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Sample records for address multiple management

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

    PubMed Central

    Anderson, Kylie L; Congdon, Bradley C

    2013-01-01

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

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

    SciTech Connect

    Funk, Greg; Longsworth, Paul

    2007-07-01

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

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

    NASA Astrophysics Data System (ADS)

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

    2015-12-01

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

  4. Management of multiple sclerosis.

    PubMed

    Perrin Ross, Amy

    2013-11-01

    Patients with multiple sclerosis (MS), a disease of the central nervous system that disrupts signals within the brain and also the signals between the brain and body, will likely experience symptoms that may negatively impact their quality of life (QOL). Due to the complexity of MS and its disease burden, multidisciplinary management that combines pharmacologic and nonpharmacologic strategies with patient education is necessary. Diagnosing relapses of MS in clinical practice can be difficult due to the multiple subtypes of MS, variations of symptomatology, and pseudo-relapses. Managing relapses also presents its own set of challenges, for example, evaluating if treatment is appropriate and determining which agent would be most effective for a patient if treatment is recommended. Patient education is essential for achieving optimal outcomes for patients with MS and improving patient QOL, and should increase awareness of: (1) the disease itself and its progression; (2) the signs and symptoms of MS; (3) current treatment strategies and plan of care; (4) the recognition and management of relapses; (5) the value of treatment adherence and impact of nonadherence; and (6) hope for the future. The management of active MS may be further complicated by the complex variety of pharmacotherapeutic options, and in some instances, by having to switch between agents and drug classes. Newer agents in development (eg, alemtuzumab, ocrelizumab, laquinimod) offer the opportunity to expand the therapeutic armamentarium, although further long-term data are required to evaluate any safety concerns associated with newer agents.

  5. 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.

  6. 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.

  7. Multiple Sclerosis and its Management

    PubMed Central

    Weinshenker, Brian

    1992-01-01

    Multiple sclerosis, the most common disabling disease of the central nervous system affecting young adults, is diagnosed primarily from a history of typical relapsing and remitting white matter symptoms supported by objective signs. Multiple sclerosis may present in more insidious ways or may be mimicked by other diseases, which seemingly satisfy the diagnostic criteria of dissemination in time and space. Patients need psychological support to deal with an uncertain future. A multidisciplinary team approach can best manage both acute temporary disability and, often later, progressive physical and occasionally mental disability. ImagesFigures 1-3 PMID:21221279

  8. A WiFi Public Address System for Disaster Management

    PubMed Central

    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 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. PMID:17238466

  9. Time Management: Addressing and Assessing Classroom Participation Problems

    DTIC Science & Technology

    2015-01-01

    Time Management Addressing and Assessing Classroom Participation Problems Cary A. Balser Abstract While research shows that technology in...the classroom has costs, in econometrics (as in other technical courses) computer use is very nearly a necessary condition. Therefore, I used a...undergraduate institution with a clear focus on STEM, technology in the classroom is very nearly necessitated by the content in many technical courses

  10. 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.

  11. Spasticity management in multiple sclerosis.

    PubMed

    Hughes, Christina; Howard, Ileana M

    2013-11-01

    Spasticity is a prevalent and potentially disabling symptom common in individuals with multiple sclerosis. Adequate evaluation and management of spasticity requires a careful assessment of the patient's history to determine functional impact of spasticity and potential exacerbating factors, and physical examination to determine the extent of the condition and culpable muscles. A host of options for spasticity management are available: therapeutic exercise, physical modalities, complementary/alternative medicine interventions, oral medications, chemodenervation, and implantation of an intrathecal baclofen pump. Choice of treatment hinges on a combination of the extent of symptoms, patient preference, and availability of services.

  12. 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

  13. 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

  14. A flexible analog memory address list manager for PHENIX

    SciTech Connect

    Ericson, M.N.; Musrock, M.S.; Britton, C.L. Jr.; Walker, J.W.; Wintenberg, A.L.; Young, G.R.; Allen, M.D.

    1996-06-01

    A programmable analog memory address list manager has been developed for use with all analog memory-based detector subsystems of PHENIX. The unit provides simultaneous read/write control, cell write-over protection for both a Level-1 trigger decision delay and digitization latency, and re-ordering of AMU addresses following conversion, at a beam crossing rate of 105 ns. Addresses are handled such that up to 5 Level-1 (LVL-1) events can be maintained in the AMU without write-over. Data tagging is implemented for handling overlapping and shared beam-event data packets. Full usage in all PHENIX analog memory-based detector subsystems is accomplished by the use of detector-specific programmable parameters--the number of data samples per valid LVL-1 trigger and the sample spacing. Architectural candidates for the system are discussed with emphasis on implementation implications. Details of the design are presented including application specifics, timing information, and test results from a full implementation using field programmable gate arrays (FPGAs).

  15. Addressing structural and observational uncertainty in resource management.

    PubMed

    Fackler, Paul; Pacifici, Krishna

    2014-01-15

    Most natural resource management and conservation problems are plagued with high levels of uncertainties, which make good decision making difficult. Although some kinds of uncertainties are easily incorporated into decision making, two types of uncertainty present more formidable difficulties. The first, structural uncertainty, represents our imperfect knowledge about how a managed system behaves. The second, observational uncertainty, arises because the state of the system must be inferred from imperfect monitoring systems. The former type of uncertainty has been addressed in ecology using Adaptive Management (AM) and the latter using the Partially Observable Markov Decision Processes (POMDP) framework. Here we present a unifying framework that extends standard POMDPs and encompasses both standard POMDPs and AM. The approach allows any system variable to be observed or not observed and uses any relevant observed variable to update beliefs about unknown variables and parameters. This extends standard AM, which only uses realizations of the state variable to update beliefs and extends standard POMDP by allowing more general stochastic dependence among the observable variables and the state variables. This framework enables both structural and observational uncertainty to be simultaneously modeled. We illustrate the features of the extended POMDP framework with an example.

  16. 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.

  17. 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…

  18. Clutter Management for Individuals with Multiple Sclerosis

    PubMed Central

    2014-01-01

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

  19. 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

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

    PubMed

    Kessler, Laura E; Waehler, Charles A

    2005-02-01

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

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

    ERIC Educational Resources Information Center

    Lim, Kien H.

    2011-01-01

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

  2. 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

  3. 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.

  4. DOD Financial Management: Continued Actions Needed to Address Congressional Committee Panel Recommendations

    DTIC Science & Technology

    2015-09-01

    DOD FINANCIAL MANAGEMENT Continued Actions Needed to Address Congressional Committee Panel Recommendations Report...2015 2. REPORT TYPE 3. DATES COVERED 00-00-2015 to 00-00-2015 4. TITLE AND SUBTITLE DOD Financial Managment : Continued Actions Needed to Address...Did This Study A congressional panel examined the capacity of DOD’s financial management system for providing timely, reliable, and useful

  5. Which issues concerning multiple pregnancies should be addressed during psychosocial counselling?

    PubMed

    Emery, Marysa

    2007-01-01

    The global rise in multiple pregnancy rates due to assisted reproductive technology has led to the development of various strategies to diminish these rates without jeopardising pregnancy. Policies at treatment centres may include the option of fetal reduction, although each centre is subject to national laws and its own guidelines. However, personal opinions and goals may also influence practice. The development of clinical decisions, therefore, is complex and subject to change. Primary prevention is the best way to reduce multiple births. For preventative psychosocial counselling, some centres employ counsellors, but if not, this becomes the physician's task. An in-depth assessment is required to define how many embryos to transfer and what risk of multiple birth is acceptable to patients. Counselling should address the following: the relationship between pregnancy rate, multiple pregnancy rate and the number of embryos transferred; benefits and risks of multiple pregnancy; and possibilities for primary and secondary prevention. Patients should voice how they feel facing these issues; which issues are worrisome; how they anticipate these possibilities; and what psychosocial support exists that could be mobilized. In summary, psychosocial counselling reinforces the partnership between couples and the assisted reproductive technology team, allowing for primary prevention and informed consent on multiple pregnancy issues.

  6. Assessing and Managing Multiple Risks in a Changing World ...

    EPA Pesticide Factsheets

    Roskilde University hosted a November 2015 workshop on “Environmental Risk – Assessing and Managing Multiple Risks in a Changing World”. Thirty attendees from 9 countries developed consensus recommendations regarding: implementation of a common currency (ecosystem services) for holistic environmental risk assessment and management; improvements to risk assessment and management in a complex, human-modified, and changing world; appropriate development of protection goals in a 2-stage process involving both universal and site-, region-, or problem-specific protection goals; addressing societal issues; risk management information needs; conducting risk assessment of risk management; and development of adaptive and flexible regulatory systems. We encourage both cross- and inter-disciplinary approaches to address 10 recommendations: 1) adopt ecosystem services as a common currency for risk assessment and management; 2) consider cumulative stressors (chemical and non-chemical) and determine which dominate to best manage and restore ecosystem services; 3) fully integrate risk managers and communities of interest into the risk assessment process; 4) fully integrate risk assessors and communities of interest into the risk management process; 5) consider socio-economics and increase transparency in both risk assessment and risk management; 6) recognize the ethical rights of humans and ecosystems to an adequate level of protection; 7) determine relevant reference con

  7. Telerobotic management system: coordinating multiple human operators with multiple robots

    NASA Astrophysics Data System (ADS)

    King, Jamie W.; Pretty, Raymond; Brothers, Brendan; Gosine, Raymond G.

    2003-09-01

    This paper describes an application called the Tele-robotic management system (TMS) for coordinating multiple operators with multiple robots for applications such as underground mining. TMS utilizes several graphical interfaces to allow the user to define a partially ordered plan for multiple robots. This plan is then converted to a Petri net for execution and monitoring. TMS uses a distributed framework to allow robots and operators to easily integrate with the applications. This framework allows robots and operators to join the network and advertise their capabilities through services. TMS then decides whether tasks should be dispatched to a robot or a remote operator based on the services offered by the robots and operators.

  8. Ultrasensitive photoelectrochemical biosensing of multiple biomarkers on a single electrode by a light addressing strategy.

