (1) monophyletic status of extant taxa Cricosaura, Lepidophyma, and Xantusia; (2) a species endemic to Cuba (Cricosaura typica) of disputed age; (3) origins of the parthenogenetic species of Lepidophyma; (4) pronounced micro-habitat differences accompanied by distinct morphologies in both Xantusia and Lepidophyma; and (5) placement of Xantusia riversiana, the only vertebrate species endemic to the California Channel Islands, which is highly divergent from its mainland relatives. This study incorporates extensive new character data from multiple gene regions to investigate the phylogeny of Xantusiidae using the most comprehensive taxonomic sampling available to date. Parsimony and partitioned Bayesian analyses of more than 7 kb of mitochondrial and nuclear sequence data from 11 loci all confirm that Xantusiidae is monophyletic, and comprises three well-supported clades: Cricosaura, Xantusia, and Lepidophyma. The Cuban endemic Cricosaura typica is well supported as the sister to all other xantusiids. Estimates of divergence time indicate that Cricosaura diverged from the (Lepidophyma+Xantusia) clade ≈ 81 million years ago (Ma), a time frame consistent with the separation of the Antilles from North America. Our results also confirm and extend an earlier study suggesting that parthenogenesis has arisen at least twice within Lepidophyma without hybridization, that rock-crevice ecomorphs evolved numerous times (>9) within Xantusia and Lepidophyma, and that the large-bodied Channel Island endemic X. riversiana is a distinct, early lineage that may form the sister group to the small-bodied congeners of the mainland.

  2. Tablet-based screening improves continence management in multiple sclerosis

    PubMed Central

    Beadnall, Heidi N; Kuppanda, Kushi E; O’Connell, Annmaree; Hardy, Todd A; Reddel, Stephen W; Barnett, Michael H

    2015-01-01

    Objective To investigate whether electronic continence questionnaires aid early identification and optimizes management of sphincter dysfunction in a multiple sclerosis clinic. Methods A custom designed, tablet-based cross-platform software tool was designed to capture validated multiple sclerosis (MS) patient-reported outcomes. An unselected cohort of MS patients from a tertiary referral clinic completed electronic tablet-based versions of the Bladder Control Scale (BLCS) and the Bowel Control Scale in the waiting room. Data were captured wirelessly “on-the-fly” and stored in a deidentified, secure database; and individual questionnaire results were immediately available to the treating neurologist in the electronic medical record. Scores of ≥2 on either questionnaire generated an automated electronic referral to the clinic MS continence nurse (MS CN). Results One hundred and fifty-seven MS patients completed a total of 184 electronic continence test sets and on two occasions only the BLCS was completed. An automatic electronic referral for formal continence review was generated 128 times in 108 patients. Fifty-seven formal continence assessments were undertaken by the MS CN following automated referral. All reviews resulted in at least one clinical intervention being made. Interpretation Tablet-based data capture and automated continence referral using this software tool is an efficient, sensitive, and feasible method of screening MS patients for bladder and bowel dysfunction. Concordance with the results of formal continence assessment in this pilot study validates the use of this technology as a screening tool. PMID:26125042

  3. Multiple sclerosis pathways: an innovative nursing role in disease management.

    PubMed

    Madonna, M G; Keating, M M

    1999-12-01

    Multiple sclerosis (MS), a chronic disease of the central nervous system, is characterized by a variable and unpredictable course. The most common pattern of the disease is the relapsing-remitting form in which clearly defined relapses (also called exacerbations) are followed by complete or incomplete recovery. Interferon beta-1b (Betaseron), a drug that affects the natural course of the disease, was developed for the treatment of relapsing-remitting MS. Multiple Sclerosis Pathways (MSP), a disease management program, was developed to provide comprehensive and personal support to MS patients taking interferon beta-1b and to serve as an information resource for all people with MS, their families, and healthcare professionals. The MSP program includes personal patient assistance, reimbursement services, a 24-hour nurse hotline, training program, educational resources, and injection supplies. The nurse hotline counselor (NHC) utilizes the nursing process in a unique telephone nursing practice in this program. The positive impact of education and support on adherence to therapy has been validated by training and nurse hotline data.

  4. Clinical strategies to address patients' concerns in osteoporosis management with bisphosphonates.

    PubMed

    Cole, Raymond E

    2011-03-01

    Approximately 44 million Americans either have, or are at risk of developing, osteoporosis, a disease associated with an increased risk of fracture and, consequently, morbidity and mortality. Osteoporosis affects 20% to 30% of postmenopausal women, and resulting fractures pose a major economic burden, with estimated annual direct costs ranging from $17 billion to $19 billion. Hip fractures account for the majority of costs (~60%) because they often require costly long-term follow-up care in addition to the direct costs of initial treatment. Screening, diagnosis, and disease management are of paramount importance when treating patients at risk for osteoporosis. The National Osteoporosis Foundation recommends that all postmenopausal women be evaluated for osteoporosis risk factors and that all women aged ≥ 65 years undergo bone mineral density testing. Once the primary care physician has identified a patient at risk for osteoporosis-related fracture, the physician must decide whether and how to treat the patient (ie, nonpharmacologic or pharmacologic options). Bisphosphonates are the first-line pharmacologic treatment for women aged ≥ 50 years with postmenopausal osteoporosis. Bisphosphonates-which have a favorable safety and tolerability profile in clinical trials-have shown efficacy in reducing fractures. However, achieved real world effectiveness is very much dependent on good treatment adherence by the patient. Media attention to rare adverse events has motivated some patients to deliberate nonadherence. Physicians should screen patients for contraindications and adverse event risk factors, educate them on the risks of fracture and benefits and risks of treatment, and monitor them during therapy. To assist primary care physicians in clinical decision making for women at risk for or with confirmed osteoporosis, this article presents a review of the guidelines for the diagnosis and treatment of postmenopausal osteoporosis, recent long-term efficacy data for

  5. 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

  6. 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

  7. 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.

  8. Clinical Management of Multiple Sclerosis Through Home Telehealth Monitoring

    PubMed Central

    Wallin, Mitchell T.; Sloan, Alicia; Maloni, Heidi; Kane, Robert; Martz, Lore; Haselkorn, Jodie K.

    2013-01-01

    This study examined the feasibility of using home telehealth monitoring to improve clinical care and promote symptom self-management among veterans with multiple sclerosis (MS). This was a longitudinal cohort study linking mailed survey data at baseline and 6-month follow-up with information from home telehealth monitors. The study was conducted in two large Department of Veterans Affairs (VA) MS clinics in Seattle, Washington, and Washington, DC, and involved 41 veterans with MS. The measures were demographic information and data from a standardized question set using a home telehealth monitor. Participants reported moderate levels of disability (median Expanded Disability Status Scale [EDSS] score, 6.5) and substantial distance from the nearest VA MS clinic (mean distance, 93.6 miles). Of the participants, 61.0% reported current use of MS disease-modifying treatments. A total of 85.4% of participants provided consistent data from home monitoring. Overall satisfaction with home telehealth monitoring was high, with 87.5% of participants rating their experience as good or better. The most frequently reported symptoms at month 1 were fatigue (95.1%), depression (78.0%), and pain (70.7%). All symptoms were reported less frequently by month 6, with the greatest reduction in depression (change of 23.2 percentage points), although these changes were not statistically significant. Home telehealth monitoring is a promising tool for the management of chronic disease, although substantial practical barriers to efficient implementation remain. PMID:24453757

  9. Self-presentational persona: simultaneous management of multiple impressions.

    PubMed

    Leary, Mark R; Allen, Ashley Batts

    2011-11-01

    Most research on self-presentation has examined how people convey images of themselves on only 1 or 2 dimensions at a time. In everyday interactions, however, people often manage their impressions on several image-relevant dimensions simultaneously. By examining people's self-presentations to several targets across multiple dimensions, these 2 studies offer new insights into the nature of self-presentation and provide a novel paradigm for studying impression management. Results showed that most people rely on a relatively small number of basic self-presentational personas in which they convey particular profiles of impressions as a set and that these personas reflect both normative influences to project images that are appropriate to a particular target and distinctive influences by which people put an idiosyncratic spin on these normative images. Furthermore, although people's self-presentational profiles correlate moderately with their self-views, they tailor their public images to specific targets. The degree to which participants' self-presentations were normative and distinctive, as well as the extent to which they reflected their own self-views, were moderated by individual differences in agreeableness, self-esteem, authenticity, and Machiavellianism.

  10. A conceptual framework for addressing complexity and unfolding transition dynamics when developing sustainable adaptation strategies in urban water management.

    PubMed

    Fratini, C F; Elle, M; Jensen, M B; Mikkelsen, P S

    2012-01-01

    To achieve a successful and sustainable adaptation to climate change we need to transform the way we think about change. Much water management research has focused on technical innovation with a range of new solutions developed to achieve a 'more sustainable and integrated urban water management cycle'. But Danish municipalities and utility companies are struggling to bring such solutions into practice. 'Green infrastructure', for example, requires the consideration of a larger range of aspects related to the urban context than the traditional urban water system optimization. There is the need for standardized methods and guidelines to organize transdisciplinary processes where different types of knowledge and perspectives are taken into account. On the basis of the macro-meso-micro pattern inspired by complexity science and transition theory, we developed a conceptual framework to organize processes addressing the complexity characterizing urban water management in the context of climate change. In this paper the framework is used to organize a research process aiming at understanding and unfolding urban dynamics for sustainable transition. The final goal is to enable local authorities and utilities to create the basis for managing and catalysing the technical and organizational innovation necessary for a sustainable transition towards climate change adaptation in urban areas.

  11. 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

  12. 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

  13. 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

  14. 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

  15. Delaware Estuary situation reports. Emergency response: How do emergency management officials address disasters in the Delaware Estuary

    SciTech Connect

    Sylves, R.T.

    1991-01-01

    From hurricanes and other natural threats to oil spills and other manmade emergencies, the Delaware Estuary has experienced a variety of disasters over the years. The toll that these events take on the estuary and those who live on its shores depends largely upon the degree of emergency preparedness, speed of response, and effectiveness of recovery operations. In Emergency Response: How Do Emergency Management Officials Address Disasters in the Delaware Estuary, the latest addition to its Delaware Estuary Situation Report series, the University of Delaware Sea Grant College Program defines emergency management; examines the roles that the Coast Guard, Army Corps of Engineers, and Environmental Protection Agency play in an emergency; and reviews how each of these federal agencies operated during an actual disaster--the 1985 Grand Eagle oil spill. The report was written by Dr. Richard T. Sylves, a professor of political science at the University of Delaware. Sylves has been studying emergency management for the past 15 years, with special emphasis on oil spill preparedness and response in the Mid-Atlantic Region. The Delaware Estuary Situation Report is 12 pages long and contains maps and photographs, as well as a detailed account of response and recovery operations undertaken during the Grand Eagle oil spill. A comparison of the 1985 Grand Eagle spill and the 1989 Presidente Rivera spill also is included.

  16. Integrating multiple disturbance aspects: management of an invasive thistle, Carduus nutans

    PubMed Central

    Zhang, Rui; Shea, Katriona

    2012-01-01

    Background and Aims Disturbances occur in most ecological systems, and play an important role in biological invasions. We delimit five key disturbance aspects: intensity, frequency, timing, duration and extent. Few studies address more than one of these aspects, yet interactions and interdependence between aspects may lead to complex outcomes. Methods In a two-cohort experimental study, we examined how multiple aspects (intensity, frequency and timing) of a mowing disturbance regime affect the survival, phenology, growth and reproduction of an invasive thistle Carduus nutans (musk thistle). Key Results Our results show that high intensity and late timing strongly delay flowering phenology and reduce plant survival, capitulum production and plant height. A significant interaction between intensity and timing further magnifies the main effects. Unexpectedly, high frequency alone did not effectively reduce reproduction. However, a study examining only frequency and intensity, and not timing, would have erroneously attributed the importance of timing to frequency. Conclusions We used management of an invasive species as an example to demonstrate the importance of a multiple-aspect disturbance framework. Failure to consider possible interactions, and the inherent interdependence of certain aspects, could result in misinterpretation and inappropriate management efforts. This framework can be broadly applied to improve our understanding of disturbance effects on individual responses, population dynamics and community composition. PMID:22199031

  17. 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

  18. 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

  19. Precision medicine in chronic disease management: The multiple sclerosis BioScreen.

    PubMed

    Gourraud, Pierre-Antoine; Henry, Roland G; Cree, Bruce A C; Crane, Jason C; Lizee, Antoine; Olson, Marram P; Santaniello, Adam V; Datta, Esha; Zhu, Alyssa H; Bevan, Carolyn J; Gelfand, Jeffrey M; Graves, Jennifer S; Goodin, Douglas S; Green, Ari J; von Büdingen, H-Christian; Waubant, Emmanuelle; Zamvil, Scott S; Crabtree-Hartman, Elizabeth; Nelson, Sarah; Baranzini, Sergio E; Hauser, Stephen L

    2014-11-01

    We present a precision medicine application developed for multiple sclerosis (MS): the MS BioScreen. This new tool addresses the challenges of dynamic management of a complex chronic disease; the interaction of clinicians and patients with such a tool illustrates the extent to which translational digital medicine-that is, the application of information technology to medicine-has the potential to radically transform medical practice. We introduce 3 key evolutionary phases in displaying data to health care providers, patients, and researchers: visualization (accessing data), contextualization (understanding the data), and actionable interpretation (real-time use of the data to assist decision making). Together, these form the stepping stones that are expected to accelerate standardization of data across platforms, promote evidence-based medicine, support shared decision making, and ultimately lead to improved outcomes.

  20. Posttraumatic stress disorder among survivors of critical illness: creation of a conceptual model addressing identification, prevention, and management.

    PubMed

    Long, Ann C; Kross, Erin K; Davydow, Dimitry S; Curtis, J Randall

    2014-06-01

    Quality of life is frequently impaired among survivors of critical illness, and psychiatric morbidity is an important element contributing to poor quality of life in these patients. Among potential manifestations of psychiatric morbidity following critical illness, symptoms of posttraumatic stress are prevalent and intricately linked to the significant stressors present in the intensive care unit (ICU). As our understanding of the epidemiology of post-ICU posttraumatic stress disorder improves, so must our ability to identify those at highest risk for symptoms in the period of time following critical illness and our ability to implement strategies to prevent symptom development. In addition, a focus on strategies to address clinically apparent psychiatric morbidity will be essential. Much remains to be understood about the identification, prevention, and management of this significant public health problem. This article addresses the importance of uniformity in future epidemiologic studies, proposes framing of risk factors into those likely to be modifiable versus non-modifiable, and provides an assessment of modifiable risk factors in the context of a novel conceptual model that offers insight into potential strategies to attenuate symptoms of posttraumatic stress among survivors of critical illness.

  1. Forest management under uncertainty for multiple bird population objectives

    USGS Publications Warehouse

    Moore, C.T.; Plummer, W.T.; Conroy, M.J.; Ralph, C. John; Rich, Terrell D.

    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.

  2. 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.

  3. 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

  4. 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

  5. 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

  6. 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

  7. An architecture model for multiple disease management information systems.

    PubMed

    Chen, Lichin; Yu, Hui-Chu; Li, Hao-Chun; Wang, Yi-Van; Chen, Huang-Jen; Wang, I-Ching; Wang, Chiou-Shiang; Peng, Hui-Yu; Hsu, Yu-Ling; Chen, Chi-Huang; Chuang, Lee-Ming; Lee, Hung-Chang; Chung, Yufang; Lai, Feipei

    2013-04-01

    Disease management is a program which attempts to overcome the fragmentation of healthcare system and improve the quality of care. Many studies have proven the effectiveness of disease management. However, the case managers were spending the majority of time in documentation, coordinating the members of the care team. They need a tool to support them with daily practice and optimizing the inefficient workflow. Several discussions have indicated that information technology plays an important role in the era of disease management. Whereas applications have been developed, it is inefficient to develop information system for each disease management program individually. The aim of this research is to support the work of disease management, reform the inefficient workflow, and propose an architecture model that enhance on the reusability and time saving of information system development. The proposed architecture model had been successfully implemented into two disease management information system, and the result was evaluated through reusability analysis, time consumed analysis, pre- and post-implement workflow analysis, and user questionnaire survey. The reusability of the proposed model was high, less than half of the time was consumed, and the workflow had been improved. The overall user aspect is positive. The supportiveness during daily workflow is high. The system empowers the case managers with better information and leads to better decision making.

  8. 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 ...

  9. Crafting Coherence: How Schools Strategically Manage Multiple, External Demands

    ERIC Educational Resources Information Center

    Honig, Meredith I.; Hatch, Thomas C.

    2004-01-01

    "Policy coherence" is an often cited but seldom achieved education policy goal. We argue that addressing this policy-practice gap requires a reconceptualization of coherence not as the objective alignment of external requirements but as a dynamic process. This article elaborates this re-conceptualization using theories of institutional…

  10. 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.

  11. Role of oral teriflunomide in the management of multiple sclerosis.

    PubMed

    Tanasescu, Radu; Evangelou, Nikos; Constantinescu, Cris S

    2013-01-01

    The landscape of the treatment of relapsing-remitting multiple sclerosis is changing fast. Several oral treatments have shown benefit and generate much interest because of the convenience of their administration. Two oral compounds, fingolimod and teriflunomide, have been approved in relapsing-remitting multiple sclerosis, while others have completed Phase III trials and are awaiting review for registration. Teriflunomide is a pyrimidine synthesis inhibitor with selective immunomodulatory and immunosuppressive properties that have shown consistent efficacy in clinical trials, and a good safety profile. This paper provides an overview of the mechanisms of action and efficacy and safety results from clinical trials with this drug. The role of teriflunomide in the treatment of relapsing-remitting multiple sclerosis is discussed. PMID:23637535

  12. 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

  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.

  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. Managing for multiple resources under climate change: national forests.

    PubMed

    Joyce, Linda A; Blate, Geoffrey M; McNulty, Steven G; Millar, Constance I; Moser, Susanne; Neilson, Ronald P; Peterson, David L

    2009-12-01

    This study explores potential adaptation approaches in planning and management that the United States Forest Service might adopt to help achieve its goals and objectives in the face of climate change. Availability of information, vulnerability of ecological and socio-economic systems, and uncertainties associated with climate change, as well as the interacting non-climatic changes, influence selection of the adaptation approach. Resource assessments are opportunities to develop strategic information that could be used to identify and link adaptation strategies across planning levels. Within a National Forest, planning must incorporate the opportunity to identify vulnerabilities to climate change as well as incorporate approaches that allow management adjustments as the effects of climate change become apparent. The nature of environmental variability, the inevitability of novelty and surprise, and the range of management objectives and situations across the National Forest System implies that no single approach will fit all situations. A toolbox of management options would include practices focused on forestalling climate change effects by building resistance and resilience into current ecosystems, and on managing for change by enabling plants, animals, and ecosystems to adapt to climate change. Better and more widespread implementation of already known practices that reduce the impact of existing stressors represents an important "no regrets" strategy. These management opportunities will require agency consideration of its adaptive capacity, and ways to overcome potential barriers to these adaptation options.

  16. 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

  17. "United Pedicle Flap" for management of multiple gingival recessions.

    PubMed

    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

  18. Management of multiple myeloma in Asia: resource-stratified guidelines.

    PubMed

    Tan, Daryl; Chng, Wee Joo; Chou, Takaaki; Nawarawong, Weerasak; Hwang, Shang-Yi; Chim, Chor Sang; Chen, Wenming; Durie, Brian G M; Lee, Jae Hoon

    2013-11-01

    Treatment of multiple myeloma has undergone substantial developments in the past 10 years. The introduction of novel drugs has changed the treatment of the disease and substantially improved survival outcomes. Clinical practice guidelines based on evidence have been developed to provide recommendations on standard treatment approaches. However, the guidelines do not take into account resource limitations encountered by developing countries. The huge disparities in economy, health-care infrastructure, and access to novel drugs in Asian countries hinder the delivery of optimum care to every patient with multiple myeloma in Asia. In this Review we outline the guidelines that correspond with different levels of health-care resources and expertise, with the aim to unify diagnostic and therapeutic guidelines and help with the design of future studies in Asia.

  19. [Preclinical management of multiples injuries: S3 guideline].

    PubMed

    Waydhas, C

    2012-01-01

    The guidelines follow the priorities established by the A-B-C-D-E scheme. They focus on the treatment of actual disturbances of vital functions and not so much on their anticipated development. Important recommendations with regard to the indication for intubation and ventilation, fluid therapy, diagnosis and treatment of severe chest injuries (tension pneumothorax in particular), management of severe traumatic brain injury, pelvic and vertebral injuries, priorities in the management of extremity fractures as well as indications for the choice of the receiving hospital are given. The recommendations are discussed in view of future concerns and developments.

  20. Monoclonal gammopathy and smoldering multiple myeloma: diagnosis, staging, prognosis, management.

    PubMed

    Hillengass, Jens; Moehler, Thomas; Hundemer, Michael

    2011-01-01

    Monoclonal gammopathy of unknown significance (MGUS) as one of the most common premalignant disorders and smoldering multiple myeloma (sMM) are both caused by a proliferation of monoclonal plasma cells leading to a detectable serum monoclonal protein and/or excess of plasma cells in the bone marrow. Prerequisite for the diagnosis is that plasma cell disease does not cause clinical symptoms. Cytogenetic aberrations are detectable in the majority of patient in the clonally expanded plasma cells. MGUS consistently proceeds symptomatic MM. The lifetime risk of progression into symptomatic multiple myeloma lies between 15% and 59% for patients with MGUS or sMM. Prognostic parameters for development of symptomatic multiple myeloma from MGUS or sMM are concentration of monoclonal protein, bone marrow plasmocytosis, a non- IgG subtype and an abnormal free-light chain ratio. Detection of more than 1 focal lesion in whole body MRI, 95% or more of bone marrow plasma cells displaying an aberrant phenotype in flow cytometry and an evolving clinical course in two consecutive follow-up visits are additional prognostic parameters for sMM. Currently there is no accepted secondary prevention strategy available for sMM and MGUS progression. Future studies are required to combine increasing knowledge on risk factors and molecular pathogenesis with targeted agents to prevent progression. PMID:21509683

  1. 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

  2. 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.

  3. 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.

  4. 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…

  5. 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.

  6. Addressing Concerns.

    ERIC Educational Resources Information Center

    Cronin, Greg; Helmig, Mary; Kaplan, Bill; Kosch, Sharon

    2002-01-01

    Four camp directors discuss how the September 11 tragedy and current world events will affect their camps. They describe how they are addressing safety concerns, working with parents, cooperating with outside agencies, hiring and screening international staff, and revising emergency plans. Camps must continue to offer community and support to…

  7. Challenges of self-management when living with multiple chronic conditions

    PubMed Central

    Liddy, Clare; Blazkho, Valerie; Mill, Karina

    2014-01-01

    Abstract Objective To explore the perspectives of patients who live with multiple chronic conditions as they relate to the challenges of self-management. Data sources On September 30, 2013, we searched MEDLINE, EMBASE, and CINAHL using relevant key words including chronic disease, comorbidity, multimorbidity, multiple chronic conditions, self-care, self-management, perspective, and perception. Study selection Three reviewers assessed and extracted the data from the included studies after study quality was rated. Qualitative thematic synthesis method was then used to identify common themes. Twenty-three articles met the inclusion criteria, with most coming from the United States. Synthesis Important themes raised by people living with multiple chronic conditions related to their ability to self-manage included living with undesirable physical and emotional symptoms, with pain and depression highlighted. Issues with conflicting knowledge, access to care, and communication with health care providers were raised. The use of cognitive strategies, including reframing, prioritizing, and changing beliefs, was reported to improve people’s ability to self-manage their multiple chronic conditions. Conclusion This study provides a unique view into patients’ perspectives of living with multiple chronic conditions, which are clearly linked to common functional challenges as opposed to specific diseases. Future policy and programming in self-management support should be better aligned with patients’ perspectives on living with multiple chronic conditions. This might be achieved by ensuring a more patient-centred approach is adopted by providers and health service organizations. PMID:25642490

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

    PubMed

    Döring, Andrea; Pfueller, Caspar F; Paul, Friedemann; Dörr, Jan

    2011-12-24

    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.

  9. 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

  10. Defining ecological and economical hydropoweroperations: a framework for managing dam releasesto meet multiple conflicting objectives

    USGS Publications Warehouse

    Irwin, Elise R.

    2014-01-01

    Hydroelectric dams are a flexible source of power, provide flood control, and contribute to the economic growth of local communities through real-estate and recreation. Yet the impoundment of rivers can alter and fragment miles of critical riverine habitat needed for other competing needs such as downstream consumptive water use, fish and wildlife population viability, or other forms of recreation. Multiple conflicting interests can compromise progressive management especially with recognized uncertainties related to whether management actions will fulfill the objectives of policy makers, resource managers and/or facility owners. Decision analytic tools were used in a stakeholder-driven process to develop and implement a template for evaluation and prediction of the effects of water resource management of multiple-use systems under the context provided by R.L. Harris Dam on the Tallapoosa River, Alabama, USA. The approach provided a transparent and structured framework for decision-making and incorporated both existing and new data to meet multiple management objectives. Success of the template has been evaluated by the stakeholder governing body in an adaptive resource management framework since 2005 and is ongoing. Consequences of management of discharge at the dam were evaluated annually relative to stakeholder satisfaction to allow for adjustment of both management scenarios and objectives. This template can be applied to attempt to resolve conflict inherent in many dam-regulated systems where management decisions impact diverse values of stakeholders.

  11. 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...

  12. 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

  13. 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.

  14. 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.

  15. 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

  16. 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

  17. 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.

  18. Evaluation and management of a patient with multiple drug allergies.

    PubMed

    Blumenthal, Kimberly G; Saff, Rebecca R; Banerji, Aleena

    2014-01-01

    Multiple drug allergy syndrome (MDAS) is a clinical diagnosis made in patients with adverse reactions to two or more structurally unrelated drugs with an underlying immune-mediated mechanism causing the reaction. The evaluation of a patient with MDAS begins with a comprehensive drug allergy history and consideration of the underlying immune mechanism for each reaction. Skin testing is a useful diagnostic tool; however, the only validated immediate hypersensitivity skin testing is for penicillin where the antigenic determinants have been identified. Skin testing to most other drugs, although not validated, can be considered using a nonirritating concentration (NIC). In general, skin test positivity using an NIC suggests that the drug should be avoided, but a negative result does not rule out an IgE-mediated allergy. A test dose, also called a drug provocation test, graded oral challenge, or incremental challenge, should be performed when there is a low likelihood of an IgE-mediated mechanism for the reaction. In patients with a recent IgE-mediated hypersensitivity reaction or positive skin testing with no reasonable alternative treatment options, desensitization protocols can be used to allow the patient to safely receive a necessary drug. The evaluation of patients with MDAS is both challenging and time-consuming for the practicing allergist, who must systematically evaluate each reaction to help determine which drugs can be safely used again in the future. The molecular mechanisms and risk factors for this condition remain poorly understood, but research to further understand this condition is ongoing.

  19. 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

  20. 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…

  1. Guidelines for management of high-risk African Americans with multiple cardiovascular risk factors: recommendations of an expert consensus panel.

    PubMed

    Williams, Richard Allen; Flack, John M; Gavin, James R; Schneider, Wendy R; Hennekens, Charles H

    2007-01-01

    African Americans have higher rates of cardiovascular disease (CVD) than do Caucasians, which contributes significantly to their reduced life expectancy. Most African American adults have at least one major risk factor for CVD. Nonetheless, African Americans are often underdiagnosed and undertreated, despite presenting to the healthcare system late in their course, often after a CVD event. Patients with multiple risk factors have a CVD risk far greater than the sum of their individual risks. Metabolic syndrome tends to be clustered to a greater degree in African American women. Aggressive management of African Americans is necessary. In this report, we provide guidelines for the management of high-risk African Americans. For each individual risk factor, we address existing data and guidelines in the general population, existing data in African Americans, and proposed guidelines for African Americans based on evidence or extrapolation. In particular, for elevated cholesterol and blood pressure, evidence is emerging that lower is better, so aggressive management strategies are necessary. For dyslipidemia, statins alone will generally reach the goal, but for hypertension, multiple drugs are usually necessary. We conclude that further research in African Americans is necessary to complete the totality of evidence.

  2. 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.

  3. 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

  4. 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.

  5. 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.

  6. 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

  7. 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

  8. 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

  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

    ... 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, 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...

  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. 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...

  13. 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…

  14. 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...

  15. "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...

  16. 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…

  17. 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.

  18. Responses to changing multiple-use demands: New directions for water resource planning and management

    SciTech Connect

    Sale, M.J.; Wadlington, R.O.

    1994-06-01

    Abstracts of papers from the American Water Resources Association Spring Symposium are presented in this text. Topics discussed include: multiple-use demands on water resources; water quality; recreational water activities; management of water resources are described for the Tennessee, Missouri, Columbia, and Sacramento-San Joaquin Rivers; wetlands and drainage; erosion control; environmental transport of pollutants; multiobjective optimization; flood management; ground water assessment; and ground water issues. Individual papers are catalogued separately.

  19. 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

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

    PubMed

    Guo, P; Huang, G H

    2010-03-01

    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

  1. 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

  2. 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.

  3. The Small Helm Project: an academic activity addressing international corruption for undergraduate civil engineering and construction management students.

    PubMed

    Benzley, Steven E

    2006-04-01

    This paper presents an academic project that addresses the issue of international corruption in the engineering and construction industry, in a manner that effectively incorporates several learning experiences. The major objectives of the project are to provide the students a learning activity that will 1) make a meaningful contribution within the disciplines being studied; 2) teach by experience a significant principle that can be valuable in numerous situations during an individual's career, and 3) engage the minds, experiences, and enthusiasm of the participants in a real ethical challenge that is prevalent in all of their chosen professional fields. The paper describes the full details of the project, the actual implementation of it during Winter Semester 2005, the experiences gained during the initial trial, and the modifications and improvements incorporated for future implementation.