    PubMed

    Wang, Juan; Liu, Zhihong; Hu, Chengguo; Hu, Shengshui

    2015-09-15

    Ultrasensitive multiplexed detection of biomarkers on a single electrode is usually a great challenge for electrochemical sensors. Here, a light addressable photoelectrochemical sensor (LAPECS) for the sensitive detection of multiple DNA biomarkers on a single electrode was reported. The sensor was constructed through four steps: (1) immobilization of capture DNA (C-DNA) of different targets on different areas of a single large-sized gold film electrode, (2) recognition of each target DNA (T-DNA) and the corresponding biotin-labeled probe DNA (P-DNA) through hybridization, (3) reaction of the biotin-labeled probe DNA with a streptavidin-labeled all-carbon PEC bioprobe, and (4) PEC detection of multiple DNA targets one by one via a light addressing strategy. Through this principle, the LAPECS can achieve ultrasensitive detection of three DNA sequences related to hepatitis B (HBV), hepatitis C (HCV) and human immunodeficiency (HIV) viruses with a similar wide calibration range of 1.0 pM ∼ 0.01 μM and a low detection limit of 0.7 pM by using one kind of PEC bioprobe. Moreover, the detection throughput of LAPECS may be conveniently expanded by simply enlarging the size of the substrate electrode or reducing the size of the sensing arrays and the light beam. The present work thus demonstrates the promising applications of LAPECS in developing portable, sensitive, high-throughput, and cost-effective biosensing systems.

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

    NASA Astrophysics Data System (ADS)

    Lim, Kien H.

    2011-12-01

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

  10. [Management of neuropathic bladder in multiple sclerosis].

    PubMed

    Pappalardo, A; Patti, F; Reggio, A

    2004-05-01

    It is estimated that almost 70% of patients affected by multiple sclerosis (MS) suffer from urinary symptoms, with devastant impact on Quality of Life (QoL). The major aims of management should be to ameliorate the patients quality of life and to prevent the frequent complications of bladder dysfunction such as infention and renal damage. Therapy can usually eliminate or reduce the symptoms of neuropathic bladder. In the following pages is discussed the complex management of urinary symptoms in MS patients.

  11. Managing Human Resources. Greater OPM Leadership Needed To Address Critical Challenges. Report to the Congress.

    ERIC Educational Resources Information Center

    General Accounting Office, Washington, DC. General Government Div.

    The General Accounting Office examined the Office of Personnel Management's (OPM's) leadership role in addressing critical human resource problems and preparing the government to meet future challenges. Federal managers, OPM employees, and federal personnel officials were surveyed to study federal government problems in hiring, managing, and…

  12. Assessing and managing multiple risks in a changing world ...

    EPA Pesticide Factsheets

    Roskilde University (Denmark) hosted a November 2015 workshop, Environmental Risk—Assessing and Managing Multiple Risks in a Changing World. This Focus article presents the consensus recommendations of 30 attendees from 9 countries regarding implementation of a common currency (ecosystem services) for holistic environmental risk assessment and management; improvements to risk assessment and management in a complex, human-modified, and changing world; appropriate development of protection goals in a 2-stage process; dealing with societal issues; risk-management information needs; conducting risk assessment of risk management; and development of adaptive and flexible regulatory systems. The authors encourage both cross-disciplinary and interdisciplinary approaches to address their 10 recommendations: 1) adopt ecosystem services as a common currency for risk assessment and management; 2) consider cumulative stressors (chemical and nonchemical) and determine which dominate to best manage and restore ecosystem services; 3) fully integrate risk managers and communities of interest into the risk-assessment process; 4) fully integrate risk assessors and communities of interest into the risk-management process; 5) consider socioeconomics and increased transparency in both risk assessment and risk management; 6) recognize the ethical rights of humans and ecosystems to an adequate level of protection; 7) determine relevant reference conditions and the proper ecological c

  13. Management of high-order multiple gestation.

    PubMed

    Elliott, John P

    2005-06-01

    High-order multiple gestation presents unique challenges to the clinician to obtain the best possible outcome. An aggressive proactive approach works best compared with a wait-and-treat strategy when complications occur. Frequent ultrasound evaluations, fetal fibronectin testing, and contraction monitoring are important diagnostic tools. Aggressive weight gain, bed rest, and relaxation techniques are important interventions. Tocolytic drugs are used to prevent preterm labor, and aggressive dosing of MgSO4, terbutaline pumps, and oral agents are advocated to treat preterm labor. Outcome is generally good with high-order multiple gestation with this management protocol.

  14. Veterans Affairs: Sustained Management Attention Needed to Address Numerous IT Challenges

    DTIC Science & Technology

    2016-06-22

    VETERANS AFFAIRS Sustained Management Attention Needed to Address Numerous IT Challenges Statement of Valerie C. Melvin...Sustained Management Attention Needed to Address Numerous IT Challenges What GAO Found In February 2015, GAO designated Veterans Affairs (VA) health care...as a high- risk area based on its concerns about the department’s ability to ensure the quality and safety of veterans’ health care in five broad

  15. 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.

  16. 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…

  17. Analyzing multiple endpoints in a confirmatory randomized clinical trial-an approach that addresses stratification, missing values, baseline imbalance and multiplicity for strictly ordinal outcomes.

    PubMed

    Sun, Hengrui; Kawaguchi, Atsushi; Koch, Gary

    2017-03-01

    Confirmatory randomized clinical trials with a stratified design may have ordinal response outcomes, ie, either ordered categories or continuous determinations that are not compatible with an interval scale. Also, multiple endpoints are often collected when 1 single endpoint does not represent the overall efficacy of the treatment. In addition, random baseline imbalances and missing values can add another layer of difficulty in the analysis plan. Therefore, the development of an approach that provides a consolidated strategy to all issues collectively is essential. For a real case example that is from a clinical trial comparing a test treatment and a control for the pain management for patients with osteoarthritis, which has all aforementioned issues, multivariate Mann-Whitney estimators with stratification adjustment are applicable to the strictly ordinal responses with stratified design. Randomization based nonparametric analysis of covariance is applied to account for the possible baseline imbalances. Several approaches that handle missing values are provided. A global test followed by a closed testing procedure controls the family wise error rate in the strong sense for the analysis of multiple endpoints. Four outcomes indicating joint pain, stiffness, and functional status were analyzed collectively and also individually through the procedures. Treatment efficacy was observed in the combined endpoint as well as in the individual endpoints. The proposed approach is effective in addressing the aforementioned problems simultaneously and straightforward to implement.

  18. Using risk management files to identify and address causative factors associated with adverse events in pediatrics

    PubMed Central

    Hain, Paul D; Pichert, James W; Hickson, Gerald B; Bledsoe, Sandra H; Hamming, David; Hathaway, Jacob; Nguyen, Carolyn

    2007-01-01

    We report a retrospective analysis of 84 consecutive pediatrics-related internal review files opened by a medical center’s risk managers between 1996 and 2001. The aims were to identify common causative factors associated with adverse events/adverse outcomes (AEs) in a Pediatrics Department, then suggest ways to improve care. The main outcome was identification of any patterns of factors that contributed to AEs so that interventions could be designed to address them. Cases were noted to have at least one apparent contributing problem; the most common were with communication (44% of cases), diagnosis and treatment (37%), medication errors (20%), and IV/Central line issues (17%). 45% of files involved a child with an underlying diagnosis putting her/him at high risk for an adverse outcome. All Pediatrics Departments face multiple challenges in assuring consistent quality care. The extent to which the data generalize to other institutions is unknown. However, the data suggest that systematic analysis of aggregated claims files may help identify and drive opportunities for improvement in care. PMID:18472985

  19. Panobinostat for the management of multiple myeloma.

    PubMed

    Sivaraj, Dharshan; Green, Michael M; Gasparetto, Cristina

    2017-03-01

    Multiple myeloma (MM) is the second most common blood cancer following non-Hodgkin's lymphoma. While the treatments for MM have improved over the past decade, for the most part, it remains an incurable disease. For this reason newer therapeutic agents are needed to combat this malignancy. Panobinostat is a pan-deacetylase inhibitor that impedes protein destruction by disturbing the enzymatic activity of deacetylases. It was US FDA approved in February 2015 for the management of relapsed/refractory MM in combination with bortezomib and dexamethasone. Several trials are ongoing, exploring the utility of panobinostat in various other settings for the management of MM. This review will detail the biology, clinical efficacy and potential future applications of panobinostat in the treatment of MM.

  20. 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.

  1. 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

  2. Addressing heterogeneous parental concerns about vaccination with a multiple-source model

    PubMed Central

    Hagood, E Allison; Herlihy, Stacy Mintzer

    2013-01-01

    Previous models of vaccine education have not addressed differences in levels and motives of vaccine concerns in parents. These differences may require changes in education approaches based on type of parental concern. Addressing vaccine concerns will require a multi-modal approach involving more than just a pediatrician or primary health care provider, as well as more than one educational approach. PMID:23732902

  3. Therapeutic Yoga: Symptom Management for Multiple Sclerosis

    PubMed Central

    MacDonald, Megan

    2015-01-01

    Abstract 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

  4. 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.

  5. 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.

  6. Who Is Responsible for Addressing Cyberbullying? Perspectives from Teachers and Senior Managers

    ERIC Educational Resources Information Center

    Green, Vanessa A.; Johnston, Michael; Mattioni, Loreto; Prior, Tessa; Harcourt, Susan; Lynch, Tegan

    2017-01-01

    This study investigates responsibility for addressing cyberbullying and the extent to which specific training is needed. A total of 888 school staff completed an anonymous online survey and included two groups: (a) teachers, including heads of departments, and (b) principals, deputy principals, and deans (i.e., school managers). The majority…

  7. Report: Complaints Regarding Debris Management at the West, Texas, Fertilizer Plant Explosion Have Been Addressed

    EPA Pesticide Factsheets

    Report #14-P-0123, February 24, 2014. Debris from a fertilizer plant explosion was moved without EPA or TCEQ knowledge but is being managed. A water main break existed under the debris but has been addressed. The debris was found to be non-hazardous.