  4. 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

  5. Convocation address.

    PubMed

    Ghatowar, P S

    1993-07-01

    The Union Deputy Minister of Health and Family Welfare in India addressed the 35th convocation of the International Institute for Population Sciences in Bombay in 1993. Officials in developing countries have been concerned about population growth for more than 30 years and have instituted policies to reduce population growth. In the 1960s, population growth in developing countries was around 2.5%, but today it is about 2%. Despite this decline, the world will have 1 billion more individuals by the year 2001. 95% of these new people will be born in developing countries. India's population size is so great that India does not have the time to wait for development to reduce population growth. Population needs to be viewed as an integrated part of overall development, since it is linked to poverty, illiteracy, environmental damage, gender issues, and reproductive health. Despite a large population size, India has made some important advancements in health and family planning. For example, India has reduced population growth (to 2.14% annually between 1981-1991), infant mortality, and its birth rate. It has increased the contraceptive use rate and life expectancy. Its southern states have been more successful at achieving demographic goals than have the northern states. India needs to implement efforts to improve living conditions, to change attitudes and perceptions about small families and contraception, and to promote family planning acceptance earlier among young couples. Improvement of living conditions is especially important in India, since almost 33% of the people live in poverty. India needs to invest in nutrition, health, and education. The mass media and nongovernmental organizations need to create population awareness and demand for family planning services. Improvement in women's status accelerates fertility decline, as has happened in Kerala State. The government needs to facilitate generation of jobs. Community participation is needed for India to achieve

  6. 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…

  7. 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

  8. Presidential address.

    PubMed

    Shunglu, V K

    1994-07-01

    Rapid and substantial population growth in India is hampering development. Family welfare programs in the country during the last four years have not met population reduction goals. The decentralization of political and administrative power in relevant programs, however, will help the country attain its goal of replacement fertility. To that end, the 73rd and 74th amendments to the constitution have recently been enacted to help decentralize power to people at the village, intermediate, and district levels. The participation of the people is essential for success. State ministers of health must begin assigning management of the rural health care systems to the Panchayats. Population policy has changed so that family planning is now provided within the broader context of maternal and child health care, emphasizing voluntarism and informed choice among contraceptive methods and popular participation. The speaker laments the decline of male participation in family planning and calls for high priority to be given to developing fertility regulation methods for men as well as identifying factors which prohibit male participation. The country's unbalanced female to male sex ratio and interstate and inter-district variations in social parameters which have a bearing upon population growth rates also merit attention. Investing in human resources is crucial to the success of population programs. Financing has therefore increased for poverty alleviation programs and other social sector programs.

  9. 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.

  10. 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.

  11. 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.

  12. 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

  13. 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

  14. 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

  15. 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

  16. 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

  17. 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

  18. 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...

  19. Ethical challenges in the management of multiple pregnancies: the professional responsibility model of perinatal ethics.

    PubMed

    Chervenak, Frank A; McCullough, Laurence B

    2013-01-01

    Abstract Ethics is an essential component for the responsible clinical management of multiple gestation and decision-making about such pregnancies with pregnant women. The ethical concept of the fetus as a patient is presented as the basis for identifying a professionally responsible approach to selective termination, twin-to-twin transfusion syndrome, and to discordant beneficence-based obligations that exist when one or more fetuses are adversely affected by a fetal anomaly or complication of pregnancy. The roles for directive counseling, i.e., making evidence-based recommendations, and for non-directive counseling, i.e., offering evidence-based alternatives but making no recommendations, are described. The professional responsibility model of perinatal ethics creates a practical framework to guide the clinical judgment of perinatologists and the informed process about the clinical management of multiple pregnancies.

  20. Illustrating the multiple facets and levels of fidelity of implementation to a teacher classroom management intervention.

    PubMed

    Reinke, Wendy M; Herman, Keith C; Stormont, Melissa; Newcomer, Lori; David, Kimberly

    2013-11-01

    Many school-based interventions to promote student mental health rely on teachers as implementers. Thus, understanding the interplay between the multiple domains of fidelity to the intervention and intervention support systems such as coaching and teacher implementation of new skills is an important aspect of implementation science. This study describes a systematic process for assessing multiple domains of fidelity. Data from a larger efficacy trial of the Incredible Years Teacher Classroom Management (IY TCM) program are utilized. Data on fidelity to the IY TCM workshop training sessions and onsite weekly coaching indicate that workshop leaders and the IY TCM coach implemented the training and coaching model with adequate adherence. Further, workshop leaders' ratings of engagement were associated with teacher implementation of specific praise, following training on this content. Lastly, the IY TCM coach differentiation of teacher exposure to coaching was evaluated and found to be associated with teacher implementation of classroom management practices and student disruptive behavior.

  1. Management of Multiple Myeloma Complicated by Hepatitis C Virus Reactivation: The Role of New Antiviral Therapy.

    PubMed

    Mahale, Parag; Thomas, Sheeba K; Kyvernitakis, Andreas; Torres, Harrys A

    2016-01-01

    Reactivation of chronic hepatitis C virus (HCV) infection has been reported in cancer patients receiving chemotherapy. In this study, we report the first case, to our knowledge, of thalidomide-induced acute exacerbation and reactivation of chronic HCV infection complicating management of multiple myeloma. Sofosbuvir-based antiviral therapy helped achieve viral clearance and normalization of liver enzymes, thus allowing access to future potentially life-saving chemotherapy agents. PMID:26885541

  2. Case report: A time study of management of a chronically transfused patient with multiple antibodies.

    PubMed

    Kitchen, K; Corgan, M; Hillard, B

    1993-01-01

    This case report describes laboratory management of a chronically transfused sickle cell anemia patient with multiple antibodies and the time involved in providing compatible red cells for transfusion. Time was evaluated using the laboratory workload record ing method of the College of American Pathologists. Red cell units were sent to the hospital within 24 to 48 hours from receipt of a referral sample, despite a workload recording time in excess of 15 hours for a typical sample.

  3. Management of Multiple Myeloma Complicated by Hepatitis C Virus Reactivation: The Role of New Antiviral Therapy

    PubMed Central

    Mahale, Parag; Thomas, Sheeba K.; Kyvernitakis, Andreas; Torres, Harrys A.

    2016-01-01

    Reactivation of chronic hepatitis C virus (HCV) infection has been reported in cancer patients receiving chemotherapy. In this study, we report the first case, to our knowledge, of thalidomide-induced acute exacerbation and reactivation of chronic HCV infection complicating management of multiple myeloma. Sofosbuvir-based antiviral therapy helped achieve viral clearance and normalization of liver enzymes, thus allowing access to future potentially life-saving chemotherapy agents. PMID:26885541

  4. Management of Globally Distributed Software Development Projects in Multiple-Vendor Constellations

    NASA Astrophysics Data System (ADS)

    Schott, Katharina; Beck, Roman; Gregory, Robert Wayne

    Global information systems development outsourcing is an apparent trend that is expected to continue in the foreseeable future. Thereby, IS-related services are not only increasingly provided from different geographical sites simultaneously but beyond that from multiple service providers based in different countries. The purpose of this paper is to understand how the involvement of multiple service providers affects the management of the globally distributed information systems development projects. As research on this topic is scarce, we applied an exploratory in-depth single-case study design as research approach. The case we analyzed comprises a global software development outsourcing project initiated by a German bank together with several globally distributed vendors. For data collection and data analysis we have adopted techniques suggested by the grounded theory method. Whereas the extant literature points out the increased management overhead associated with multi-sourcing, the analysis of our case suggests that the required effort for managing global outsourcing projects with multiple vendors depends among other things on the maturation level of the cooperation within the vendor portfolio. Furthermore, our data indicate that this interplay maturity is positively impacted through knowledge about the client that has been derived based on already existing client-vendor relationships. The paper concludes by offering theoretical and practical implications.

  5. 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

  6. 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

  7. Care Management by Oncology Nurses To Address Palliative Care Needs: A Pilot Trial To Assess Feasibility, Acceptability, and Perceived Effectiveness of the CONNECT Intervention

    PubMed Central

    White, Douglas; Rosenzweig, Margaret; Chu, Edward; Moore, Charity; Ellis, Peter; Nikolajski, Peggy; Ford, Colleen; Tiver, Greer; McCarthy, Lauren; Arnold, Robert

    2015-01-01

    Abstract Background: Specialty palliative care is not accessible for many patients with advanced cancer. There is a need to find alternative palliative care strategies in oncology clinics. Objective: The objective of the study was to assess the feasibility, acceptability, and perceived effectiveness of an oncology nurse-led care management approach to improve primary palliative care. Methods: The study design was a single-arm pilot trial of the Care Management by Oncology Nurses (CONNECT) intervention, in which registered oncology nurses receive specialized training and work closely with oncologists to (1) address symptom needs; (2) engage patients and caregivers in advance care planning; (3) provide emotional support; and (4) coordinate care. The subjects were 23 patients with advanced cancer, 19 caregivers, and 5 oncologists from a community oncology clinic in western Pennsylvania. Feasibility was assessed through enrollment rates, outcome assessment rates, and visit checklists. Patients, caregivers, and oncologists completed three-month assessments of acceptability and perceived effectiveness. Results: The consent-to-approach rate was 86% and enrolled-to-consent rate, 77%. CONNECT was implemented according to protocol for all participants. No participants withdrew after enrollment. Four patients died during the study; three-month outcome assessments were completed with all remaining participants (83%). Patients and caregivers reported high satisfaction with CONNECT and perceived the intervention as helpful in addressing symptoms (85%), coping (91%), and planning for the future (82%). Oncologists unanimously agreed that CONNECT improved the quality of care provided for patients with advanced cancer. Conclusion: An oncology nurse-led care management intervention is feasible, acceptable, and was perceived to be effective for improving provision of primary palliative care. A randomized trial of CONNECT is warranted. PMID:25517219

  8. 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

  9. 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

  10. 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.

  11. Goals Set After Completing a Teleconference-Delivered Program for Managing Multiple Sclerosis Fatigue

    PubMed Central

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

    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

  12. Integrated dementia care in The Netherlands: a multiple case study of case management programmes.

    PubMed

    Minkman, Mirella M N; Ligthart, Suzanne A; Huijsman, Robbert

    2009-09-01

    The number of dementia patients is growing, and they require a variety of services, making integrated care essential for the ability to continue living in the community. Many healthcare systems in developed countries are exploring new approaches for delivering health and social care. The purpose of this study was to describe and analyse a new approach in extensive case management programmes concerned with long-term dementia care in The Netherlands. The focus is on the characteristics, and success and failure factors of these programmes.A multiple case study was conducted in eight regional dementia care provider networks in The Netherlands. Based on a literature study, a questionnaire was developed for the responsible managers and case managers of the eight case management programmes. During 16 semistructured face-to-face interviews with both respondent groups, a deeper insight into the dementia care programmes was provided. Project documentation for all the cases was studied. The eight programmes were developed independently to improve the quality and continuity of long-term dementia care. The programmes show overlap in terms of their vision, tasks of case managers, case management process and the participating partners in the local dementia care networks. Differences concern the targeted dementia patient groups as well as the background of the case managers and their position in the local dementia care provider network. Factors for success concern the expert knowledge of case managers, investment in a strong provider network and coherent conditions for effective inter-organizational cooperation to deliver integrated care. When explored, caregiver and patient satisfaction was high. Further research into the effects on client outcomes, service use and costs is recommended in order to further analyse the impact of this approach in long-term care. To facilitate implementation, with a focus on joint responsibilities of the involved care providers, policy

  13. 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

  14. 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.

  15. Intelligent power management in a vehicular system with multiple power sources

    NASA Astrophysics Data System (ADS)

    Murphey, Yi L.; Chen, ZhiHang; Kiliaris, Leonidas; Masrur, M. Abul

    This paper presents an optimal online power management strategy applied to a vehicular power system that contains multiple power sources and deals with largely fluctuated load requests. The optimal online power management strategy is developed using machine learning and fuzzy logic. A machine learning algorithm has been developed to learn the knowledge about minimizing power loss in a Multiple Power Sources and Loads (M_PS&LD) system. The algorithm exploits the fact that different power sources used to deliver a load request have different power losses under different vehicle states. The machine learning algorithm is developed to train an intelligent power controller, an online fuzzy power controller, FPC_MPS, that has the capability of finding combinations of power sources that minimize power losses while satisfying a given set of system and component constraints during a drive cycle. The FPC_MPS was implemented in two simulated systems, a power system of four power sources, and a vehicle system of three power sources. Experimental results show that the proposed machine learning approach combined with fuzzy control is a promising technology for intelligent vehicle power management in a M_PS&LD power system.

  16. 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

  17. Multiple-use Management of Irrigation Systems: Technical Constraints and Challenges

    NASA Astrophysics Data System (ADS)

    Gowing, J.; Li, Q.; Mayilswami, C.; Gunawardhana, K.

    It is now widely recognised that many irrigation systems, originally planned only for irrigation supply, are de facto multiple-use systems. However, the importance of non- irrigation uses (such as bathing, laundry, livestock watering and fishing), to the liveli- hoods of the rural poor has generally been ignored. This has significant implications for irrigation engineers, water resources managers and other decision-makers. An im- proved understanding of competition and complementarity between these uses and irrigation demands is essential for effective multiple-use management of irrigation systems.This paper presents a study of multiple-use management, where the focus is on integrating aquaculture within irrigation systems with and without secondary storage. The Lower Bhavani scheme in South India and Mahaweli System H in Sri- Lanka were selected as representative smallholder irrigation schemes: - The Lower Bhavani scheme comprises a 200km contour canal serving a command area of 78,500ha. Apart from the main dam, there are no storage structures within the irriga- tion system. - Mahaweli System H comprises a command area of 43,000ha served by three main canals. The feature of particular interest in this scheme is the large number of secondary storage structures (known locally as tanks), which are in- tegrated within the canal network. It is apparent from these two sites and from studies elsewhere that non-irrigation uses are important to the livelihoods of the local peo- ple, but these uses are largely opportunistic. The failure to give explicit recognition to non-irrigation uses has important implications for assessments of economic per- formance and water productivity of irrigation systems. However, any attempt to give proper recognition to these alternative uses also has implication for irrigation project management. This paper describes a detailed study of water management in the two irrigation systems. The method of investigation involves in-depth studies in

  18. 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

  19. 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

  20. 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.

  1. Decision aids for multiple-decision disease management as affected by weather input errors.

    PubMed

    Pfender, W F; Gent, D H; Mahaffee, W F; Coop, L B; Fox, A D

    2011-06-01

    Many disease management decision support systems (DSSs) 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 management decision recommendations. The extent to which errors in weather inputs affect the quality of the final management outcome depends on a number of aspects of the disease management context, including whether management consists of a single dichotomous decision, or of a multi-decision process extending over the cropping season(s). Decision aids for multi-decision disease management typically are based on simple or complex algorithms of weather data which may be accumulated over several days or weeks. It is difficult to quantify accuracy of multi-decision DSSs due to temporally overlapping disease events, existence of more than one solution to optimizing the outcome, opportunities to take later recourse to modify earlier decisions, and the ongoing, complex decision process in which the DSS is only one component. One approach to assessing importance of weather input errors is to conduct an error analysis in which the DSS outcome from high-quality weather data is compared with that from weather data with various levels of bias and/or variance from the original data. We illustrate this analytical approach for two types of DSS, an infection risk index for hop powdery mildew and a simulation model for grass stem rust. Further exploration of analysis methods is needed to address problems associated with assessing uncertainty in multi-decision DSSs.

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

    PubMed Central

    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

  3. 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

  4. 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.

  5. 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

  6. 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.