  8. 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…

  9. 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…

  10. Scientifically defensible fish conservation and recovery plans: Addressing diffuse threats and developing rigorous adaptive management plans

    USGS Publications Warehouse

    Maas-Hebner, Kathleen G.; Schreck, Carl B.; Hughes, Robert M.; Yeakley, Alan; Molina, Nancy

    2016-01-01

    We discuss the importance of addressing diffuse threats to long-term species and habitat viability in fish conservation and recovery planning. In the Pacific Northwest, USA, salmonid management plans have typically focused on degraded freshwater habitat, dams, fish passage, harvest rates, and hatchery releases. However, such plans inadequately address threats related to human population and economic growth, intra- and interspecific competition, and changes in climate, ocean, and estuarine conditions. Based on reviews conducted on eight conservation and/or recovery plans, we found that though threats resulting from such changes are difficult to model and/or predict, they are especially important for wide-ranging diadromous species. Adaptive management is also a critical but often inadequately constructed component of those plans. Adaptive management should be designed to respond to evolving knowledge about the fish and their supporting ecosystems; if done properly, it should help improve conservation efforts by decreasing uncertainty regarding known and diffuse threats. We conclude with a general call for environmental managers and planners to reinvigorate the adaptive management process in future management plans, including more explicitly identifying critical uncertainties, implementing monitoring programs to reduce those uncertainties, and explicitly stating what management actions will occur when pre-identified trigger points are reached.

  11. 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

  12. Addressing challenges for future strategic-level emergency management: reframing, networking, and capacity-building.

    PubMed

    Bosomworth, Karyn; Owen, Christine; Curnin, Steven

    2017-04-01

    The mounting frequency and intensity of natural hazards, alongside growing interdependencies between social-technical and ecological systems, are placing increased pressure on emergency management. This is particularly true at the strategic level of emergency management, which involves planning for and managing non-routine, high-consequence events. Drawing on the literature, a survey, and interviews and workshops with Australia's senior emergency managers, this paper presents an analysis of five core challenges that these pressures are creating for strategic-level emergency management. It argues that emphasising 'emergency management' as a primary adaptation strategy is a retrograde step that ignores the importance of addressing socio-political drivers of vulnerabilities. Three key suggestions are presented that could assist the country's strategic-level emergency management in tackling these challenges: (i) reframe emergency management as a component of disaster risk reduction rather than them being one and the same; (ii) adopt a network governance approach; and (iii) further develop the capacities of strategic-level emergency managers.

  13. 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…

  14. Binary variable multiple-model multiple imputation to address missing data mechanism uncertainty: application to a smoking cessation trial.

    PubMed

    Siddique, Juned; Harel, Ofer; Crespi, Catherine M; Hedeker, Donald

    2014-07-30

    The true missing data mechanism is never known in practice. We present a method for generating multiple imputations for binary variables, which formally incorporates missing data mechanism uncertainty. Imputations are generated from a distribution of imputation models rather than a single model, with the distribution reflecting subjective notions of missing data mechanism uncertainty. Parameter estimates and standard errors are obtained using rules for nested multiple imputation. Using simulation, we investigate the impact of missing data mechanism uncertainty on post-imputation inferences and show that incorporating this uncertainty can increase the coverage of parameter estimates. We apply our method to a longitudinal smoking cessation trial where nonignorably missing data were a concern. Our method provides a simple approach for formalizing subjective notions regarding nonresponse and can be implemented using existing imputation software.

  15. Addressing Missing Data Mechanism Uncertainty using Multiple-Model Multiple Imputation: Application to a Longitudinal Clinical Trial.

    PubMed

    Siddique, Juned; Harel, Ofer; Crespi, Catherine M

    2012-12-01

    We present a framework for generating multiple imputations for continuous data when the missing data mechanism is unknown. Imputations are generated from more than one imputation model in order to incorporate uncertainty regarding the missing data mechanism. Parameter estimates based on the different imputation models are combined using rules for nested multiple imputation. Through the use of simulation, we investigate the impact of missing data mechanism uncertainty on post-imputation inferences and show that incorporating this uncertainty can increase the coverage of parameter estimates. We apply our method to a longitudinal clinical trial of low-income women with depression where nonignorably missing data were a concern. We show that different assumptions regarding the missing data mechanism can have a substantial impact on inferences. Our method provides a simple approach for formalizing subjective notions regarding nonresponse so that they can be easily stated, communicated, and compared.

  16. Integrated management of multiple reservoir field developments

    SciTech Connect

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

    1995-10-01

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

  17. 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.

  18. Addressing 3D metrology challenges by using a multiple detector CDSEM

    NASA Astrophysics Data System (ADS)

    Hiroyama, Mitsuo; Murakawa, Tsutomu; Kuribara, Masayuki; Iwai, Toshimichi; Soma, Minoru; Iko, Ikuo; Seyama, Masahiro; Matsumoto, Jun; Nakamura, Takayuki; Hakii, Hidemitsu; Yonekura, Isao; Kawashita, Masashi; Nishiyama, Yasushi; Tanaka, Keishi; Komoto, Kenji

    2011-11-01

    In next generation lithography (NGL) for the 22nm node and beyond, the three dimensional (3D) shape measurements of side wall angle (SWA) and height of the photomask pattern will become critical for controlling the exposure characteristics and wafer printability. Until today, cross-section SEM (X-SEM) and Atomic Force Microscope (AFM) methods are used to make 3D measurements, however, these techniques require time consuming preparation and observation. This paper presents an innovative technology for 3D measurement using a multiple detector CDSEM and reports its accuracy and precision.

  19. Multiple nanowire species synthesized on a single chip by selectively addressable horizontal nanochannels.

    PubMed

    Xiang, Ying; Keilbach, Andreas; Codinachs, Lia Moreno; Nielsch, Kornelius; Abstreiter, Gerhard; Fontcuberta i Morral, Anna; Bein, Thomas

    2010-04-14

    The synthesis of horizontal porous anodic alumina (PAA) structures with individually addressable channel systems is demonstrated. This was achieved by developing a multicontact design of aluminum finger structures (two to five contacts) on silicon wafers. These aluminum contacts were electrically isolated from each other, allowing the individual anodization of each contact at different conditions. This way it is possible to synthesize different pore diameters, pore densities, and channel lengths on a single chip. Scanning electron microscopy (SEM) characterization revealed that the neighboring contacts are not significantly altered during the anodization procedure. After successful barrier-layer thinning, the individual finger structures of each contact were filled by electrodeposition and thermal chemical vapor deposition. The resulting metal (Au, Cu, Ni, Co) and semiconductor (Te, Si) nanowires embedded within the porous anodic alumina mold were characterized by SEM and energy dispersive X-ray measurements. The multicontact fabrication results open a new route toward complex nanoelectronic and sensing applications.

  20. 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...

  1. 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

  2. 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

  3. Managing Multiple Goals in Real Learning Contexts

    ERIC Educational Resources Information Center

    Mansfield, Caroline F.

    2009-01-01

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

  4. Management of multiple drug-resistant tuberculosis.

    PubMed

    Hutchison, D C S; Drobniewski, F A; Milburn, H J

    2003-01-01

    There has been a worldwide increase in multiple drug-resistant tuberculosis (MDR-TB) which has in the past been associated with a poor prognosis. In the U.K., about half of the cases live in the London area and we have set out to obtain further information on their treatment and outcome. We examined the risk factors, drug resistance, drug treatment, sputum conversion, and outcome in patients with MDR-TB at three hospitals in South London and diagnosed during the period June 1995-January 1999. Human Immunodeficiency Virus (HIV)-positive patients were excluded. There were 760 patients resident in Lambeth, Southwark and Lewisham Health Authority (LSLHA) who were notified as tuberculosis (TB) during the time period and who were of negative or unknown HIV status. (The population of LSLHA is approx.750,000.) There was a total of 13 patients with MDR-TB, known or presumed to be HlV negative. Their median age was 28 years (range 15-53); nine (69%) were born outside the U.K. and 11 had pulmonary disease; they had organisms resistant to a median of two first-line drugs (range 2-4) and to a median of four of all drugs tested (range 2-10). They received treatment with a median of six drugs (range 3-9). Eight were followed up for at least 3 years (range 3-6) after the completion of treatment; at their last assessment none had features of active TB and all were sputum negative (smear and culture). Two returned to their countries of origin during treatment; they were sputum negative at that time. Two patients are well and continue on treatment in the U.K. One patient (known HIV negative) died following treatment failure. In conclusion, we obtained disease-free survival in eight cases of MDR-TB, known or presumed to be HIV negative and followed up for 3 years or more. The prognosis for patients treated at specialised centres is good (and better than is generally believed). We describe a new protocol for the detection and management of MDR-TB.

  5. Pharmacologic options for the management of multiple sclerosis symptoms.

    PubMed

    Schapiro, Randall T

    2002-09-01

    Multiple sclerosis (MS) is a disease with a wide-ranging impact on physical functioning. Although pharmacotherapy plays an indispensable role in the management of MS symptoms, optimal disease management requires a multidisciplinary approach that combines medication, rehabilitation, and patient education. Successful control of symptoms is critical to quality of life for MS patients. Immunomodulating drugs provide a means of controlling the underlying disease process, but they are not a cure. This places responsibility on health care providers to control a patient's MS-related symptoms to limit disability and delay impairment in the activities of daily living. Owing to the importance of symptom control, comprehensive patient evaluations should be performed at regular intervals to determine the extent of neurological damage and disease progression and to address changing patient needs. The goal of interventions should be not only to treat the primary and secondary symptoms of MS but also to provide access to the psychosocial support that will help MS patients and their families continue to cope as disease status changes.

  6. 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.

  7. 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.

  8. 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.

  9. 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.

  10. A flexible analog memory address list manager/controller for PHENIX

    SciTech Connect

    Ericson, M.N.; Walker, J.W.; Britton, C.L.; Wintenberg, A.L.; Young, G.R.

    1995-06-01

    A programmable analog memory address list manager/controller has been developed for use with all analog memory-based detector subsystems of PHENIX. The unit provides simultaneous read/write control, cell write-over protection for both a Level-1 trigger decision delay and digitization latency, and re-ordering of AMU addresses following conversion, at a beam crossing rate of 112 ns. Addresses are handled such that up to 5 Level-1 events can be maintained in the AMU without write-over. Data tagging is implemented for handling overlapping and shared beam event data packets. Full usage in all PHENIX analog memory-based detector sub-systems is accomplished by the use of detector-specific programmable parameters -- the number of data samples per Level-1 trigger valid and the swnple spacing. Architectural candidates for the system are discussed with emphasis on implementation implications. Details of the design are presented including design simulations, timing information, and test results from a full implementation using programmable logic devices.

  11. 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.

  12. 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

    ... action for solid waste management units? 267.101 Section 267.101 Protection of Environment ENVIRONMENTAL... FACILITIES OPERATING UNDER A STANDARDIZED PERMIT Releases from Solid Waste Management Units § 267.101 What must I do to address corrective action for solid waste management units? (a) You must...

  13. 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... FACILITIES OPERATING UNDER A STANDARDIZED PERMIT Releases from Solid Waste Management Units § 267.101 What must I do to address corrective action for solid waste management units? (a) You must...

  14. 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

    ... action for solid waste management units? 267.101 Section 267.101 Protection of Environment ENVIRONMENTAL... FACILITIES OPERATING UNDER A STANDARDIZED PERMIT Releases from Solid Waste Management Units § 267.101 What must I do to address corrective action for solid waste management units? (a) You must...

  15. 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

    ... action for solid waste management units? 267.101 Section 267.101 Protection of Environment ENVIRONMENTAL... FACILITIES OPERATING UNDER A STANDARDIZED PERMIT Releases from Solid Waste Management Units § 267.101 What must I do to address corrective action for solid waste management units? (a) You must...

  16. 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.

  17. 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.

  18. 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.

  19. Systematic regional planning for multiple objective natural resource management.

    PubMed

    Bryan, Brett A; Crossman, Neville D

    2008-09-01

    On-ground natural resource management actions such as revegetation and remnant vegetation management can simultaneously affect multiple objectives including land, water and biodiversity resources. Hence, planning for the sustainable management of natural resources requires consideration of these multiple objectives. However, planning the location of management actions in the landscape often treats these objectives individually to reduce the process and spatial complexity inherent in human-modified and natural landscapes. This can be inefficient and potentially counterproductive given the linkages and trade-offs involved. We develop and apply a systematic regional planning approach to identify geographic priorities for on-ground natural resource management actions that most cost-effectively meet multiple natural resource management objectives. Our systematic regional planning approach utilises integer programming within a structured multi-criteria decision analysis framework. Intelligent siting can capitalise on the multiple benefits of on-ground actions and achieve natural resource management objectives more efficiently. The focus of this study is the human-modified landscape of the River Murray, South Australia. However, the methodology and analyses presented here can be adapted to other regions requiring more efficient and integrated planning for the management of natural resources.

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

    PubMed

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

    2010-12-01

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

  1. Optimal invasive species management under multiple uncertainties.

    PubMed

    Kotani, Koji; Kakinaka, Makoto; Matsuda, Hiroyuki

    2011-09-01

    The management programs for invasive species have been proposed and implemented in many regions of the world. However, practitioners and scientists have not reached a consensus on how to control them yet. One reason is the presence of various uncertainties associated with the management. To give some guidance on this issue, we characterize the optimal strategy by developing a dynamic model of invasive species management under uncertainties. In particular, focusing on (i) growth uncertainty and (ii) measurement uncertainty, we identify how these uncertainties affect optimal strategies and value functions. Our results suggest that a rise in growth uncertainty causes the optimal strategy to involve more restrained removals and the corresponding value function to shift up. Furthermore, we also find that a rise in measurement uncertainty affects optimal policies in a highly complex manner, but their corresponding value functions generally shift down as measurement uncertainty rises. Overall, a rise in growth uncertainty can be beneficial, while a rise in measurement uncertainty brings about an adverse effect, which implies the potential gain of precisely identifying the current stock size of invasive species.

  2. 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.

  3. 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.

  4. Autonomic management of multiple non-functional concerns in behavioural skeletons

    NASA Astrophysics Data System (ADS)

    Aldinucci, Marco; Danelutto, Marco; Kilpatrick, Peter

    We introduce and address the problem of concurrent autonomic management of different non-functional concerns in parallel applications build as a hierarchical composition of behavioural skeletons. We first define the problems arising when multiple concerns are dealt with by independent managers, then we propose a methodology supporting coordinated management, and finally we discuss how autonomic management of multiple concerns may be implemented in a typical use case. Being based on the behavioural skeleton concept proposed in the CoreGRID GCM, it is anticipated that the methodology will be readily integrated into the current reference implementation of GCM based on Java ProActive and running on top of major grid middleware systems.

  5. Managing Neuropsychological Impairment in Multiple Sclerosis

    PubMed Central

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

    2015-01-01

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

  6. 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…

  7. 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

  8. 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.

  9. 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.

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

    PubMed

    Butler, Cameron; Adamowski, Jan

    2015-04-15

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

  11. 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.

  12. 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

  13. The management of multiple sclerosis in children: a European view.

    PubMed

    Ghezzi, Angelo; Banwell, Brenda; Boyko, Alexey; Amato, Maria Pia; Anlar, Banu; Blinkenberg, Morten; Boon, Maartje; Filippi, Massimo; Jozwiak, Sergiusz; Ketelslegers, Immy; Kornek, Barbara; Lim, Ming; Lindstrom, Eva; Nadj, Congor; Neuteboom, Rinze; Rocca, Maria A; Rostasy, Kevin; Tardieu, Marc; Wassmer, Evangeline; Catsman-Berrevoets, Coriene; Hintzen, Rogier

    2010-10-01

    About 3-5% of all patients with multiple sclerosis experience the onset of their disease under the age of 16. A significant proportion of paediatric multiple sclerosis patients develop significant cognitive disturbances and persistent physical disability. The high relapse rate and the morbidity in the paediatric multiple sclerosis population has triggered the use of disease-modifying therapies that have been shown to reduce relapse rate, disease progression and cognitive decline in adult patients with multiple sclerosis. Hard evidence for the right treatment and its appropriate timing is scarce in paediatric multiple sclerosis. Nevertheless, expertise in this field has grown thanks to recent open-label trials and experience generated in specialized centres. In spring 2009, a first meeting was held in Rotterdam with clinicians from 11 European countries (one from Canada) that are all active in the management of paediatric multiple sclerosis. One of the aims was to generate a common view on the management of paediatric multiple sclerosis patients. The result of this meeting is presented here to help standardize treatment and to support clinicians with less experience in this field.

  14. Management of type 2 diabetes: more evidence is required to address the clinical and contextual facets.

    PubMed

    Hernandez-Jimenez, Sergio; Aguilar-Salinas, Carlos A; Mehta, Roopa; Rull, Juan A; Gómez-Pérez, Francisco J

    2011-03-01

    Evidence based medicine has changed the manner in which medicine is practiced and learned. Epidemiological studies, meta-analyses and systematic reviews have been used to create algorithms for the treatment of hyperglycemia in patients with type 2 diabetes. Recently, several randomized controlled trials (i.e. ACCORD, ADVANCE, VADT) have generated new and valuable information regarding the benefits and risks of achieving optimal glucose control. As a result, guidelines and algorithms have been updated. However, many aspects remain controversial. In this article, the clinical implications of the existing guidelines are critically analyzed. The limitations of the current guidelines include the lack of applicability to relevant diabetic subgroups, the exclusion of important factors that modify the therapeutic response to glucose-lowering agents and the limited recognition of the importance of the socioeconomic situation on treatment efficacy. Many subgroups of patients have not been included in the studies used to generate recommendations. There is insufficient evidence to support the use of current treatment recommendations in patients with early onset type 2 diabetes, patients with advanced microvascular complications, and the elderly with or without chronic complications. The characteristics of the candidates for conservative or intensive treatment are poorly defined. Interventions are recommended without considering clinical variables (i.e. obesity, time since diagnosis or prolonged exposure to hyperglycemia) that may modify treatment efficacy and the occurrence of side effects. Finally, no consideration is given to the socioeconomic context of the population in which the guidelines are to be applied. In summary, this manuscript highlights the key areas which require further work. If these issues are adequately addressed, the guidelines for the management of type 2 diabetes will be relevant and applicable to all diabetic groups.

  15. 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.

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

    PubMed Central

    Porto, Miguel; Correia, Otília; Beja, Pedro

    2014-01-01

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

  17. 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…

  18. Rural Residents' Perspectives on Multiple Morbidity Management and Disease Prevention.

    PubMed

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

    2011-12-01

    Middle-aged and older adults often experience several simultaneously occurring chronic conditions or "multiple morbidity" (MM). The task of both managing MM and preventing chronic conditions can be overwhelming, particularly in populations with high disease burdens, low socioeconomic status, and health care provider shortages. This article sought to understand Appalachian residents' perspectives on MM management and prevention. Forty-one rural Appalachian residents aged 50 and above with MM were interviewed about disease management and colorectal cancer (CRC) prevention. Transcripts were examined for overall analytic categories and coded using techniques to enhance transferability and rigor. Participants indicate facing various challenges to prevention due, in part, to conditions within their rural environment. Patients and providers spend significant time and energy on MM management, often precluding prevention activities. This article discusses implications of MM management for CRC prevention and strategies to increase disease prevention among this rural, vulnerable population burdened by MM.

  19. Recommendations for the detection and therapeutic management of cognitive impairment in multiple sclerosis.

    PubMed

    Bensa, C; Bodiguel, E; Brassat, D; Laplaud, D; Magy, L; Ouallet, J-C; Zephir, H; De Seze, J; Blanc, F

    2012-11-01

    The aim of the Multiple Sclerosis Think Tank (Groupe de réflexion sur la sclérose en plaques [GRESEP]) is to prescribe recommendations following a systematic literature search and using a Rand Corporation and California University (RAND/UCLA) appropriateness derived method, in response to practical questions that are raised in the management of patients with multiple sclerosis (MS). The topics of this working program were chosen because they were not addressed in the French recommendations and because of the few data in the literature that enabled practices to be based on validated data. Following the theme on useful serum testing with suspected multiple sclerosis, the subjects of the present work concern the detection and management of cognitive impairment in the beginning stages of the disease course. Two clinical questions were asked: which complementary exams (besides physical examination and neuropsychological tests) would help in the screening of cognitive impairment at the beginning of the disease? What care management should the person with MS and cognitive impairment be offered (treatments and neurocognitive rehabilitation)? The recommendations are the result of a consensus amongst a working group, a rating group and a reading group comprised of hospital neurologists involved in the management of patients with multiple sclerosis. Each recommendation is presented with the degree of consensus that it was accorded.