  7. 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

  8. 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

  9. 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…

  10. A UK consensus on the management of the bladder in multiple sclerosis.

    PubMed

    Fowler, C J; Panicker, J N; Drake, M; Harris, C; Harrison, S C W; Kirby, M; Lucas, M; Macleod, N; Mangnall, J; North, A; Porter, B; Reid, S; Russell, N; Watkiss, K; Wells, M

    2009-05-01

    Bladder symptoms in multiple sclerosis (MS) are common and distressing but also highly amenable to treatment. A meeting of stakeholders involved in patients' continence care, including neurologists, urologists, primary care, MS nurses and nursing groups was recently convened to formulate a UK consensus for management. National Institute for Health and Clinical Excellence (NICE) criteria were used for producing recommendations based on a review of the literature and expert opinion. It was agreed that in the majority of cases, successful management could be based on a simple algorithm which includes using reagent sticks to test for urine infection and measurement of the post micturition residual urine volume. This is in contrast with published guidelines from other countries which recommend cystometry. Throughout the course of their disease, patients should be offered appropriate management options for treatment of incontinence, the mainstay of which is antimuscarinic medications, in combination, if necessary, with clean intermittent self-catheterisation. The evidence for other measures, including physiotherapy, alternative strategies aimed at improving bladder emptying, other medications and detrusor injections of botulinum toxin A was reviewed. The management of urinary tract infections as well as the bladder problems as part of severe disability were discussed and recommendations agreed. PMID:19372287

  11. 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

  12. 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

  13. 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.

  14. Cost of managing an episode of relapse in multiple sclerosis in the United States

    PubMed Central

    O'Brien, Judith A; Ward, Alexandra J; Patrick, Amanda R; Caro, Jaime

    2003-01-01

    Background The purpose of this study was to determine the direct medical US cost of managing multiple sclerosis relapses. Methods Direct data analysis and cost modeling were employed to derive typical resource use profiles and costs in 2002 US dollars, from the perspective of a third-party payer responsible for comprehensive health-care. The location and scope of health care services provided over a 90-day period were used to define three levels of relapse management. Hospitalization and resulting subsequent care was defined as high intensity management. A medium level of intervention was defined as either use of the emergency room, an observational unit, or administration of acute treatments, such as intravenous methylprednisolone in an outpatient or home setting. The lowest intensity of care comprised physician office visits and symptom-related medications. Data were obtained from many sources including all payer inpatient, ambulatory and emergency room databases from several states, fee schedules, government reports, and literature. All charges were adjusted using cost-to-charge ratios. Results Average cost per person for high management level was $12,870, based on analysis of 4,634 hospital cases (mean age 48 years, 73% female). Hospital care comprised 71% of that cost. At discharge, 36% required inpatient sub-acute care, rehabilitation or home care. The typical cost per moderate episode was $1,847 and mild episode $243. Conclusions Management strategies leading to a reduction in the frequency and severity of a relapse, less reliance on inpatient care, or increased access to steroid infusions in the home, would have a substantial impact on the economic consequences of managing relapses. PMID:12952552

  15. Teaching Mathematics That Addresses Learners' Multiple Intelligences

    ERIC Educational Resources Information Center

    Gouws, E.; Dicker, A-M.

    2011-01-01

    To meet the demands of our highly technological and globally competitive society, it is becoming increasingly important for all learners in South Africa to obtain skills and knowledge in mathematics. However, South Africa performed the worst of all the countries who participated in the Trends in International Mathematics and Science Study (TIMMS).…

  16. A multiple criteria analysis for household solid waste management in the urban community of Dakar.

    PubMed

    Kapepula, Ka-Mbayu; Colson, Gerard; Sabri, Karim; Thonart, Philippe

    2007-01-01

    Household solid waste management is a severe problem in big cities of developing countries. Mismanaged solid waste dumpsites produce bad sanitary, ecological and economic consequences for the whole population, especially for the poorest urban inhabitants. Dealing with this problem, this paper utilizes field data collected in the urban community of Dakar, in view of ranking nine areas of the city with respect to multiple criteria of nuisance. Nine criteria are built and organized in three families that represent three classical viewpoints: the production of wastes, their collection and their treatment. Thanks to the method PROMETHEE and the software ARGOS, we do a pair-wise comparison of the nine areas, which allows their multiple criteria rankings according to each viewpoint and then globally. Finding the worst and best areas in terms of nuisance for a better waste management in the city is our final purpose, fitting as well as possible the needs of the urban community. Based on field knowledge and on the literature, we suggest applying general and area-specific remedies to the household solid waste problems. PMID:17064885

  17. 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.

  18. Multiple-target tracking and track management for an FMCW radar network

    NASA Astrophysics Data System (ADS)

    Kim, Dae-Bong; Hong, Sun-Mog

    2013-12-01

    A multiple-target tracking problem for a frequency-modulated continuous-wave (FMCW) radar network is formulated and an integrated track management system is presented to solve the tracking problem in the presence of clutter. The FMCW radar network obtains beat frequency measurements with multiple collocated radars, each transmitting a sequence of chirps. The beat frequency measurements are associated to tracks directly in the beat frequency measurement space. The direct association eliminates range/range-rate calculations and multilateration processing, and it allows to process beat frequency measurements sequentially on a chirp by chirp basis. The sequential processing effectively decomposes the measurement-to-track association problem into a series of two-dimensional assignment problems that can be solved with much less computational effort. The solution to the measurement-to-track association problem is utilized to initiate and form new tracks and to update or delete existing tracks. Monte Carlo simulations were performed to evaluate the performance of the track management system.

  19. 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

  20. 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.

  1. 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

  2. How we manage autologous stem cell transplantation for patients with multiple myeloma

    PubMed Central

    Dingli, David

    2014-01-01

    An estimated 22 350 patients had multiple myeloma diagnosed in 2013, representing 1.3% of all new cancers; 10 710 deaths are projected, representing 1.8% of cancer deaths. Approximately 0.7% of US men and women will have a myeloma diagnosis in their lifetime, and with advances in therapy, 77 600 US patients are living with myeloma. The 5-year survival rate was 25.6% in 1989 and was 44.9% in 2005. The median age at diagnosis is 69 years, with 62.4% of patients aged 65 or older at diagnosis. Median age at death is 75 years. The rate of new myeloma cases has been rising 0.7% per year during the past decade. The most common indication for autologous stem cell transplantation in the United States is multiple myeloma, and this article is designed to provide the specifics of organizing a transplant program for multiple myeloma. We review the data justifying use of stem cell transplantation as initial management in myeloma patients. We provide selection criteria that minimize the risks of transplantation. Specific guidelines on mobilization and supportive care through the transplant course, as done at Mayo Clinic, are given. A review of the data on tandem vs sequential autologous transplants is provided. PMID:24973360

  3. 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

  4. 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

  5. The Role of Physical Management and Handling in Facilitating Skills Acquisition and Learning by People with Severe and Multiple Disabilities.

    ERIC Educational Resources Information Center

    Rees, Roger J.; And Others

    1995-01-01

    Training in appropriate physical management and handling procedures for caregivers of four children with severe and multiple disabilities found positive effects on the children's orientation, communication, and social interaction skills. The importance of appropriate physical managing and handling in natural environments for enhancement of…

  6. 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…

  7. 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.

  8. 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.

  9. 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.

  10. 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.

  11. 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

  12. 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

  13. 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.

  14. Overview of magnetic resonance imaging for management of relapsing-remitting multiple sclerosis in everyday practice.

    PubMed

    Oreja-Guevara, C

    2015-10-01

    Although the value of magnetic resonance imaging (MRI) for diagnosis/differential diagnosis of patients with clinically isolated syndromes suggestive of multiple sclerosis (MS) is widely accepted, adoption of MRI into clinical practice to monitor disease evolution remains a work in progress. However, an accumulating body of evidence points to a central role for MRI in managing patients with relapsing-remitting MS along the disease continuum. Routine MRI surveillance provides insight into disease activity that is not evident clinically and this information, in turn, can be used to inform prognosis and guide treatment decisions. In Europe, practical guidelines have been developed to reduce the heterogeneity of imaging (both intracentre and intercentre) and improve the quality of MRI assessment and interpretation. Aimed at the general neurologist, this review explores some of the issues associated with MRI and examines evidence supporting its use for routine monitoring of MS patients in everyday practice.

  15. 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

  16. Multiple functional ingredient approach in formulating dietary supplement for management of diabetes: a review.

    PubMed

    Pawar, Kanika; Thompkinson, Dilip Kumar

    2014-01-01

    Food and nutrition science has moved from identifying and correcting nutritional deficiencies to designing foods that promote optimal health and reduce the risk of disease. Diabetes is rapidly emerging as a pandemic. It is also accompanied by several health implications viz. cardiovascular diseases, obesity, hypertension, cancer, depression, and eating disorders. International Diabetes Federation estimates that in 2010, India is home to 50.8 million diabetics and the number is expected to go up to a whopping 87 million by 2030. The primary goal of medical nutrition therapy was to design special dietary products for patients with hyperglycemia, intended in controlling postprandial plasma glucose fluctuations and hypercholesterolemic tendencies. However, an effective way to minimize these health risks could be through modifications in the diet by inclusion of multiple functional ingredients, aimed for their concerted role in management of individuals suffering with diabetes.

  17. 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

  18. 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

  19. 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

  20. 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.

  1. [MANAGEMENT OF THE MULTIPLE ENVIRONMENTAL RISK FOR THE HEALTH OF THE POPULATION OF INDUSTRIALIZED CITIES OF THE SVERDLOVSK REGION].

    PubMed

    Kornilkov, A S; Privalova, L I; Kuz'mina, E A; Iarushin, S V; Mazhaeva, T V; Kochneva, N I; Plotko, E G

    2015-01-01

    In the Sverdlovsk region for the assessment and management of environment and health of the population over more than 10 years there is used a methodology for the assessment of the multiple environmental risk, allowing to identify priority routes of toxicants entering the body, to evaluate the possible dose-response relationships and elaborate targeted measures for their correction. In the article there is shown how are effective management decisions, elaborated on the base of the results of the assessment of multiple environmental risk to public health in cities of Pervouralsk and Revda of the Sverdlovsk region and directed to the mitigation of the exposure to chemical factors of the environment.

  2. 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

  3. 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

  4. 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

  5. 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

  6. 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

  7. Use of lenalidomide in the management of relapsed or refractory multiple myeloma: expert recommendations in Korea

    PubMed Central

    Kim, Hyo Jung; Eom, Hyeon Seok; Kim, Kihyun; Kim, Jin Seok; Lee, Je-Jung; Bang, Soo-Mee; Min, Chang-Ki; Park, Joon Seong; Lee, Jae-Hoon

    2015-01-01

    Multiple myeloma (MM) is the third most common hematologic malignancy in Korea. Historically, the incidence of MM in Korea has been lower than that in Western populations, although there is growing evidence that the incidence of MM in Asian populations, including Korea, is increasing rapidly. Despite advances in the management of MM, patients will ultimately relapse or become refractory to their current treatment, and alternative therapeutic options are required in the relapsed/refractory setting. In Korea, although lenalidomide/dexamethasone is indicated for the treatment of relapsed or refractory MM (RRMM) in patients who have received at least one prior therapy, lenalidomide is reimbursable specifically only in patients with RRMM who have failed bortezomib-based treatment. Based on evidence from pivotal multinational clinical trials as well as recent studies in Asia, including Korea, lenalidomide/dexamethasone is an effective treatment option for patients with RRMM, regardless of age or disease status. Adverse events associated with lenalidomide/dexamethasone, including hematologic toxicity, venous thromboembolism, fatigue, rash, infection, and muscle cramps, are largely predictable and preventable/manageable with appropriate patient monitoring and/or the use of standard supportive medication and dose adjustment/interruption. Lenalidomide/dexamethasone provides an optimal response when used at first relapse, and treatment should be continued long term until disease progression. With appropriate modification of the lenalidomide starting dose, lenalidomide/dexamethasone is effective in patients with renal impairment and/or cytopenia. This review presents updated evidence from the published clinical literature and provides recommendations from an expert panel of Korean physicians regarding the use of lenalidomide/dexamethasone in patients with RRMM. PMID:25830125

  8. 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.

  9. 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

  10. 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

  11. 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.

  12. 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.…

  13. 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…

  14. Anesthetic management of a patient with multiple sclerosis undergoing cesarean section with low dose epidural bupivacaine

    PubMed Central

    Sethi, Sameer; Kapil, Sonia

    2014-01-01

    A 32-year-old Indian female 38 weeks pregnant, with a history of multiple sclerosis since 2008 was admitted in obstetric ward for safe confinement. She had a history of diminution of vision in both eyes and limb weakness, relapsing – remitting type with movement-induced muscle spasms, in all the four limbs. Her symptoms were usually diplopia, difficulty in vision and ataxic gait. Sh was then treated with methylprednisolone. She was on oral dimethyl fumarate trial, which was stopped at the beginning of pregnancy. Presently, she was completely asymptomatic. Epidural anesthesia with an indwelling catheter was administered with 15 ml of 0.25% bupivacaine in 5 ml increments. A total of 3 mg of epidural morphine was given for post-operative analgesia. The surgery evolved without any intercurrences and patient was discharged from the hospital 72 h after surgery without worsening of her symptoms. We report a safe anesthetic management of a patient with MS undergoing cesarean section with low dose epidural bupivacaine with the addition of morphine for post-operative analgesia. PMID:25191198

  15. Managing multiple masculinities in donor insemination: doctors configuring infertile men and sperm donors in Taiwan.

    PubMed

    Wu, Chia-Ling

    2011-01-01

    This article investigates how doctors configured infertile men and sperm donors in the development of donor insemination (DI) in Taiwan. In the initial stage (1950s-1970s) doctors adjusted clinical procedures to repair the deformed gender identities of infertile men. To expand DI in the late 1970s and early 1980s, doctors stressed the positive eugenics of DI by spotlighting the high intelligence of donors, playing down biological patrilineage and re-emphasising the contribution of men of higher rank in society. In the mid-1980s, when donors came to be seen as potential carriers of fatal diseases like acquired immune deficiency syndrome, doctors managed to associate risky donors with socially stigmatised men, and therefore perpetuate the conventional hierarchy of masculinities. As the intracytoplasmic sperm injection emerged in the early 1990s doctors quickly presented infertile men as universally longing for biological fatherhood and hence devalued DI in an attempt to augment paternal masculinity. These diverse configuration activities come together to create a socio-technical network of DI that most of the time perpetuates the reigning gender order, rather than destabilising it. I argue the importance of incorporating various types of participants in analysis to understand the changing dynamics of multiple masculinities along with the development of DI.

  16. 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.

  17. 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

  18. 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.

  19. Multiple-source spatial data fusion and integration research in the region unified planning management information system

    NASA Astrophysics Data System (ADS)

    Liu, Zhijun; Zhang, Liangpei; Liu, Zhenmin; Jiao, Hongbo; Chen, Liqun

    2008-12-01

    In order to manage the internal resources of Gulf of Tonkin and integrate multiple-source spatial data, the establishment of region unified plan management system is needed. The data fusion and the integrated research should be carried on because there are some difficulties in the course of the system's establishment. For example, kinds of planning and the project data format are different, and data criterion is not unified. Besides, the time state property is strong, and spatial reference is inconsistent, etc. In this article the ARCGIS ENGINE is introduced as the developing platform, key technologies are researched, such as multiple-source data transformation and fusion, remote sensing data and DEM fusion and integrated, plan and project data integration, and so on. Practice shows that the system improves the working efficiency of Guangxi Gulf of Tonkin Economic Zone Management Committee significantly and promotes planning construction work of the economic zone remarkably.