  20. 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…

  1. 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.

  2. 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

  3. 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.

  4. 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.

  5. Using management to address vegetation stress related to land-use and climate change

    USGS Publications Warehouse

    Middleton, Beth A.; Boudell, Jere; Fisichelli, Nicholas

    2017-01-01

    While disturbances such as fire, cutting, and grazing can be an important part of the conservation of natural lands, some adjustments to management designed to mimic natural disturbance may be necessary with ongoing and projected climate change. Stressed vegetation that is incapable of regeneration will be difficult to maintain if adults are experiencing mortality, and/or if their early life-history stages depend on disturbance. A variety of active management strategies employing disturbance are suggested, including resisting, accommodating, or directing vegetation change by manipulating management intensity and frequency. Particularly if land-use change is the main cause of vegetation stress, amelioration of these problems using management may help vegetation resist change (e.g. strategic timing of water release if a water control structure is available). Managers could direct succession by using management to push vegetation toward a new state. Despite the historical effects of management, some vegetation change will not be controllable as climates shift, and managers may have to accept some of these changes. Nevertheless, proactive measures may help managers achieve important conservation goals in the future.

  6. 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.

  7. 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…

  8. 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…

  9. 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.

  10. Effectiveness of knowledge translation tools addressing multiple high-burden chronic diseases affecting older adults: protocol for a systematic review alongside a realist review

    PubMed Central

    Kastner, Monika; Perrier, Laure; Hamid, Jemila; Tricco, Andrea C; Cardoso, Roberta; Ivers, Noah M; Liu, Barbara; Marr, Sharon; Holroyd-Leduc, Jayna; Wong, Geoff; Graves, Lisa; Straus, Sharon E

    2015-01-01

    Introduction The burden of chronic disease is a global phenomenon, particularly among people aged 65 years and older. More than half of older adults have more than one chronic disease and their care is not optimal. Chronic disease management (CDM) tools have the potential to meet this challenge but they are primarily focused on a single disease, which fails to address the growing number of seniors with multiple chronic conditions. Methods and analysis We will conduct a systematic review alongside a realist review to identify effective CDM tools that integrate one or more high-burden chronic diseases affecting older adults and to better understand for whom, under what circumstances, how and why they produce their outcomes. We will search MEDLINE, EMBASE, CINAHL, AgeLine and the Cochrane Library for experimental, quasi-experimental, observational and qualitative studies in any language investigating CDM tools that facilitate optimal disease management in one or more high-burden chronic diseases affecting adults aged ≥65 years. Study selection will involve calibration of reviewers to ensure reliability of screening and duplicate assessment of articles. Data abstraction and risk of bias assessment will also be performed independently. Analysis will include descriptive summaries of study and appraisal characteristics, effectiveness of each CDM tool (meta-analysis if appropriate); and a realist programme theory will be developed and refined to explain the outcome patterns within the included studies. Ethics and dissemination Ethics approval is not required for this study. We anticipate that our findings, pertaining to gaps in care across high-burden chronic diseases affecting seniors and highlighting specific areas that may require more research, will be of interest to a wide range of knowledge users and stakeholders. We will publish and present our findings widely, and also plan more active dissemination strategies such as workshops with our key stakeholders

  11. Surgical Management of Multiple Valve Endocarditis Associated with Dialysis Catheter

    PubMed Central

    Sanchez, M.; Castañeda, E.

    2016-01-01

    Endocarditis associated with dialysis catheter is a disease that must be suspected in every patient with hemodialysis who develops fever. Multiple valve disease is a severe complication of endocarditis that needs to be managed in a different way. There is very limited data for treatment and every case must be considered individually. We present a patient with this complication and describe the medical treatment and surgical management. We report the case of a 15-year-old patient with acute renal failure that develops trivalvular endocarditis after the hemodialysis catheter was placed, with multiple positive blood culture for Staphylococcus aureus. Transesophageal echocardiography was done and aortic and tricuspid valvular vegetations and mitral insufficiency were reported. Patient was successfully treated by surgery on the three valves, including aortic valve replacement. There is limited data about the appropriate treatment for multiple valvular endocarditis; it is important to consider this complication in the setting of hemodialysis patients that develop endocarditis and, despite the appropriate treatment, have a torpid evolution. In countries where endovenous drug abuse is uncommon, right sided endocarditis is commonly associated with vascular catheters. Aggressive surgical management should be the treatment of choice in these kinds of patients. PMID:27994895

  12. 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.

  13. 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

  14. Addressing hospital-acquired pressure ulcers: patient care managers enhancing outcomes at the point of service.

    PubMed

    Frumenti, Jeanine M; Kurtz, Abby

    2014-01-01

    An innovative leadership training program for patient care managers (PCMs) aimed at improving the management of operational failures was conducted at a large metropolitan hospital center. The program focused on developing and enhancing the transformational leadership skills of PCMs by improving their ability to manage operational failures in general and, in this case, hospital-acquired pressure ulcers. The PCMs received 8 weeks of intense training using the Toyota Production System process improvement approach, along with executive coaching. Compared with the control group, the gains made by the intervention group were statistically significant.

  15. Management by Agreement: Its Impact on Training. Opening Address of the BACIE Annual Conference 1973

    ERIC Educational Resources Information Center

    Cadbury, G. A. H.

    1974-01-01

    One of the keys to decision making in business and industry today is through a proper balance of participation. Without participation, innovation and change cannot take place. Proper management education and training are the vital components of promoting participation. (DS)

  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. 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.

  18. 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…

  19. "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...

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

    ERIC Educational Resources Information Center

    Corcoran, Lucie; Mc Guckin, Conor

    2014-01-01

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

  1. 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…

  2. Non-secretory multiple myeloma: from biology to clinical management

    PubMed Central

    Dupuis, Megan Murray; Tuchman, Sascha A

    2016-01-01

    Multiple myeloma (MM) is the second most common hematologic malignancy in the US. It is typically characterized by production of large amounts of defective immunoglobulin (Ig). Diagnosing MM and monitoring treatment response, including eventual relapse, are largely based on sequential measurements of Ig. However, a small subset of MM called non-secretory multiple myeloma (NSMM) produces no detectable Ig. This subset of true NSMM has become even smaller over time, as the advent of the serum free light chain assay has resulted in the majority of NSMM patients being recategorized as light-chain MM – that is, MM cells that produce only the light-chain component of Ig. True forms of NSMM, meaning MM that secretes no monoclonal proteins whatsoever, constitute a distinct entity that is reviewed; definition of NSMM using current detection methods, discuss the biology underpinning NSMM development, and share recommendations for how NSMM should be managed clinically with respect to detection, treatment, and monitoring. PMID:28008276

  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. 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.

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

    NASA Astrophysics Data System (ADS)

    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. 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.

  7. 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.

  8. 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

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

    PubMed Central

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

    2011-01-01

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

  10. Exercise in the management of persons with multiple sclerosis

    PubMed Central

    2015-01-01

    For decades, persons with multiple sclerosis (MS) were counseled to avoid excessive physical activity and exercise because of concerns about worsening disease activity. Recent studies indicate that, not only can those with MS tolerate physical exercise, but that it is helpful in managing symptoms, preventing complications and comorbidities, and may possibly have neuroprotective actions. This article reviews previous studies on the effects of different exercise protocols in people with MS, and provides summaries of suggested exercise regimens that may be appropriate and beneficial for this patient population. PMID:25941539

  11. 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.

  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. Bone Disease in Multiple Myeloma: Pathophysiology and Management

    PubMed Central

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

    2014-01-01

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

  14. [Importance of interdisciplinary cooperation in multiple trauma management].

    PubMed

    Vyhnánek, F

    2014-05-01

    Multiple trauma represents the most serious type of trauma in which the result of the treatment depends on the quality of pre-hospital care according to ATLS (Advanced Trauma Life Support) as well as on the availability of emergency specialized care in traumatology centres. Resuscitation in the early post-injury phase involves prevention of the lethal triad (hypothermia, acidosis, coagulopathy) development, as early as during pre-hospital care and also during admission to a traumatology department (damage control resuscitation). Damage control resuscitation involves permissive hypotension and coagulopathy correction with red blood cells (RBCs), fresh frozen plasma and platelets administration with crystalloid solutions restriction. Management in a traumatology centre involves : 1. Determining the sequence for treating each of the injuries step by step: a) control of external and intracavitary bleeding, b) operation for craniocerebral injuries, c) external fixation of fractures. 2. Phased management of intracavitary injuries (damage control surgery) and injuries of the extremities (damage control orthopaedics). 3. Non-operative management of solid organs injuries including radiointervention procedures. 4. Post-injury intensive care after the primary operation (treatment of the lethal triad). 5. Treatment regimen extension in craniocerebral injuries (stabilisation of cerebral perfusion pressure with sufficient oxygenation). 6. Modern therapeutic strategies in mechanical ventilation (protective, non-invasive ventilation). 7. Integration of new imaging methods such as MDCT (Multidetector Computed Tomography). Ensuring complex management in polytrauma treatment requires active cooperation of numerous clinical disciplines, already in the early post-injury period.

  15. Addressing methodological challenges in implementing the nursing home pain management algorithm randomized controlled trial

    PubMed Central

    Ersek, Mary; Polissar, Nayak; Du Pen, Anna; Jablonski, Anita; Herr, Keela; Neradilek, Moni B

    2015-01-01

    Background Unrelieved pain among nursing home (NH) residents is a well-documented problem. Attempts have been made to enhance pain management for older adults, including those in NHs. Several evidence-based clinical guidelines have been published to assist providers in assessing and managing acute and chronic pain in older adults. Despite the proliferation and dissemination of these practice guidelines, research has shown that intensive systems-level implementation strategies are necessary to change clinical practice and patient outcomes within a health-care setting. One promising approach is the embedding of guidelines into explicit protocols and algorithms to enhance decision making. Purpose The goal of the article is to describe several issues that arose in the design and conduct of a study that compared the effectiveness of pain management algorithms coupled with a comprehensive adoption program versus the effectiveness of education alone in improving evidence-based pain assessment and management practices, decreasing pain and depressive symptoms, and enhancing mobility among NH residents. Methods The study used a cluster-randomized controlled trial (RCT) design in which the individual NH was the unit of randomization. The Roger's Diffusion of Innovations theory provided the framework for the intervention. Outcome measures were surrogate-reported usual pain, self-reported usual and worst pain, and self-reported pain-related interference with activities, depression, and mobility. Results The final sample consisted of 485 NH residents from 27 NHs. The investigators were able to use a staggered enrollment strategy to recruit and retain facilities. The adaptive randomization procedures were successful in balancing intervention and control sites on key NH characteristics. Several strategies were successfully implemented to enhance the adoption of the algorithm. Limitations/Lessons The investigators encountered several methodological challenges that were inherent to

  16. 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.

  17. "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…

  18. 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

  19. Management and control of multidrug-resistant tuberculosis (MDR-TB): Addressing policy needs for India.

    PubMed

    Atre, Sachin R; Murray, Megan B

    2016-05-06

    Multidrug-resistant tuberculosis (MDR-TB) challenges TB control efforts because of delays in diagnosis plus its long-term treatment which has toxic effects. Of TB high-incidence countries, India carries the highest burden of MDR-TB cases. We describe policy issues in India concerning MDR-TB diagnosis and management in a careful review of the literature including a systematic review of studies on the prevalence of MDR-TB. Of 995 articles published during 2001-2016 and retrieved from the PubMed, only 20 provided data on the population prevalence of MDR-TB. We further reviewed and describe diagnostic criteria and treatment algorithms in use and endorsed by the Revised National TB Control Program of India. We discuss problems encountered in treating MDR-TB patients with standardized regimens. Finally, we provide realistic suggestions for policymakers and program planners to improve the management and control of MDR-TB in India.Journal of Public Health Policy advance online publication, 6 May 2016; doi:10.1057/jphp.2016.14.

  20. 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.

  1. 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’.

  2. 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

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

    PubMed

    Kalincik, Tomas

    2015-01-01

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

  4. Multiple sclerosis: basic knowledge and new insights in perioperative management.

    PubMed

    Makris, Alexandros; Piperopoulos, Alexandros; Karmaniolou, Iosifina

    2014-04-01

    Multiple sclerosis (MS) is a chronic demyelinating disease of the central nervous system affecting young adults that may lead to significant disability. The clinical course varies among the types of the disease as well as among individuals. Herein we provide a brief review of the recent data concerning the clinical presentation, diagnosis, causes, and pathogenesis of MS as well as medication used, followed by the anesthetic considerations of patients diagnosed with the disease. To accomplish this, we conducted a systematic PubMed literature search for articles, using the terms multiple sclerosis, anesthesia, general, regional, perioperative, and preoperative, and we then manually reviewed the references from each pertinent article. Because randomized controlled trials on the field are rare, most information is derived by case reports and case series. We concluded that the disease itself as well as the treatment modalities may have several implications in the conduct of anesthesia and perioperative management of MS patients. General and regional anesthetic techniques have been successfully used. With thorough preoperative evaluation and in depth knowledge of the disease and its complications, the MS patients can be managed safely.

  5. Damaris: Addressing performance variability in data management for post-petascale simulations

    SciTech Connect

    Dorier, Matthieu; Antoniu, Gabriel; Cappello, Franck; Snir, Marc; Sisneros, Robert; Yildiz, Orcun; Ibrahim, Shadi; Peterka, Tom; Orf, Leigh

    2016-10-01

    With exascale computing on the horizon, reducing performance variability in data management tasks (storage, visualization, analysis, etc.) is becoming a key challenge in sustaining high performance. Here, this variability significantly impacts the overall application performance at scale and its predictability over time. In this article, we present Damaris, a system that leverages dedicated cores in multicore nodes to offload data management tasks, including I/O, data compression, scheduling of data movements, in situ analysis, and visualization. We evaluate Damaris with the CM1 atmospheric simulation and the Nek5000 computational fluid dynamic simulation on four platforms, including NICS’s Kraken and NCSA’s Blue Waters. Our results show that (1) Damaris fully hides the I/O variability as well as all I/O-related costs, thus making simulation performance predictable; (2) it increases the sustained write throughput by a factor of up to 15 compared with standard I/O approaches; (3) it allows almost perfect scalability of the simulation up to over 9,000 cores, as opposed to state-of-the-art approaches that fail to scale; and (4) it enables a seamless connection to the VisIt visualization software to perform in situ analysis and visualization in a way that impacts neither the performance of the simulation nor its variability. In addition, we extended our implementation of Damaris to also support the use of dedicated nodes and conducted a thorough comparison of the two approaches—dedicated cores and dedicated nodes—for I/O tasks with the aforementioned applications.

  6. Librarians and Scientists Partner to Address Data Management: Taking Collaboration to the Next Level

    PubMed Central

    Medina-Smith, Andrea; Tryka, Kimberly A.; Silcox, Barbara P.; Hanisch, Robert J.

    2016-01-01

    Purpose This study looks at the changing way in which the Information Services Office (ISO) at the National Institute of Standards and Technology (NIST) provides services to NIST scientific and technical staff throughout their research and publishing cycles. These services include the more traditional services of a research library as well as publishing NIST technical reports and The Journal of Research of NIST, and preserving and exhibiting scientific instruments and other artifacts. ISO has always prided itself on having a close relationship with its customers, providing a high level of service, and developing new services to stay in front of NIST researcher needs. Through a concerted, strategic effort since the late 1990s, ISO has developed and promoted relationships with its key customers through its Lab Liaison Program. Design/methodology/approach This paper discusses the relationship ISO has developed with the Office of Data and Informatics (ODI), how this relationship was forged, and how this collaboration will serve as a model for working with the other labs and programs at NIST. It will also discuss the risks and opportunities of this new collaborative service model, how ISO positioned itself to become an equal partner with ODI in the exploration of solutions to data management issues, and the benefits of the relationship from ODI's perspective. Findings A pattern of strategic changes to the services and activities offered by the Lab Liaison program has put ISO in the position to collaborate as peers with researchers at NIST. Originality/value This study provides an overview of how ISO made strategic decisions to incorporate non-traditional services to support data management at NIST. PMID:27891247

  7. Damaris: Addressing performance variability in data management for post-petascale simulations

    DOE PAGES

    Dorier, Matthieu; Antoniu, Gabriel; Cappello, Franck; ...

    2016-10-01

    With exascale computing on the horizon, reducing performance variability in data management tasks (storage, visualization, analysis, etc.) is becoming a key challenge in sustaining high performance. Here, this variability significantly impacts the overall application performance at scale and its predictability over time. In this article, we present Damaris, a system that leverages dedicated cores in multicore nodes to offload data management tasks, including I/O, data compression, scheduling of data movements, in situ analysis, and visualization. We evaluate Damaris with the CM1 atmospheric simulation and the Nek5000 computational fluid dynamic simulation on four platforms, including NICS’s Kraken and NCSA’s Blue Waters.more » Our results show that (1) Damaris fully hides the I/O variability as well as all I/O-related costs, thus making simulation performance predictable; (2) it increases the sustained write throughput by a factor of up to 15 compared with standard I/O approaches; (3) it allows almost perfect scalability of the simulation up to over 9,000 cores, as opposed to state-of-the-art approaches that fail to scale; and (4) it enables a seamless connection to the VisIt visualization software to perform in situ analysis and visualization in a way that impacts neither the performance of the simulation nor its variability. In addition, we extended our implementation of Damaris to also support the use of dedicated nodes and conducted a thorough comparison of the two approaches—dedicated cores and dedicated nodes—for I/O tasks with the aforementioned applications.« less

  8. 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.

  9. 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

  10. 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.

  11. Power Aware Management Middleware for Multiple Radio Interfaces

    NASA Astrophysics Data System (ADS)

    Friedman, Roy; Kogan, Alex

    Modern mobile phones and laptops are equipped with multiple wireless communication interfaces, such as WiFi and Bluetooth (BT), enabling the creation of ad-hoc networks. These interfaces significantly differ from one another in their power requirements, transmission range, bandwidth, etc. For example, BT is an order of magnitude more power efficient than WiFi, but its transmission range is an order of magnitude shorter. This paper introduces a management middleware that establishes a power efficient overlay for such ad-hoc networks, in which most devices can shut down their long range power hungry wireless interface (e.g., WiFi). Yet, the resulting overlay is fully connected, and for capacity and latency needs, no message ever travels more than 2k short range (e.g., BT) hops, where k is an arbitrary parameter. The paper describes the architecture of the solution and the management protocol, as well as a detailed simulations based performance study. The simulations largely validate the ability of the management infrastructure to obtain considerable power savings while keeping the network connected and maintaining reasonable latency. The performance study covers both static and mobile networks.

  12. 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.

  13. 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

  14. 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.

  15. Cannabinoids in the management of spasticity associated with multiple sclerosis

    PubMed Central

    Malfitano, Anna Maria; Proto, Maria Chiara; Bifulco, Maurizio

    2008-01-01

    The endocannabinoid system and cannabinoid-based treatments have been involved in a wide number of diseases. In particular, several studies suggest that cannabinoids and endocannabinoids may have a key role in the pathogenesis and therapy of multiple sclerosis (MS). In this study we highlight the main findings reported in literature about the relevance of cannabinoid drugs in the management and treatment of MS. An increasing body of evidence suggests that cannabinoids have beneficial effects on the symptoms of MS, including spasticity and pain. In this report we focus on the effects of cannabinoids in the relief of spasticity describing the main findings in vivo, in the mouse experimental allergic encephalomyelitis model of MS. We report on the current treatments used to control MS symptoms and the most recent clinical studies based on cannabinoid treatments, although long-term studies are required to establish whether cannabinoids may have a role beyond symptom amelioration in MS. PMID:19183777

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

    SciTech Connect

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

    2007-07-01

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

  17. Using mixture models with known class membership to address incomplete covariance structures in multiple-group growth models.