  20. 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…

  1. 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

  2. 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

  3. 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

  4. 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

  5. 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

  6. 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.

  7. The influence of forest management on headwater stream amphibians at multiple spatial scales

    USGS Publications Warehouse

    Stoddard, M.; Hayes, J.P.

    2005-01-01

    Understanding how habitat structure at multiple spatial scales influences vertebrates can facilitate development of effective conservation strategies, but until recently most studies have focused on habitat relationships only at fine or intermediate scales. In particular, patterns of amphibian occurrence across broad spatial scales are not well studied, despite recent concerns over regional and global declines. We examined habitat relationships of larval and neotenic Pacific giant salamanders (Dicamptodon tenebrosus), larval and adult Pacific tailed frogs (Ascaphus truei) (hereafter 'tailed frogs'), and torrent salamanders (Rhyacotriton spp.) at three spatial scales (2-m sample unit, intermediate, and drainage). In 1998 and 1999, we captured 1568 amphibians in 702 sample units in 16 randomly chosen drainages in the Oregon Coast Range. We examined species-habitat associations at each spatial scale using an information-theoretic approach of analysis to rank sets of logistic regression models developed a priori. At the 2-m sample unit scale, all groups were negatively associated with proportion of small substrate and positively associated with stream width or elevation. At the intermediate scale, Pacific giant salamanders, adult tailed frogs, and torrent salamanders were positively associated with presence of a 46-m band of forested habitat on each side of the stream, and larval tailed frogs were positively associated with presence of forest >105 years old. Aspect was important for Pacific giant salamanders and larval tailed frogs at the intermediate scale. At the drainage scale, all groups except torrent salamanders were positively associated with proportion of stream length having forested bands >46 m in width, but further analysis suggests narrower bands may provide adequate protection for some groups. Population- and community-level responses at broad spatial scales may be reflected in species-level responses at fine spatial scales, and our results suggest that

  8. 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

  9. 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

  10. 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.

  11. 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.

  12. 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

  13. 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.

  14. Multiple Case Study of Event Management Curricula and Industry Professionals' Expectations of New Graduates

    ERIC Educational Resources Information Center

    Whitney, Premila A.

    2016-01-01

    The event management segment of the hospitality industry has experienced tremendous growth in recent years. As a result, demand for qualified event management professionals continues to increase. To help prepare qualified professionals for the event management industry, higher education institutions in the United States are now offering…

  15. 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

  16. 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.

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

    PubMed

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

    2015-01-01

    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.

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

    PubMed

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

    2015-01-01

    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. PMID:25301545

  19. 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

  20. Variable addressability imaging systems

    NASA Astrophysics Data System (ADS)

    Kubala, Kenneth Scott

    The use of variable addressability for creating an optimum human-machine interface is investigated. Current wide field optical systems present more information to the human visual system than it has the capacity to perceive. The axial resolution, and/or the field of view can be increased by minimizing the difference between what the eye can perceive and what the system presents. The variable addressability function was developed through the use of a human factors experiment that characterized the position of the eye during the simulated use of a binocular system. Applying the variable addressability function to a conventional optical design required the development of a new metric for evaluating the expected performance of the variable addressability system. The new metric couples psycho-visual data and traditional optical data in order to specify the required performance of the variable addressability system. A non-linear mapping of the pixels is required in order to have the system work most efficiently with the human visual system, while also compensating for eye motion. The non-linear mapping function, which is the backbone of the variable addressability technique, can be created using optical distortion. The lens and system design is demonstrated in two different spectral bands. One of the designs was fabricated, tested, and assembled into a prototype. Through a second human factors study aimed at measuring performance, the variable addressability prototype was directly compared to a uniform addressability prototype, quantifying the difference in performance for the two prototypes. The human factors results showed that the variable addressability prototype provided better resolution 13% of the time throughout the experiment, but was 15% slower in use than the uniform addressability prototype.

  1. 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...

  2. Therapeutics for multiple sclerosis symptoms.

    PubMed

    Ben-Zacharia, Aliza Bitton

    2011-01-01

    Symptoms management in multiple sclerosis is an integral part of its care. Accurate assessment and addressing the different symptoms provides increased quality of life among patients with multiple sclerosis. Multiple sclerosis symptoms may be identified as primary, secondary, or tertiary symptoms. Primary symptoms, such as weakness, sensory loss, and ataxia, are directly related to demyelination and axonal loss. Secondary symptoms, such as urinary tract infections as a result of urinary retention, are a result of the primary symptoms. Tertiary symptoms, such as reactive depression or social isolation, are a result of the social and psychological consequences of the disease. Common multiple sclerosis symptoms include fatigue and weakness; decreased balance, spasticity and gait problems; depression and cognitive issues; bladder, bowel, and sexual deficits; visual and sensory loss; and neuropathic pain. Less-common symptoms include dysarthria and dysphagia, vertigo, and tremors. Rare symptoms in multiple sclerosis include seizures, hearing loss, and paralysis. Symptom management includes nonpharmacological methods, such as rehabilitation and psychosocial support, and pharmacological methods, ie, medications and surgical procedures. The keys to symptom management are awareness, knowledge, and coordination of care. Symptoms have to be recognized and management needs to be individualized. Multiple sclerosis therapeutics include nonpharmacological strategies that consist of lifestyle modifications, rehabilitation, social support, counseling, and pharmacological agents or surgical procedures. The goal is vigilant management to improve quality of life and promote realistic expectations and hope.

  3. Managing Multiple Roles. Dual Role Homemaker/Wage-Earner. Final Report.

    ERIC Educational Resources Information Center

    Bourque, Janet

    A project was conducted at the Lake Washington Vocational Technical Institute to develop a curriculum and provide a pilot class in the consumer and homemaking program to address the needs of persons with the dual role of homemaker and wage earner. The format chosen for the course was a series of seminars to be conducted on-site at business offices…

  4. 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

  5. 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

  6. 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.

  7. 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

  8. 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.

  9. 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 Central

    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

  10. 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.

  11. 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

  12. 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.

  13. Reproductive Health Assessment After Disasters: embedding a toolkit within the disaster management workforce to address health inequalities among Gulf-Coast women.

    PubMed

    Arosemena, Farah A; Fox, Laila; Lichtveld, Maureen Y

    2013-11-01

    Gulf Coast women are especially vulnerable to the effects of disaster and for many this vulnerability is compounded by existing poor health-related quality of life. Post-Hurricane Isaac, a baseline survey battery utilizing the Reproductive Health Assessment After Disasters (RHAD) Toolkit, the Medical Outcomes Study Social Support Survey, and the Edinburgh Postnatal Depression Scale were used quantitatively to assess reproductive health risks, services, and outcomes and to explore the psychosocial effects of disaster among pregnant and postpartum women aged 18-45 years (N=300). The pilot study included trained community health workers and patient navigators to implement a community needs assessment in Southeast Louisiana. The community health navigation corps administered RHAD and the brief psychosocial battery to gain a closer understanding of post-disaster reproductive health needs. Findings demonstrate the importance of making a transition from patient navigation into disaster management in order to reduce fragmentation in health care systems and to implement innovative approaches in survey methodology.

  14. 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…

  15. Managing Family Data on Multiple Roles and Changing Statuses over Time.

    ERIC Educational Resources Information Center

    Otto, Luther B.; Call, Vaughan R. A.

    1990-01-01

    Presents procedure, mixed-radix positional number algorithm, for reducing set of numerous changes and stabilities in multiple roles at given time to a single empirical code. Demonstrates applicability and utility of procedure to wide array of complex family analyses through a simple pedagogical example. (Author/NB)

  16. 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.

  17. Management of a rare case of idiopathic multiple unerupted impacted permanent teeth in an adult female patient.

    PubMed

    Shetty, Karunakar; Kumar, Mahesh; Amanna, Susan; Sridharan, Srirangarajan; Reddy, Satyanarayan

    2016-01-01

    This clinical case report describes the multi-disciplinary approach in the management of an unusual presentation of idiopathic multiple unerupted impacted permanent teeth in a 20-year-old female patient. The case was unique in that, not only were there multiple missing permanent teeth, but also over retained deciduous teeth and attrited existing permanent teeth with loss of vertical dimension of occlusion. Since the patient was young, it was decided to retain all the erupted permanent teeth and extract the infected deciduous teeth with the objective of fabricating overlay complete dentures. This is a simple, reversible and an economical treatment modality, which satisfies both the esthetic and functional demands where the extraction of teeth is not generally indicated and, in addition, provides a stable occlusion. PMID:27621553

  18. Processing requirements of secure C3/I and battle management systems - Development of Gemini trusted multiple microcomputer base

    NASA Astrophysics Data System (ADS)

    Tao, T. F.; Schell, R. R.

    The present investigation is concerned with the potential applications of trusted computer system technologies in space. It is suggested that the rapidly expanding roles of new space defense missions will require space-borne command, control, communication, intelligence, and battle management (C2/I-BM) systems. The trusted computer system technology can be extended to develop new computer architectures which are able to support the broader requirements of C3/I-BM processing. The Gemini Trusted Multiple Microcomputer Base product is being developed to meet the demanding requirements and to support simultaneously the multiple capabilities. Attention is given to recent important events of trusted computer system developments, and to the Gemini system architecture.

  19. 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.

  20. 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.

  1. 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.

  2. Eutrophication assessment and management methodology of multiple pollution sources of a landscape lake in North China.

    PubMed

    Chen, Yanxi; Niu, Zhiguang; Zhang, Hongwei

    2013-06-01

    Landscape lakes in the city suffer high eutrophication risk because of their special characters and functions in the water circulation system. Using a landscape lake HMLA located in Tianjin City, North China, with a mixture of point source (PS) pollution and non-point source (NPS) pollution, we explored the methodology of Fluent and AQUATOX to simulate and predict the state of HMLA, and trophic index was used to assess the eutrophication state. Then, we use water compensation optimization and three scenarios to determine the optimal management methodology. Three scenarios include ecological restoration scenario, best management practices (BMPs) scenario, and a scenario combining both. Our results suggest that the maintenance of a healthy ecosystem with ecoremediation is necessary and the BMPs have a far-reaching effect on water reusing and NPS pollution control. This study has implications for eutrophication control and management under development for urbanization in China.

  3. 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.

  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. “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

  6. 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...

  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. MGUS and smoldering multiple myeloma: update on pathogenesis, natural history, and management.

    PubMed

    Rajkumar, S Vincent

    2005-01-01

    Monoclonal gammopathy of undetermined significance (MGUS) and smoldering multiple myeloma (SMM) are asymptomatic, pre-malignant disorders characterized by monoclonal plasma cell proliferation in the bone marrow and absence of end-organ damage. Recent advances in the pathogenesis, natural history, and prognosis of MGUS and SMM are reviewed. A new risk stratification system to determine the prognosis of MGUS using the size and type of M protein, and the serum free light chain assay is discussed. PMID:16304401

  9. Surgical management of the juvenile idiopathic arthritis patient with multiple joint involvement.

    PubMed

    Abdel, Matthew P; Figgie, Mark P

    2014-10-01

    Juvenile idiopathic arthritis (JIA) is recognized as a heterogenous group of disorders in which the common factor is persistent arthritis in at least 1 joint occurring before the age of 16 years. Although conservative management with nonsteroidal anti-inflammatory drugs and disease-modifying antirheumatic drugs can be effective, approximately 10% of JIA patients have end-stage degenerative changes requiring total hip arthroplasties (THAs) and total knee arthroplasties (TKAs). This article discusses the overall epidemiology, coordination of care, and medical and surgical management of JIA patients undergoing THA and TKA.

  10. 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.

  11. 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

  12. 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

  13. 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

  14. [Coping with chronic illness and multiple medicines in older age: self-management support as an obligation in nursing].

    PubMed

    Müller-Mundt, G; Schaeffer, D

    2011-02-01

    In later stages of chronic disease and especially in older age, chronically ill people are often dependent on multiple medicines. Coming to terms with complex medication regimes in everyday life is a challenging task. To provide the support actually needed, patient-centered interventions are essential, not only taking into account the patients' needs and preferences, but also promoting their ability to self manage their disease(s) and their medication regime. This paper outlines the results of a research project aimed at developing and evaluating an intervention to integrate self-management support into primary care, based on a qualitative exploration of the patients' and professionals' views. The findings stress that home care nurses should take an active part in self-management support but need to be prepared adequately. Therefore, a two-tier intervention was developed and evaluated in a prospective control study, consisting of a qualified training and guidelines for practice. The intervention serves to expand the nurses' professional competence to provide the needed individually tailored self-management support in home care. PMID:21279371

  15. 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

  16. 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...

  17. 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…

  18. 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…

  19. 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).

  20. 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…

  1. 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...

  2. 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

  3. 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.

  4. 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

  5. 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

  6. 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

  7. How do we manage and treat a patient with multiple sclerosis at risk of tuberculosis?

    PubMed

    Fragoso, Yara Dadalti; Adoni, Tarso; Anacleto, Andrea; Brooks, Joseph Bruno Bidin; Carvalho, Margarete de Jesus; Claudino, Rinaldo; Damasceno, Alfredo; Ferreira, Maria Lucia Brito; Gama, Paulo Diniz da; Goncalves, Marcus Vinicus Magno; Grzesiuk, Anderson Kuntz; Matta, Andre Palma da Cunha; Parolin, Monica Fiuza Koncke

    2014-11-01

    Tuberculosis continues to be a serious health problem worldwide. The disease continues to be underdiagnosed and not properly treated. In conditions that affect the immune system, such as multiple sclerosis (MS), latent tuberculosis may thrive and reactivate during the use of immunomodulatory and immunosuppressive drugs. Among the best treatment options for patients with latent or active tuberculosis who have MS are IFN-β, glatiramer acetate and mitoxantrone. Drugs leading to a reduced number and/or function of lymphocytes should be avoided or used with caution. Tuberculosis must always be investigated in patients with MS and treated with rigor.

  8. How do we manage and treat a patient with multiple sclerosis at risk of tuberculosis?

    PubMed

    Fragoso, Yara Dadalti; Adoni, Tarso; Anacleto, Andrea; Brooks, Joseph Bruno Bidin; Carvalho, Margarete de Jesus; Claudino, Rinaldo; Damasceno, Alfredo; Ferreira, Maria Lucia Brito; Gama, Paulo Diniz da; Goncalves, Marcus Vinicus Magno; Grzesiuk, Anderson Kuntz; Matta, Andre Palma da Cunha; Parolin, Monica Fiuza Koncke

    2014-11-01

    Tuberculosis continues to be a serious health problem worldwide. The disease continues to be underdiagnosed and not properly treated. In conditions that affect the immune system, such as multiple sclerosis (MS), latent tuberculosis may thrive and reactivate during the use of immunomodulatory and immunosuppressive drugs. Among the best treatment options for patients with latent or active tuberculosis who have MS are IFN-β, glatiramer acetate and mitoxantrone. Drugs leading to a reduced number and/or function of lymphocytes should be avoided or used with caution. Tuberculosis must always be investigated in patients with MS and treated with rigor. PMID:25242167

  9. 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…

  10. 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…

  11. 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.

  12. The control of land-use patterns for stormwater management at multiple spatial scales.

    PubMed

    Zhang, Ge; Guhathakurta, Subhro; Dai, Gang; Wu, Lingying; Yan, Lijiao

    2013-03-01

    While most research about the relationship between land use and watershed hydrological output has focused primarily on land-use types and their impact on hydrological processes, the relationship between characteristics of land-use patterns (such as pattern fragmentation, connectivity, and coherence) and hydrological processes has not been well examined. Using historical stormwater data, this study evaluates the hydrological effects of different land-use scenarios in the Qing-shui watershed in Beijing, China, at a variety of spatial scales. This study demonstrates that planning and managing land-use patterns can significantly reduce runoff under different scales, particularly for small storm events. In contrast to other aspects of land-use structure characteristics, such as the shape complexity of land-use patches, fragmented level of the patches of land-use types appear as dominant drivers of runoff. The results of the study suggest that land-use pattern management should be an important component of Best Management Practices to reduce the impacts of urbanization on natural hydrological processes.

  13. 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.

  14. 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.

  15. 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.

  16. Management of monoclonal gammopathy of undetermined significance (MGUS) and smoldering multiple myeloma (SMM).

    PubMed

    Kyle, Robert A; Buadi, Francis; Rajkumar, S Vincent

    2011-06-01

    Monoclonal gammopathy of undetermined significance (MGUS) is defined as a serum M protein level of less than 3 g/dL, less than 10% clonal plasma cells in the bone marrow, and the absence of end-organ damage. The prevalence of MGUS is 3.2% in the white population but is approximately twice that high in the black population. MGUS may progress to multiple myeloma, AL amyloidosis, Waldenström macroglobulinemia, or lymphoma. The risk of progression is approximately 1% per year, but the risk continues even after more than 25 years of observation. Risk factors for progression include the size of the serum M protein, the type of serum M protein, the number of plasma cells in the bone marrow, and the serum free light chain ratio. Smoldering (asymptomatic) multiple myeloma (SMM) is characterized by the presence of an M protein level of 3 g/dL or higher and/or 10% or more monoclonal plasma cells in the bone marrow but no evidence of end-organ damage. The overall risk of progression to a malignant condition is 10% per year for the first 5 years, approximately 3% per year for the next 5 years, and 1% to 2% per year for the following 10 years. Patients with both MGUS and SMM must be followed up for their lifetime. PMID:21888255

  17. 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.

  18. 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

  19. 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.

  20. 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

  1. 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

  2. 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.

  3. Bone disease in multiple myeloma and precursor disease: novel diagnostic approaches and implications on clinical management.

    PubMed

    Kristinsson, Sigurdur Y; Minter, Alex R; Korde, Neha; Tan, Esther; Landgren, Ola

    2011-07-01

    The manifestations of bone involvement in patients with multiple myeloma (MM) can have devastating clinical effects and increase mortality. Recent studies demonstrate that patients with the precursor conditions smoldering MM (SMM) and monoclonal gammopathy of undetermined significance (MGUS) show evidence of bone disease and increased risk of fractures. The understanding of the pathogenesis of bone disease in MM has expanded in recent years. The traditional skeletal survey will probably be replaced by newer and more sensitive imaging techniques, which may have a prognostic impact and change our definition of MGUS and SMM. Bisphosphonates are recommended to prevent skeletal events in patients with MM, and have also been studied in SMM and MGUS. This article summarizes the current knowledge of bone disease in plasma cell disorders, and discusses the current standard and future role of novel imaging techniques, as well as the evidence and current guidelines for bisphosphonates in MM, SMM and MGUS. PMID:21745013

  4. Bone disease in multiple myeloma and precursor disease: novel diagnostic approaches and implications on clinical management.

    PubMed

    Kristinsson, Sigurdur Y; Minter, Alex R; Korde, Neha; Tan, Esther; Landgren, Ola

    2011-07-01

    The manifestations of bone involvement in patients with multiple myeloma (MM) can have devastating clinical effects and increase mortality. Recent studies demonstrate that patients with the precursor conditions smoldering MM (SMM) and monoclonal gammopathy of undetermined significance (MGUS) show evidence of bone disease and increased risk of fractures. The understanding of the pathogenesis of bone disease in MM has expanded in recent years. The traditional skeletal survey will probably be replaced by newer and more sensitive imaging techniques, which may have a prognostic impact and change our definition of MGUS and SMM. Bisphosphonates are recommended to prevent skeletal events in patients with MM, and have also been studied in SMM and MGUS. This article summarizes the current knowledge of bone disease in plasma cell disorders, and discusses the current standard and future role of novel imaging techniques, as well as the evidence and current guidelines for bisphosphonates in MM, SMM and MGUS.

  5. Targeting Toll-like receptors: emerging therapeutics for multiple sclerosis management.

    PubMed

    Gambuzza, M; Licata, N; Palella, E; Celi, D; Foti Cuzzola, V; Italiano, D; Marino, S; Bramanti, P

    2011-10-28

    Toll-like receptors (TLR) are important innate immune proteins for the identification and clearance of invading pathogen. TLR signal through adaptor proteins, most commonly myeloid differentiation primary response gene 88 (MyD88). Inappropriate response of specific TLR has been implicated in certain autoimmune diseases, such as multiple sclerosis (MS). Activation of TLR2, TLR4, TLR7 and TLR9 plays a role in experimental allergic encephalomyelitis (EAE), a murine model of MS, while TLR3 activation protects from disease. Therefore, TLR-modulation could be an important adjuvant to current treatments. Here, we focus on TLR involved in EAE and MS pathogenesis highlighting specific components targeting TLR that might offer further therapeutic possibilities.

  6. 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.

  7. Explaining diversity of livestock-farming management strategies of multiple-job holders: importance of level of production objectives and role of farming in the household.

    PubMed

    Fiorelli, C; Dedieu, B; Pailleux, J-Y

    2007-09-01

    We characterised the livestock-farming management strategies of multiple-job holders and identified which variables contributed most to the differentiation of these strategies. We hypothesised that they would mainly be differentiated by the contribution of the farming income to the total household income and the availability of the household members for farming. The multiple-job holding livestock-farmer's motivations, decisions and actions about both multiple-job holding and livestock farming were obtained in semi-directed interviews of 35 sheep farmers who held multiple jobs, on farm and off farm. They were synthesised into six variables characterising the diversity of the livestock-farming objectives and management guidelines. Thanks to a multiple factorial analysis, we showed that the diversity of the sheep-farming management strategies of multiple-job holders was better explained by two factors 'level of motivation of the farmer to get high technical results' and 'more personal fulfilling v. the family business conception of farming', than the factors we hypothesised. Within our sample, the performances ranged from 0.7 to 1.4 weaned lambs per ewe per year. Six sheep-farming management strategies were identified. They illustrated the importance of the level of production objectives and of farming income expectation, which were found to be independent, in explaining diversity. No direct relationship between farm work organisation and sheep-farming management strategy was identified. Explaining the diversity of the livestock-farming management strategies of multiple-job holders appears to require that all the benefits expected from farming and their hierarchy be identified before analysing how they are translated into production objectives and management guidelines.

  8. 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.

  9. 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

  10. 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.

  11. 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

  12. Single- Versus Multiple-Drug Pharmacotherapy in the Management of Diabetic Painful Neuropathy.

    PubMed

    Kuo, Kuan-Ling; Brixner, Diana; Lipman, Arthur G; Goodman, Michael; Hung, Man; Oderda, Gary M

    2016-09-01

    This study compared patient characteristics and health care costs between newly treated diabetic painful neuropathy (DPN) patients receiving mono- pharmacotherapy and those receiving combination pharmacotherapy. A retrospective cohort was developed through Inovalon's Medical Outcomes Research for Effectiveness and Economics Registry (MORE2) database. Patients included were ≥18 years on the date of first DPN prescription: tricyclic antidepressant, opioids, duloxetine, gabapentin, pregabalin, or lidocaine. The authors conducted a simple proportional hazards model comparing times to discontinuation, switch, or addon. Multiple logistic regression was used to identify predictors of combination pharmacotherapy. There were 7145 patients on mono-pharmacotherapy and 421 patients on combination pharmacotherapy. Patients receiving combination pharmacotherapy were 130% more likely to discontinue their medications than patients receiving mono-pharmacotherapy. Female patients and those with > 7 comorbidities were more likely to be started with combination pharmacotherapy. Elderly patients were less likely to be started with combination pharmacotherapy. The total cost of care difference between mono- and combination pharmacotherapy was not statistically significant (P = .66); therefore, newly treated DPN patients should add on another medication sooner than 30 days when considering combination pharmacotherapy. All first-line medications have similar efficacy; for this reason, cost should be considered in the treatment decision. PMID:27541383

  13. 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

  14. 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

  15. Understanding the role of adjunctive nonpharmacological therapies in management of the multiple pathways to depression.

    PubMed

    Velehorschi, Corina; Bleau, Pierre; Vermani, Monica; Furtado, Melissa; Klassen, Larry J

    2014-12-01

    Major depressive disorder (MDD) is a common disorder with a lifetime prevalence of 16.2% and the fourth highest cause of disability globally. It is hypothesized to be a syndromatic manifestation of multiple pathological processes leading to similar clinical manifestation. MDD is associated with at least three categories of peripheral hormone-type factors including neurotrophic factors, proinflammatory cytokines, and processes that impair regulation of the hypothalamic-pituitary-adrenocortical axis. Neuroimaging studies have identified functional abnormalities including subcortical systems associated with reward and emotion processing, medial prefrontal and anterior cingulate cortical regions and the lateral prefrontal cortical systems involved in cognitive control and voluntary emotion regulation. Studies investigating the effects of psychotherapy and pharmacotherapy on functional brain measures show normalization of brain function with return to euthymia. Nevertheless, approximately 50% of patients with MDD will not respond sufficiently and 60 to 70% will not achieve full remission with first-line pharmacotherapy, therefore clinicians strive to improve patient responses through the use of adjunct therapies. This review discusses recent research in the various biological processes associated with MDD as well as recent data in support of the use of adjunctive non-pharmacological therapies including psychotherapy, bibliotherapy, Internet therapy, "natural" or herbal approaches, exercise therapy, and somatic therapies.

  16. 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

  17. Bioreactors addressing diabetes mellitus.

    PubMed

    Minteer, Danielle M; Gerlach, Jorg C; Marra, Kacey G

    2014-11-01

    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.

  18. 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.

  19. 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.

  20. 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.

  1. 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

  2. Addressing Environmental Health Inequalities

    PubMed Central

    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

  3. 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

  4. Serum-free light-chain analysis in diagnosis and management of multiple myeloma and related conditions.

    PubMed

    Milani, Paolo; Palladini, Giovanni; Merlini, Giampaolo

    2016-01-01

    The introduction of the serum-free light-chain (S-FLC) assay has been a breakthrough in the diagnosis and management of plasma cell dyscrasias, particularly monoclonal light-chain diseases. The first method, proposed in 2001, quantifies serum-free light-chains using polyclonal antibodies. More recently, assays based on monoclonal antibodies have entered into clinical practice. S-FLC measurement plays a central role in the screening for multiple myeloma and related conditions, in association with electrophoretic techniques. Analysis of S-FLC is essential in assessing the risk of progression of precursor diseases to overt plasma cell dyscrasias. It is also useful for risk stratification in solitary plasmacytoma and AL amyloidosis. The S-FLC measurement is part of the new diagnostic criteria for multiple myeloma, and provides a marker to follow changes in clonal substructure over time. Finally, the evaluation of S-FLC is fundamental for assessing the response to treatment in monoclonal light chain diseases. PMID:27467897

  5. 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

  6. Best practices in the management of newly diagnosed multiple myeloma patients who will not undergo transplant.

    PubMed

    Niesvizky, Ruben; Coleman, Morton; Mark, Tomer

    2010-03-01

    No survival advantage of autologous stem cell transplantation (ASCT) has been documented for patients older than 65 years, and in the era of thalidomide (Thalomid), bortezomib (Velcade), and lenalidomide (Revlimid), ASCT has a diminished role in the front-line treatment of older patients with myeloma. For these individuals and for those who cannot or choose not to undergo ASCT, the initial treatment regimens now recommended by both the National Comprehensive Cancer Network and the International Myeloma Working Group are melphalan (Alkeran)/prednisone/thalidomide (MPT), bortezomib/melphalan/prednisone (VMP), and lenalidomide/low-dose dexamethasone. Melphalan/prednisone should no longer be considered the reference treatment, although it may be appropriate for a small number of patients with serious comorbidity and/or poor performance status. Advantages of VMP over MPT include rapid response, high rates of complete response, patient compliance, and more extensive evidence of efficacy in patients with certain cytogenetic abnormalities. Lenalidomide/low-dose dexamethasone is particularly appropriate for patients with preexisting neurotoxicity and those who wish to postpone ASCT. Toxicity profiles differ among the newly established and emerging regimens, and oncology teams must take care to apply the appropriate risk management measures, including dose reduction where necessary.

  7. 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.

  8. VIKOR method with enhanced accuracy for multiple criteria decision making in healthcare management.

    PubMed

    Zeng, Qiang-Lin; Li, Dan-Dan; Yang, Yi-Bin

    2013-04-01

    Višekriterijumsko kompromisno rangiranje (VIKOR) method is one of the commonly used multi criteria decision making (MCDM) methods for improving the quality of decision making. VIKOR has an advantage in providing a ranking procedure for positive attributes and negative attributes when it is used and examined in decision support. However, we noticed that this method may failed to support an objective result in medical field because most medical data have normal reference ranges (e.g., for normally distributed data: NRR ∈ [μ ± 1.96σ], this limitation shows a negative effect on the acceptance of it as an effective decision supporting method in medical decision making. This paper proposes an improved VIKOR method with enhanced accuracy (ea-VIKOR) to make it suitable for such data in medical field by introducing a new data normalization method taking the original distance to the normal reference range (ODNRR) into account. In addition, an experimental example was presented to demonstrate efficiency and feasibility of the ea-VIKOR method, the results demonstrate the ability of ea-VIKOR to deal with moderate data and support the decision making in healthcare care management. For this reason, the ea-VIKOR should be considered for use as a decision support tool for future study.

  9. 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.