    PubMed

    Kim, Su-Young; Mun, Eun-Young; Smith, Stevens

    2014-02-01

    Multi-group latent growth modelling in the structural equation modelling framework has been widely utilized for examining differences in growth trajectories across multiple manifest groups. Despite its usefulness, the traditional maximum likelihood estimation for multi-group latent growth modelling is not feasible when one of the groups has no response at any given data collection point, or when all participants within a group have the same response at one of the time points. In other words, multi-group latent growth modelling requires a complete covariance structure for each observed group. The primary purpose of the present study is to show how to circumvent these data problems by developing a simple but creative approach using an existing estimation procedure for growth mixture modelling. A Monte Carlo simulation study was carried out to see whether the modified estimation approach provided tangible results and to see how these results were comparable to the standard multi-group results. The proposed approach produced results that were valid and reliable under the mentioned problematic data conditions. We also present a real data example and demonstrate that the proposed estimation approach can be used for the chi-square difference test to check various types of measurement invariance as conducted in a standard multi-group analysis.

  18. Waste Management: DOD Has Generally Addressed Legislative Requirements on the Use of Burn Pits but Needs to Fully Assess Health Effects

    DTIC Science & Technology

    2016-09-01

    WASTE MANAGEMENT DOD Has Generally Addressed Legislative Requirements on the Use of Burn Pits but Needs to Fully Assess...United States Government Accountability Office Highlights of GAO-16-781, a report to congressional committees September 2016 WASTE MANAGEMENT ...Did This Study Burn pits help base commanders manage waste generated by U.S. forces overseas, but they also produce harmful emissions that

  19. 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.

  20. Improving service delivery for relapse management in multiple sclerosis.

    PubMed

    Warner, Richard; Thomas, Del; Martin, Roswell

    This action research study was conducted over an 18 month period within a district general hospital. The study has improved the quality of the service provided to people experiencing a relapse of multiple sclerosis. The authors now identify and treat a three-fold increase in relapse patients. At least 85% of these patients are treated within 10 days of reporting symptoms to a specialist nurse. Before the study, only 12% of patients received treatment within this time. The authors' data identify what patients valued about this service and also inform debate around distress associated with relapse and how services should develop to respond to this. The study is of particular importance to the UK because the National Institute for Clinical Excellence (NICE) has published guidance to the NHS about the management of this specific patient group (NICE, 2003). This study also clearly demonstrates how specialist nursing services can combine a substantial clinical role with instigating and managing change in service delivery that results in improvements in patient care.

  1. 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.

  2. 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

  3. 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.

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

    PubMed

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

    2003-05-01

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

  5. Design Optimization for Multiple Management Period Groundwater Remediation

    NASA Astrophysics Data System (ADS)

    Rizzo, Donna M.; Dougherty, David E.

    1996-08-01

    A technique for obtaining a (nearly) optimal scheme using multiple management periods has been developed. The method has been developed for very large scale combinatorial optimization problems. Simulated annealing has been extended to this problem. An importance function is developed to accelerate the search for good solutions. These tools have been applied to groundwater remediation problems at Lawrence Livermore National Laboratory (LLNL). A deterministic site-specific engineering-type flow and transport model (based on the public domain code SUTRA) is combined with the heuristic optimization technique. The objective is to obtain the time-varying optimal locations of the remediation wells that will reduce concentration levels of volatile organic chemicals in groundwater below a given threshold at specified areas on the LLNL site within a certain time frame and subject to a variety of realistic complicating factors. The cost function incorporates construction costs, operation and maintenance costs for injection and extraction wells, costs associated with piping and treatment facilities, and a performance penalty for well configurations that generate flow and transport simulations that exceed maximum concentration levels at specified locations. The resulting application reported here comprises a huge optimization problem. The importance function detailed in this paper has led to rapid convergence to solutions. The performance penalty allows different goals to be imposed on different geographical regions of the site; in this example, short-term off-site plume containment and long-term on-site cleanup are imposed. The performance of the optimization scheme and the effects of various trade-offs in management objectives are explored through examples using the LLNL site.

  6. Safety concerns and risk management of multiple sclerosis therapies.

    PubMed

    Soelberg Sorensen, P

    2016-11-27

    Currently, more than ten drugs have been approved for treatment of relapsing-remitting multiple sclerosis (MS). Newer treatments may be more effective, but have less favorable safety record. Interferon-β preparations and glatiramer acetate treatment require frequent subcutaneous or intramuscular injections and are only moderately effective, but have very rarely life-threatening adverse effects, whereas teriflunomide and dimethyl fumarate are administered orally and have equal or better efficacy, but have more potentially severe adverse effects. The highly effective therapies fingolimod, natalizumab, daclizumab, and alemtuzumab have more serious adverse effects, some of which may be life-threatening. The choice between drugs should be based on a benefit-risk evaluation and tailored to the individual patient's requirements in a dialogue between the patient and treating neurologist. Patients with average disease activity can choose between dimethyl fumarate and teriflunomide or the "old injectable." Patients with very active MS may choose a more effective drug as the initial treatment. In case of side effects on one drug, switch to another drug can be tried. Suboptimal effect of the first drug indicates escalation to a highly efficacious drug. A favorable benefit-risk balance can be maintained by appropriate patient selection and appropriate risk management on therapy. New treatments will within the coming 1-2 years change our current treatment algorithm for relapsing-remitting MS.

  7. Fiscal Year 2015 U.S. Government Financial Statements: Need to Address the Governments Remaining Financial Management Challenges and Long Term Fiscal Path

    DTIC Science & Technology

    2016-04-06

    FINANCIAL STATEMENTS Need to Address the Government’s Remaining Financial Management Challenges and Long- Term Fiscal Path Statement of Gene L. Dodaro... Management Challenges and Long-Term Fiscal Path Why GAO Did This Study Congress and the President need reliable, useful, and timely financial and...discusses the federal government’s remaining financial management challenges and long-term fiscal path, specifically in the context of GAO’s report on

  8. 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.

  9. 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.

  10. 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

  11. 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.

  12. 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

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

    PubMed

    Warburton, Bruce; Gormley, Andrew M

    2015-01-01

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

  14. 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.

  15. 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 ...

  16. 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.

  17. 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.

  18. [First aid and management of multiple trauma: in-hospital trauma care].

    PubMed

    Boschin, Matthias; Vordemvenne, Thomas

    2012-11-01

    Injuries remain the leading cause of death in children and young adults. Management of multiple trauma patients has improved in recent years by quality initiatives (trauma network, S3 guideline "Polytrauma"). On this basis, strong links with preclinical management, structured treatment algorithms, training standards (ATLS®), clear diagnostic rules and an established risk- and quality management are the important factors of a modern emergency room trauma care. We describe the organizational components that lead to successful management of trauma in hospital.

  19. 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.

  20. 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

  1. Assessing and managing multiple risks in a changing world – the Roskilde recommendations.

    EPA Science Inventory

    Roskilde University (Denmark) hosted a November 2015 workshop, Environmental Risk—Assessing and Managing Multiple Risks in a Changing World. This Focus article presents the consensus recommendations of 30 attendees from 9 countries regarding implementation of a common curre...

  2. Assessing and Managing Multiple Risks in a Changing World – the Roskilde Recommendations

    EPA Science Inventory

    Roskilde University hosted a November 2015 workshop on “Environmental Risk – Assessing and Managing Multiple Risks in a Changing World”. Thirty attendees from 9 countries developed consensus recommendations regarding: implementation of a common currency (ecosyst...

  3. Multiple Uric Acid Bladder Stones: Clinical Presentation and Endoscopic Management

    PubMed Central

    Torricelli, Fabio Cesar Miranda; Chueh, Shih-Chieh Jeff; Shen, Shujane

    2017-01-01

    Abstract Background: Bladder urinary calculi occur in 3%–8% of men with bladder outlet obstruction, and although most of them are composed of calcium, in a few cases uric acid bladder stones are diagnosed. Case Presentation: We present clinical images and therapeutic management of a 65-year-old diabetic man with significant prostate enlargement and >30 bladder stones, the largest being 17 mm. Despite the large stone burden, the patient was managed by cystolithotripsy. Remarkably, stone composition analysis revealed 100% uric acid stone. Intraoperative and postoperative course were uneventfully. Conclusion: Uric acid bladder stone pathogenesis seems to be multifactorial with local and systemic factors contributing in different manners and even large stone burdens may be cystoscopically managed. PMID:28265592

  4. DOD Financial Management: Actions Under Way Need to Be Successfully Completed to Address Long-standing Funds Control Weaknesses

    DTIC Science & Technology

    2014-04-01

    general ledger, funds control, receipts and acceptance, accounts payable and disbursement, billing, and financial reporting for the general fund...Control Weaknesses Report to Congressional Requesters April 2014 GAO-14-94 United States Government Accountability Office Report Documentation...5e. TASK NUMBER 5f. WORK UNIT NUMBER 7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) U.S. Government Accountability Office,441 G Street NW

  5. Multiple Attempts for Online Assessments in an Operations Management Course: An Exploration

    ERIC Educational Resources Information Center

    Orchard, Ryan K.

    2016-01-01

    In learning management systems, tools for online homework assessments include a number of alternatives for the assessment settings, including the ability to permit students to attempt an assessment multiple times, with options for how the multiple attempts are administered. A specific implementation of online assessments in an introductory…

  6. 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)…

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

    NASA Technical Reports Server (NTRS)

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

    1973-01-01

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

  8. Managing multiple goals during fertility treatment: An interpretative phenomenological analysis.

    PubMed

    Phillips, Elly; Elander, James; Montague, Jane

    2014-04-01

    This study investigated how men and women made sense of multiple goals during fertility treatment. Both members of three heterosexual couples participated in two or three semi-structured interviews over 6 months, producing 14 accounts, which were analysed using interpretative phenomenological analysis. The goal of biological parenthood dominates assumptions in infertility research, but its importance varied between participants, who balanced that goal with retaining emotional well-being, avoiding financial difficulties and maintaining their relationship. These themes are discussed in the context of the self-regulation model, which allows fertility treatment experiences to be conceptualised more broadly than do other models.

  9. 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.

  10. 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.

  11. Total fidelity management in self-aligned multiple patterning process

    NASA Astrophysics Data System (ADS)

    Yamato, Masatoshi; Okabe, Noriaki; Hara, Arisa; Natori, Sakurako; Yamauchi, Shouhei; Koike, Kyohei; Oyama, Kenichi; Yaegashi, Hidetami

    2015-03-01

    Through the continuous scaling with extension of 193-immersion lithography, the multi-patterning process with the grid-based design has become nominal process for fine fabrication to relax tight pitch designs[1]. In self-aligned type multiple patterning, 7 nm node gate pattern was reported[2],[3] and it was become a focal point LER on core-pattern is essential category to control pattern placement variations. Though CD uniformity (CDU) on line pattern in self-aligned double patterning (SADP) is relatively stable caused in high thickness controllability of spacer deposition films, the variations of CDU and LER on first core pattern impinge the CDU on space and pitch pattern. In previous study, pattern fidelity of single exposure patterning was improved through photoresist smoothing process using direct-current superposition technique[4],[5]. In this paper, we will report that photoresist smoothing work in an efficient way to pattern fidelity control in self-aligned type multiple patterning.