  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. 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

  12. Future of Management of Multiple Sclerosis in the Middle East: A Consensus View from Specialists in Ten Countries

    PubMed Central

    Aljumah, Mohammed; Alsharoqi, I.; Bohlega, Saeed A.; Dahdaleh, Maurice; Deleu, Dirk; Esmat, Khaled; Khalifa, Ahmad; Sahraian, Mohammad A.; Szólics, Miklós; AlTahan, Abdulrahman; Yamout, Bassem I.; Rieckmann, Peter

    2013-01-01

    The prevalence of multiple sclerosis (MS) is now considered to be medium-to-high in the Middle East and is rising, particularly among women. While the characteristics of the disease and the response of patients to disease-modifying therapies are generally comparable between the Middle East and other areas, significant barriers to achieving optimal care for MS exist in these developing nations. A group of physicians involved in the management of MS in ten Middle Eastern countries met to consider the future of MS care in the region, using a structured process to reach a consensus. Six key priorities were identified: early diagnosis and management of MS, the provision of multidisciplinary MS centres, patient engagement and better communication with stakeholders, regulatory body education and reimbursement, a commitment to research, and more therapy options with better benefit-to-risk ratios. The experts distilled these priorities into a single vision statement: “Optimization of patient-centred multidisciplinary strategies to improve the quality of life of people with MS.” These core principles will contribute to the development of a broader consensus on the future of care for MS in the Middle East. PMID:24455267

  13. Future of management of multiple sclerosis in the middle East: a consensus view from specialists in ten countries.

    PubMed

    Aljumah, Mohammed; Alroughani, Raed; Alsharoqi, I; Bohlega, Saeed A; Dahdaleh, Maurice; Deleu, Dirk; Esmat, Khaled; Khalifa, Ahmad; Sahraian, Mohammad A; Szólics, Miklós; Altahan, Abdulrahman; Yamout, Bassem I; Rieckmann, Peter; Daif, Abdulkader

    2013-01-01

    The prevalence of multiple sclerosis (MS) is now considered to be medium-to-high in the Middle East and is rising, particularly among women. While the characteristics of the disease and the response of patients to disease-modifying therapies are generally comparable between the Middle East and other areas, significant barriers to achieving optimal care for MS exist in these developing nations. A group of physicians involved in the management of MS in ten Middle Eastern countries met to consider the future of MS care in the region, using a structured process to reach a consensus. Six key priorities were identified: early diagnosis and management of MS, the provision of multidisciplinary MS centres, patient engagement and better communication with stakeholders, regulatory body education and reimbursement, a commitment to research, and more therapy options with better benefit-to-risk ratios. The experts distilled these priorities into a single vision statement: "Optimization of patient-centred multidisciplinary strategies to improve the quality of life of people with MS." These core principles will contribute to the development of a broader consensus on the future of care for MS in the Middle East.

  14. Selecting a disease-modifying agent as platform therapy in the long-term management of multiple sclerosis.

    PubMed

    Stuart, William H; Cohan, Stanley; Richert, John R; Achiron, Anat

    2004-12-14

    Multiple sclerosis (MS) is a complex, incurable disease. Treatment consists of lifelong disease and symptom management. FDA-approved therapies for relapsing MS include subcutaneous (SC) interferon beta-1b (IFNbeta1b, Betaseron), IM interferon-beta-1a (Avonex), SC interferon-beta-1a (Rebif), glatiramer acetate (Copaxone), and mitoxantrone (Novantrone), all of which are known as disease-modifying agents (DMAs). DMAs that can be initiated and continued on a long-term basis can be referred to as platform therapies. During periods of disease instability with increased disease activity, corticosteroids or immunosuppressive agents can be used in combination with appropriate DMA platform therapy to help control symptoms. To date, long-term comparative studies of DMAs are not available. However, based on the effects of these agents on disability progression, relapse rates, MRI outcomes, and neutralizing antibodies observed in phase III randomized clinical trials, IFNbeta1a products are the DMAs of choice for platform therapy for MS. Evidence indicates that IFNbeta1a may also be beneficial in the early stages of the disease. Research is ongoing to identify other appropriate add-on agents (e.g., antigen-specific therapies) to be used in combination with existing DMAs to effectively manage MS.

  15. 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.

  16. 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

  17. [Keynote address: Climate change

    SciTech Connect

    Forrister, D.

    1994-12-31

    Broadly speaking, the climate issue is moving from talk to action both in the United States and internationally. While few nations have adopted strict controls or stiff new taxes, a number of them are developing action plans that are making clear their intention to ramp up activity between now and the year 2000... and beyond. There are sensible, economically efficient strategies to be undertaken in the near term that offer the possibility, in many countries, to avoid more draconian measures. These strategies are by-and-large the same measures that the National Academy of Sciences recommended in a 1991 report called, Policy Implications of Greenhouse Warming. The author thinks the Academy`s most important policy contribution was how it recommended the nations act in the face of uncertain science and high risks--that cost effective measures are adopted as cheap insurance... just as nations insure against other high risk, low certainty possibilities, like catastrophic health insurance, auto insurance, and fire insurance. This insurance theme is still right. First, the author addresses how the international climate change negotiations are beginning to produce insurance measures. Next, the author will discuss some of the key issues to watch in those negotiations that relate to longer-term insurance. And finally, the author will report on progress in the United States on the climate insurance plan--The President`s Climate Action Plan.

  18. 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

  19. 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

  20. Update on the use of erythropoiesis-stimulating agents (ESAs) for the management of anemia of multiple myeloma and lymphoma.

    PubMed

    Katodritou, Eirini; Dimopoulos, Meletios A; Zervas, Konstantinos; Terpos, Evangelos

    2009-12-01

    Anemia is a common side-effect of patients with multiple myeloma (MM) and lymphoma. The etiology is complex, but the main cause is the underlying mechanism of anemia of chronic disease, which is characterized among others, by impairment of iron metabolism and consequently iron restricted erythropoiesis (IRE), resulting from the up-regulation of the iron distributing regulator, hepcidin. Erythopoiesis-stimulating agents (ESAs) have been the standard of care since early 90's offering high response rates and improving the quality of life of the patients. However, the role of ESAs in the treatment of cancer-related anemia has been questioned recently, due to the growing evidence which support that ESAs may be associated with increased risk for thrombosis and may have a detrimental impact on patients' survival. Under the light of the recent considerations, the place of ESAs in the management of cancer-related anemia has been reassigned. Regarding the management of anemia in MM or lymphoma, the updated American Society of Clinical Oncology/American Society of Hematology (ASCO/ASH) 2007 clinical practice guidelines on the use of ESAs in cancer-related anemia, recommended that ESAs should be preferably omitted in patients planned to receive chemotherapy and applied in case that anemia does not improve over treatment. The quest for reliable predictors for response to ESAs and for indicators of IRE which plays a major etiological role for the development of anemia of cancer still remains an open issue. In the current review we present an update on ESAs use in anemia of MM and lymphoma.

  1. Addressing psychiatric comorbidity.

    PubMed

    Woody, G E; McLellan, A T; O'Brien, C P; Luborsky, L

    1991-01-01

    Research studies indicate that addressing psychiatric comorbidity can improve treatment for selected groups of substance-abusing patients. However, the chances for implementing the necessary techniques on a large scale are compromised by the absence of professional input and guidance within programs. This is especially true in public programs, which treat some of the most disadvantaged, disturbed, and socially destructive individuals in the entire mental health system. One starting point for upgrading the level of knowledge and training of staff members who work in this large treatment system could be to develop a better and more authoritative information dissemination network. Such a system exists in medicine; physicians are expected to read appropriate journals and to guide their treatment decisions using the data contained in the journals. Standards of practice and methods for modifying current practice are within the tradition of reading new facts, studying old ones, and comparing treatment outcome under different conditions with what is actually being done. No such general system of information-gathering or -sharing exists, particularly in public treatment programs. One of the most flagrant examples of this "educational shortfall" can be found among those methadone programs that adamantly insist on prescribing no more than 30 to 35 mg/day for all patients, in spite of the overwhelming evidence that these dose levels generally are inadequate. In some cases, program directors are unaware of studies that have shown the relationship between dose and outcome. In other cases, they are aware of the studies but do not modify their practices accordingly. This example of inadequate dosing is offered as an example of one situation that could be improved by adherence to a system of authoritative and systematic information dissemination. Many issues in substance abuse treatment do not lend themselves to information dissemination as readily as that of methadone dosing

  2. Addressing the insider threat

    SciTech Connect

    Hochberg, J.G.; Jackson, K.A.; McClary, J.F.; Simmonds, D.D.

    1993-05-01

    Computers have come to play a major role in the processing of information vital to our national security. As we grow more dependent on computers, we also become more vulnerable to their misuse. Misuse may be accidental, or may occur deliberately for purposes of personal gain, espionage, terrorism, or revenge. While it is difficult to obtain exact statistics on computer misuse, clearly it is growing. It is also clear that insiders -- authorized system users -- are responsible for most of this increase. Unfortunately, their insider status gives them a greater potential for harm This paper takes an asset-based approach to the insider threat. We begin by characterizing the insider and the threat posed by variously motivated insiders. Next, we characterize the asset of concern: computerized information of strategic or economic value. We discuss four general ways in which computerized information is vulnerable to adversary action by the insider: disclosure, violation of integrity, denial of service, and unauthorized use of resources. We then look at three general remedies for these vulnerabilities. The first is formality of operations, such as training, personnel screening, and configuration management. The second is the institution of automated safeguards, such as single-use passwords, encryption, and biometric devices. The third is the development of automated systems that collect and analyze system and user data to look for signs of misuse.

  3. Addressing the insider threat

    SciTech Connect

    Hochberg, J.G.; Jackson, K.A.; McClary, J.F.; Simmonds, D.D.

    1993-01-01

    Computers have come to play a major role in the processing of information vital to our national security. As we grow more dependent on computers, we also become more vulnerable to their misuse. Misuse may be accidental, or may occur deliberately for purposes of personal gain, espionage, terrorism, or revenge. While it is difficult to obtain exact statistics on computer misuse, clearly it is growing. It is also clear that insiders -- authorized system users -- are responsible for most of this increase. Unfortunately, their insider status gives them a greater potential for harm This paper takes an asset-based approach to the insider threat. We begin by characterizing the insider and the threat posed by variously motivated insiders. Next, we characterize the asset of concern: computerized information of strategic or economic value. We discuss four general ways in which computerized information is vulnerable to adversary action by the insider: disclosure, violation of integrity, denial of service, and unauthorized use of resources. We then look at three general remedies for these vulnerabilities. The first is formality of operations, such as training, personnel screening, and configuration management. The second is the institution of automated safeguards, such as single-use passwords, encryption, and biometric devices. The third is the development of automated systems that collect and analyze system and user data to look for signs of misuse.

  4. 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.

  5. 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…

  6. 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

  7. 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.

  8. 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

  9. Optimizing therapeutics in the management of patients with multiple sclerosis: a review of drug efficacy, dosing, and mechanisms of action.

    PubMed

    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.

  10. 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

  11. Design of experiments with multiple independent variables: a resource management perspective on complete and reduced factorial designs.

    PubMed

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

    2009-09-01

    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. 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 4 design options are compared: complete factorial, individual experiments, single factor, and fractional factorial. 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.

  12. 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

  13. 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.

  14. Public health approach to address maternal mortality.

    PubMed

    Rai, Sanjay K; Anand, K; Misra, Puneet; Kant, Shashi; Upadhyay, Ravi Prakash

    2012-01-01

    Reducing maternal mortality is one of the major challenges to health systems worldwide, more so in developing countries that account for nearly 99% of these maternal deaths. Lack of a standard method for reporting of maternal death poses a major hurdle in making global comparisons. Currently much of the focus is on documenting the "number" of maternal deaths and delineating the "medical causes" behind these deaths. There is a need to acknowledge the social correlates of maternal deaths as well. Investigating and in-depth understanding of each maternal death can provide indications on practical ways of addressing the problem. Death of a mother has serious implications for the child as well as other family members and to prevent the same, a comprehensive approach is required. This could include providing essential maternal care, early management of complications and good quality intrapartum care through the involvement of skilled birth attendants. Ensuring the availability, affordability, and accessibility of quality maternal health services, including emergency obstetric care (EmOC) would prove pivotal in reducing the maternal deaths. To increase perceived seriousness of the community regarding maternal health, a well-structured awareness campaign is needed with importance be given to avoid adolescent pregnancy as well. Initiatives like Janani Surakhsha Yojna (JSY) that have the potential to improve maternal health needs to be strengthened. Quality assessments should form an essential part of all services that are directed toward improving maternal health. Further, emphasis needs to be given on research by involving multiple allied partners, with the aim to develop a prioritized, coordinated, and innovative research agenda for women's health. PMID:23229211

  15. 41 CFR 109-26.203 - Activity address codes.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 41 Public Contracts and Property Management 3 2012-01-01 2012-01-01 false Activity address codes. 109-26.203 Section 109-26.203 Public Contracts and Property Management Federal Property Management Regulations System (Continued) DEPARTMENT OF ENERGY PROPERTY MANAGEMENT REGULATIONS SUPPLY AND PROCUREMENT...

  16. Choice--Kansas City Style: Addressing Equity from Multiple Perspectives.

    ERIC Educational Resources Information Center

    Thompson, Johnnie

    1995-01-01

    Highlights case studies of three elementary schools in the Kansas City (Missouri) System of Choice program that resulted from a court order to erase all vestiges of segregation in the Kansas City school district. The possible effects of these choices of school programs on educational equity are summarized. (GR)

  17. Physical activity prescription: a critical opportunity to address a modifiable risk factor for the prevention and management of chronic disease: a position statement by the Canadian Academy of Sport and Exercise Medicine.

    PubMed

    Thornton, Jane S; Frémont, Pierre; Khan, Karim; Poirier, Paul; Fowles, Jonathon; Wells, Greg D; Frankovich, Renata J

    2016-09-01

    Non-communicable disease is a leading threat to global health. Physical inactivity is a large contributor to this problem; in fact, the WHO ranks it as the fourth leading risk factor for overall morbidity and mortality worldwide. In Canada, at least 4 of 5 adults do not meet the Canadian Physical Activity Guidelines of 150 min of moderate-to-vigorous physical activity per week. Physicians play an important role in the dissemination of physical activity (PA) recommendations to a broad segment of the population, as over 80% of Canadians visit their doctors every year and prefer to get health information directly from them. Unfortunately, most physicians do not regularly assess or prescribe PA as part of routine care, and even when discussed, few provide specific recommendations. PA prescription has the potential to be an important therapeutic agent for all ages in primary, secondary and tertiary prevention of chronic disease. Sport and exercise medicine (SEM) physicians are particularly well suited for this role and should collaborate with their primary care colleagues for optimal patient care. The purpose of this Canadian Academy and Sport and Exercise Medicine position statement is to provide an evidence-based, best practices summary to better equip SEM and primary care physicians to prescribe PA and exercise, specifically for the prevention and management of non-communicable disease. This will be achieved by addressing common questions and perceived barriers in the field.Author note This position statement has been endorsed by the following nine sport medicine societies: Australasian College of Sports and Exercise Physicians (ACSEP), American Medical Society for Sports Medicine (AMSSM), British Association of Sports and Exercise Medicine (BASEM), European College of Sport & Exercise Physicians (ECOSEP), Norsk forening for idrettsmedisin og fysisk aktivite (NIMF), South African Sports Medicine Association (SASMA), Schweizerische Gesellschaft für Sportmedizin

  18. Physical activity prescription: a critical opportunity to address a modifiable risk factor for the prevention and management of chronic disease: a position statement by the Canadian Academy of Sport and Exercise Medicine.

    PubMed

    Thornton, Jane S; Frémont, Pierre; Khan, Karim; Poirier, Paul; Fowles, Jonathon; Wells, Greg D; Frankovich, Renata J

    2016-09-01

    Non-communicable disease is a leading threat to global health. Physical inactivity is a large contributor to this problem; in fact, the WHO ranks it as the fourth leading risk factor for overall morbidity and mortality worldwide. In Canada, at least 4 of 5 adults do not meet the Canadian Physical Activity Guidelines of 150 min of moderate-to-vigorous physical activity per week. Physicians play an important role in the dissemination of physical activity (PA) recommendations to a broad segment of the population, as over 80% of Canadians visit their doctors every year and prefer to get health information directly from them. Unfortunately, most physicians do not regularly assess or prescribe PA as part of routine care, and even when discussed, few provide specific recommendations. PA prescription has the potential to be an important therapeutic agent for all ages in primary, secondary and tertiary prevention of chronic disease. Sport and exercise medicine (SEM) physicians are particularly well suited for this role and should collaborate with their primary care colleagues for optimal patient care. The purpose of this Canadian Academy and Sport and Exercise Medicine position statement is to provide an evidence-based, best practices summary to better equip SEM and primary care physicians to prescribe PA and exercise, specifically for the prevention and management of non-communicable disease. This will be achieved by addressing common questions and perceived barriers in the field.Author note This position statement has been endorsed by the following nine sport medicine societies: Australasian College of Sports and Exercise Physicians (ACSEP), American Medical Society for Sports Medicine (AMSSM), British Association of Sports and Exercise Medicine (BASEM), European College of Sport & Exercise Physicians (ECOSEP), Norsk forening for idrettsmedisin og fysisk aktivite (NIMF), South African Sports Medicine Association (SASMA), Schweizerische Gesellschaft für Sportmedizin

  19. 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

  20. Teaching Multiple Online Sections/Courses: Tactics and Techniques

    ERIC Educational Resources Information Center

    Bates, Rodger; LaBrecque, Bryan; Fortner, Emily

    2016-01-01

    The challenge of teaching online increases as the number of sections or courses increase in a semester. The tactics and techniques which enrich online instruction in the tradition of quality matters can be modified and adapted to the demands of multiple instructional needs during a semester. This paper addresses time management and instructional…

  1. 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

  2. FORSITE, a multiple-project management system: production of critical-path development schedules for geothermal electric-power-generation projects

    SciTech Connect

    Bernstein, A.J.; Entingh, D.J.; Gerstein, R.E.; Gould, A.V.

    1982-10-01

    FORSITE is an advanced project monitoring software system that is designed to track and forecast the development of multiple projects. This paper describes the organization and operation of the FORSITE system including its overall structure and the functional relationships between its files and data bases. The paper also illustrates the operation of the system with an example of a generic critical-path management schedule produced by FORSITE. A program listing and schedule summaries are included as appendices.

  3. Management Certainly Matters, and There Are Multiple Ways to Conceptualize the Process Comment on "Management Matters: A Leverage Point for Health Systems Strengthening in Global Health".

    PubMed

    Longest, Beaufort B

    2015-01-01

    The authors of "Management matters: a leverage point for health systems strengthening in global health," raise a crucial issue. Because more effective management can contribute to better performing health systems, attempts to strengthen health systems require attention to management. As a guide toward management capacity building, the authors outline a comprehensive set of core management competencies needed for managing global health efforts. Although, I agree with the authors' central premise about the important role of management in improving global health and concur that focusing on competencies can guide management capacity building, I think it is important to recognize that a set of relevant competencies is not the only way to conceptualize and organize efforts to teach, learn, practice, or conduct research on management. I argue the added utility of also viewing management as a set of functions or activities as an alternative paradigm and suggest that the greatest utility could lie in some hybrid that combines various ways of conceptualizing management for study, practice, and research.

  4. 2015 ASHG Awards and Addresses

    PubMed Central

    2016-01-01

    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 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.

  5. 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

  6. Multiple Sclerosis.

    PubMed

    Schiess, Nicoline; Calabresi, Peter A

    2016-08-01

    It is estimated that there are 300,000 people with multiple sclerosis (MS) in the United States and 2.3 million worldwide. Each MS attack can affect function in cognitive, emotional, motoric, sensory, or visual domains. Patients are often struck in the prime of their lives as they attempt to move forward with career, and family. Since the previous 2010 Seminars in Neurology Pearls and Pitfalls issue, the world of MS has drastically changed and advanced. Here the authors address the ever-changing MS world in both treatment options and diagnostics, covering easily missed differential diagnoses, newly available immunomodulatory therapy, and the challenges of safely treating patients. PMID:27643903

  7. Management of Multiple Mandibular Fractures in a Child with Osteogenesis Imperfecta Using Arch Bar Retained Thermoformed Splints: A Novel Technique.

    PubMed

    Nilesh, Kumar; Sawant, Ashwini; Taur, Swapnil; Parkar, M I

    2016-01-01

    Osteogenesis Imperfecta (OI) is a heterogeneous group of autosomal dominant and recessive inherited disorders of type I collagen metabolism. Clinical features of OI include multiple bone fractures, muscle weakness, joint laxity, skeletal deformities, blue sclerae, hearing loss, and dentinogenesis imperfecta. This report presents a challenging case of multiple mandibular fractures in a five years old child with OI, which was successfully treated with a new, minimally invasive technique of closed reduction with arch bar retained thermoformed splint.

  8. 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

  9. Wavelet-transform-based power management of hybrid vehicles with multiple on-board energy sources including fuel cell, battery and ultracapacitor

    NASA Astrophysics Data System (ADS)

    Zhang, Xi; Mi, Chris Chunting; Masrur, Abul; Daniszewski, David

    A wavelet-transform-based strategy is proposed for the power management of hybrid electric vehicles (HEV) with multiple on-board energy sources and energy storage systems including a battery, a fuel cell, and an ultra-capacitor. The proposed wavelet-transform algorithm is capable of identifying the high-frequency transient and real time power demand of the HEV, and allocating power components with different frequency contents to corresponding sources to achieve an optimal power management control algorithm. By using the wavelet decomposition algorithm, a proper combination can be achieved with a properly sized ultra-capacitor dealing with the chaotic high-frequency components of the total power demand, while the fuel cell and battery deal with the low and medium frequency power demand. Thus the system efficiency and life expectancy can be greatly extended. Simulation and experimental results validated the effectiveness of wavelet-transform-based power management algorithm.

  10. 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…

  11. 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

  12. Addressing Chronic Disease Within Supportive Housing Programs

    PubMed Central

    Henwood, Benjamin F.; Stanhope, Victoria; Brawer, Rickie; Weinstein, Lara Carson; Lawson, James; Stwords, Edward; Crossan, Cornelius

    2015-01-01

    Background Tenants of supportive housing have a high burden of chronic health conditions. Objectives To examine the feasibility of developing a tenant-involved health promotion initiative within a “housing first” agency using a community-based participatory research (CBPR) framework. Methods Qualitative analyses of nine research capacity-building group meetings and fifteen individual pre- and post-interviews with those who completed a chronic disease self-management program, resulting in the development of several themes. Results Tenants of supportive housing successfully partnered with health care providers to implement a chronic disease self-management program, noting that “health care becomes ‘relevant’ with housing.” Conclusions Supportive housing organizations are well-situated to implement health promotion initiatives. Such publicly subsidized housing that is accompanied by comprehensive supports must also include self-management training to help people overcome both internal and external barriers to addressing chronic health needs. PMID:23543023

  13. 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

  14. Addressing adolescent pregnancy with legislation.

    PubMed

    Montgomery, Tiffany M; Folken, Lori; Seitz, Melody A

    2014-01-01

    Adolescent pregnancy is a concern among many women's health practitioners. While it is practical and appropriate to work to prevent adolescent pregnancy by educating adolescents in health care clinics, schools and adolescent-friendly community-based organizations, suggesting and supporting legislative efforts to reduce adolescent pregnancy can help address the issue on an even larger scale. This article aims to help nurses better understand current legislation that addresses adolescent pregnancy, and to encourage support of future adolescent pregnancy prevention legislation. PMID:25145716

  15. Addressing adolescent pregnancy with legislation.

    PubMed

    Montgomery, Tiffany M; Folken, Lori; Seitz, Melody A

    2014-01-01

    Adolescent pregnancy is a concern among many women's health practitioners. While it is practical and appropriate to work to prevent adolescent pregnancy by educating adolescents in health care clinics, schools and adolescent-friendly community-based organizations, suggesting and supporting legislative efforts to reduce adolescent pregnancy can help address the issue on an even larger scale. This article aims to help nurses better understand current legislation that addresses adolescent pregnancy, and to encourage support of future adolescent pregnancy prevention legislation.

  16. Addressing Cardiometabolic Risk During Treatment With Antipsychotic Medications

    PubMed Central

    Amiel, Jonathan M.; Mangurian, Christina V.; Ganguli, Rohan; Newcomer, John W.

    2009-01-01

    Purpose of Review To raise awareness of and inform evidence-based practice regarding medical and behavioral interventions for antipsychotic medication-induced metabolic abnormalities. Recent Findings The current literature indicates that individuals with severe and persistent mental illness have significantly worse health outcomes and premature mortality compared to the general population, due to a combination of under-recognition and treatment of medical risk factors, reduced access to care, sedentary lifestyle and poor diet, and the potential contribution of adverse metabolic side effects of antipsychotic medications like weight gain, hyperglycemia and dyslipidemia. A combination of administrative, behavioral and medical approaches to addressing these medical risks may be more effective than any one of these approaches alone. Summary Treatment with antipsychotic medications can induce significant weight gain and abnormalities in lipid and glucose metabolism that increase risk for cardiovascular disease and diabetes in a population already at risk from multiple other sources. Managing the side effects of antipsychotics and lowering risk in general is an important aspect of the management of chronic mental illness. There are a variety of effective medical and behavioral interventions that can be employed to achieve primary and secondary prevention aims. PMID:18852570

  17. 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…

  18. 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…

  19. 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 ...

  20. 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.

  1. 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.

  2. Addressing medical errors in hand surgery.

    PubMed

    Johnson, Shepard P; Adkinson, Joshua M; Chung, Kevin C

    2014-09-01

    Influential think tanks such as the Institute of Medicine have raised awareness about the implications of medical errors. In response, organizations, medical societies, and hospitals have initiated programs to decrease the incidence and prevent adverse effects of these errors. Surgeons deal with the direct implications of adverse events involving patients. In addition to managing the physical consequences, they are confronted with ethical and social issues when caring for a harmed patient. Although there is considerable effort to implement system-wide changes, there is little guidance for hand surgeons on how to address medical errors. Admitting an error by a physician is difficult, but a transparent environment where patients are notified of errors and offered consolation and compensation is essential to maintain physician-patient trust. Furthermore, equipping hand surgeons with a guide for addressing medical errors will help identify system failures, provide learning points for safety improvement, decrease litigation against physicians, and demonstrate a commitment to ethical and compassionate medical care.

  3. Exploring the effects of multiple management objectives and exotic species on great lakes food webs and contaminant dynamics

    NASA Astrophysics Data System (ADS)

    Fontaine, Thomas D.; Stewart, Donald J.

    1992-03-01

    A simulation model was developed to describe linkages among fish food web, nutrient cycling, and contaminant processes in the southern basin of Lake Michigan. The model was used to examine possible effects of management actions and an exotic zooplankter ( Bythotrephes) on Lake Michigan food web and contaminant dynamics. The model predicts that contaminant concentrations in salmonines will decrease by nearly 20% if Bythotrephes successfully establishes itself in the lake. The model suggests that this decrease will result from lowered transfer efficiencies within the food web and increased flux of contaminants to the hypolimnion. The model also indicates that phosphorus management will have little effect on contaminant concentrations in salmonines. The modeling exercise helped identify weaknesses in the data base (e.g., incomplete information on contaminant loadings and on the biomass, production, and ecological efficiencies of dominant organisms) that should be corrected in order to make reliable management decisions.

  4. Cost reduction performance enhancements of multiple site cooling water systems, enabled by remote system monitoring/control and multifaceted data management

    SciTech Connect

    Cook, B.; Young, D.; Tari, K.

    1998-12-31

    An outsourced cooling water treatment automated control and data acquisition package, has been designed, installed, and commissioned in over 70 sites in North America and offshore. The standard package consists of a controller, sensors, human-machine interface software, data acquisition and management software, communications, and reporting. Significant challenges to applying this standard package in multiple sites arose from variations in cooling system design and makeup water quality as well as operations, environmental considerations, metrics, and language. A standard approach has met these challenges and overcome effects of downsizing through significant reduction in non-value-added, manual activities. Overall system reliability has been improved by migration to best practice throughout the organizations involved and immediate proactive response to out-of-specification conditions. This paper documents the evolution of a standard cooling water automation and data management package from its inception to current practice.

  5. 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

  6. 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.

  7. 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.

  8. Identifying professional education gaps and barriers in multiple myeloma patient care: findings of the Managing Myeloma Continuing Educational Initiative Advisory Committee.

    PubMed

    Raje, Noopur; Faiman, Beth; Harvey, R Donald; Kurtin, Sandra E; Lonial, Sagar; Kumar, Shaji K; Cohen, Adam D; Conde, Miguel A; Giralt, Sergio A; Recine, Marie Sabo; Tombler, Eugene R; Stadtmauer, Edward; Jagannath, Sundar; Anderson, Kenneth C

    2014-10-01

    Advances in the past decade and a half have led to unprecedented improved outcomes for patients with multiple myeloma (MM), and this disease appears to be transitioning to one more characteristic of a chronic disease in large part due to rapid translation of clinical insights into practice at the community level. Although evidence-based guidelines and consensus recommendations remain an important resource for managing cancer patients, they do not fill the gap between the principles of disease management today and the translation of tailoring treatment for individual patient needs. Thus, there is a continuing need for concise, focused educational activities and resources that facilitate improved knowledge and understanding of appropriate, individualized therapeutic strategies for assessing and caring for patients with MM. The next several years will truly be a time of shifting paradigms in the treatment of MM in which new agents will be approved, response criteria will be updated, and new approaches to risk assessment and monitoring minimal residual disease will evolve and enter practice. New groundbreaking therapeutic approaches, such as immunotherapy, might result in significant changes in how MM is treated and managed over the entire life cycle of the disease. Even the definition of the disease might be further amended as insights grow regarding who should be treated and who might benefit more from observation. As such, oncology clinicians will have to carefully review and update their management approaches accordingly even as they begin to focus even more on the survivorship needs of their MM patients.

  9. 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 ...

  10. 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…

  11. 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.

  12. 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

  13. Addressing the underperformance of faculty and staff.

    PubMed

    Kenner, Carole; Pressler, Jana L

    2006-01-01

    Many new nursing leaders assuming work as deans, assistant deans, or interim deans have limited education, experience, or background to prepare them for the job. To assist new deans and those aspiring to be deans, the authors of this department, both deans, offer survival tips based on their personal experiences and insights. They address common issues, challenges, and opportunities that face academic executive teams, such as negotiating an executive contract, obtaining faculty lines, building effective work teams, managing difficult employees, and creating nimble organizational structure to respond to changing consumer, healthcare delivery, and community needs. The authors welcome counterpoint discussions with readers. PMID:17108781

  14. 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…

  15. Every Other Day. Keynote Address.

    ERIC Educational Resources Information Center

    Tiller, Tom

    Schools need to be reoriented and restructured so that what is taught and learned, and the way in which it is taught and learned, are better integrated with young people's real-world experiences. Many indicators suggest that the meaningful aspects of school have been lost in the encounter with modern times. The title of this address--"Every Other…

  16. 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.

  17. State of the Lab Address

    ScienceCinema

    King, Alex

    2016-07-12

    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. 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...

  19. 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

  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.