  12. 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.

  13. 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.

  14. [Modern concepts of trauma care and multiple trauma management in oral and maxillofacial region].

    PubMed

    Tan, Yinghui

    2015-06-01

    Multiple trauma management requires the application of modem trauma care theories. Optimal treatment results can be achieved by reinforcing cooperation and stipulating a treatment plan together with other disciplines. Based on modem theories in trauma care and our understanding of the theoretical points, this paper analyzes the injury assessment strategies and methods in oral and maxillofacial multiple trauma management. Moreover, this paper discusses operating time and other influencing factors as well as proposed definitive surgical timing and indications in comprehensive management of oral and maxillofacial multiple trauma patients associated with injuries in other body parts. We hope that this paper can help stomatological physicians deepen their understanding of modem trauma care theories and improve their capacity and results in the treatment of oral and maxillofacial multiple trauma.

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

    PubMed Central

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

    2013-01-01

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

  16. 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…

  17. 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.

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

    NASA Technical Reports Server (NTRS)

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

    1972-01-01

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

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

    PubMed Central

    2012-01-01

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

  20. Green Remediation Best Management Practices: Overview of EPA's Methodology to Address the Environmental Footprint of Site Cleanup

    EPA Pesticide Factsheets

    Contaminated site cleanups involving complex activities may benefit from a detailed environmental footprint analysis to inform decision-making about application of suitable best management practices for greener cleanups.

  1. 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.

  2. 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.

  3. 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.

  4. 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.

  5. 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.

  6. 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

  7. 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.

  8. New approaches in the management of multiple sclerosis

    PubMed Central

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

    2010-01-01

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

  9. 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

  10. Expanding the human-machine interface model to address the effect of leadership and management on performance

    SciTech Connect

    Briant, V.S.; Childress, J.R.; Hannaman, G.W.

    1988-01-01

    The US nuclear industry now focuses on improving plant performance in measurable areas such as availability, safety, and operations. Risk assessment and pioneering work in human reliability analysis (HRA) have provided methods to identify and prioritize numerous design improvements. Improvements such as control room design, training, and procedures have contributed positively to plant performance. Human performance is increasingly recognized as a fundamental contributor to safe, economic, and reliable operation. Industry leaders suggest that improved leadership and management are keys to enhanced plant performance. This paper identifies several critical aspects of individual and group behavior that, if managed, could significantly contribute to improved performance. Some existing tools for measuring performance are cited.

  11. 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…

  12. 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...

  13. 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…

  14. "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...

  15. 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.

  16. An Approach for Managing Vertebrate Diversity Across Multiple-Use Landscapes.

    PubMed

    Hansen, Andrew J; Garman, Steven L; Marks, Barbara; Urban, Dean L

    1993-08-01

    Land managers face the difficult challenge of maintaining biodiversity on lands also used for commodity production. We present an approach for managing the habitats of terrestrial vertebrates at the landscape scale on multiple-use lands. The approach is based on the hypothesis that animal community response to landscape change is a function of species life histories and local patterns of landscape change. Key steps are: (1) set clear objectives; (2) associate target species with specific habitat configurations; (3) assess the potential sensitivity of species by mapping habitat suitability and examining species life histories; (4) evaluate alternative management prescriptions using simulation models; and (5) implement preferred or experimental strategies and monitor the responses of habitats and species. The approach was demonstrated for a watershed in western Oregon. Management objectives were to maximize habitat diversity for early- and late-successional bird species and to produce saw timber at levels compatible with the habitat goals. Habitat associations of 51 bird species were described by four variables that encompass three spatial scales. An analysis of species sensitivity to landscape change revealed several species that may merit special attention. The landscape model LSPA and the gap model ZELIG.PNW were used to simulate four disturbance/management scenarios over a 140-yr period: natural fire, wood production, multiple use, and no action. The results indicated that 65% more saw timber would be produced under the wood production run than the multiple-use run, but the former would maintain habitats for many fewer bird species than the latter. The multiple-use scenario was selected as the preferred alternative. We suggest carrying out management experiments and rigorous monitoring during the implementation phase. While this approach has various limitations, it is an incremental step towards the effective management of species diversity on multiple-use lands.

  17. 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

  18. Environmental Assessment Addressing the 301st Fighter Wing Managed Airspace, Naval Air Station Joint Reserve Base, Fort Worth, Texas

    DTIC Science & Technology

    2009-05-01

    decisionmaking process. Copies of the EA and proposed FONSI were available for review at the Fort Worth Central Public Library , Texas; Brownwood Public Library ...Texas; F.M. Richards Memorial Library , Texas; Tom Green County Main Library , Texas; Killeen City Main Library , Texas; and Lawton Library , Oklahoma...through the defined areas. EA for 301 FW Managed Airspace NAS JRB Fort Worth May 2009 2-3 20 Ballinger Callahan County Haskell County Jones County

  19. Security Assistance: DOD’s Ongoing Reforms Address Some Challenges, but Additional Information Is Needed to Further Enhance Program Management

    DTIC Science & Technology

    2012-11-01

    Abbreviations BPC building partner capacity DOD Department of Defense DSCA Defense Security Cooperation Agency EFTS Enhanced Freight Tracking System...SCOs are ready to receive a planned delivery. For both FMS and pseudo-FMS processes, DOD uses the Enhanced Freight Tracking System ( EFTS ), a secure...providing data for this system. The Security Assistance Management Manual recommends that SCOs use the EFTS to maintain awareness of incoming shipments

  20. 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.

  1. 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

  2. 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

  3. Convocation address.

    PubMed

    Kakodkar, A

    1999-07-01

    This convocation addressed by Dr. Anil Kakodkar focuses on the challenges faced by graduating students. In his speech, he emphasized the high level of excellence achieved by the industrial sector; however, he noted that there has been a loss of initiative in maximizing value addition, which was worsened by an increasing population pressure. In facing a stiff competition in the external and domestic markets, it is imperative to maximize value addition within the country in a competitive manner and capture the highest possible market share. To achieve this, high-quality human resources are central. Likewise, family planning programs should become more effective and direct available resources toward national advantage. To boost the domestic market, he suggests the need to search for strengths to achieve leadership position in those areas. First, an insight into the relationship between the lifestyles and the needs of our people and the natural resource endowment must be gained. Second, remodeling of the education system must be undertaken to prepare the people for adding the necessary innovative content in our value addition activities. Lastly, Dr. Kakodkar emphasizes the significance of developing a strong bond between parents and children to provide a sound foundation and allow the education system to grow upon it.

  4. Addressing the challenges of improving primary care quality in Uzbekistan: a qualitative study of chronic heart failure management.

    PubMed

    Ahmedov, Mohir; Green, Judith; Azimov, Ravshan; Avezova, Guloyim; Inakov, Sherzod; Mamatkulov, Bahrom

    2013-08-01

    Uzbekistan has a well-developed primary care system, with universal access to care, but faces challenges in improving the quality of clinical care provided. This study aimed to identify barriers to quality improvement by focusing on one common condition, Chronic Heart Failure (CHF), for which there are evidence-based international guidelines for management. To identify the challenges to improving the quality of care for CHF in line with such guidelines we took a qualitative approach, interviewing 15 physicians and 30 patients in detail about their experiences of CHF management. Despite recent improvements to the training of primary care physicians, their access to up-to-date information was limited, and they were disproportionately reliant on information from pharmaceutical companies. The main barriers to implementing international standards of care were: reluctance of physicians (and patients) to abandon ineffective interventions; enduring, system-wide incentives for clinically unnecessary hospitalization; and the lack of structural support for evidence-based health services improvement. Patients were in general positive about adherence to medications, but faced some problems in affording drugs and hospital care. Future interventions to strengthen primary care should be implemented with evaluations of their impact on the processes and outcomes of care for chronic conditions.

  5. 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.

  6. Content Addressable Memory Project

    DTIC Science & Technology

    1990-11-01

    The Content Addressable M1-emory Project consists of the development of several experimental software systems on an AMT Distributed Array Processor...searching (database) compiler algorithms memory management other systems software) Linear C is an unlovely hybrid language which imports the CAM...memory from AMT’s operating system for the DAP; how- ever, other than this limitation, the memory management routines work exactly as their C counterparts

  7. A pregnant woman with metastatic papillary thyroid carcinoma and paraplegia: Multiple considerations involved in the management.

    PubMed

    Basu, Sandip; Kand, Purushottam

    2011-01-01

    A 35 years old primigravida hailing from a humble, rural background with no previous history related to thyroid carcinoma, presented with acute paraparesis at the last trimester of pregnancy and was diagnosed to harbor metastatic papillary thyroid carcinoma (PTC) following magnetic resonance imaging (MRI) of the spine with guided biopsy, which demonstrated near complete collapse of D5 and D10 vertebral bodies with altered signal on the D4 to D6 and D9 to D11 vertebral bodies, in addition to a gravid uterus and a large goiter. There was also evidence of bilateral nodular lesions in the lung parenchyma and a fairly large hepatic lesion in segment 8 of the liver . Histopathology revealed metastatic follicular variant of thyroid papillary carcinoma. This case with challenging presentation had multiple issues to be resolved during its management: a) acute paraparesis and the requirement of radioiodine ((131)I) treatment soon after total thyroidectomy, b) her first valuable pregnancy that required to be managed successfully, c) the poor general condition, d) the abstinence from iodine containing medications, in relation to the Cesarean section planned, e) the timing of total thyroidectomy, f) postnatal care of the newborn and g) radioprotective measures. All were important considerations in the management of this patient. Iodine restricted diet and medications were recommended and were communicated to the obstetricians involved in the patient. The patient underwent Cesarean section and total thyroidectomy at the same sitting. The newborn baby was healthy and was started on artificial feeding. Recombinant TSH primed protocol was not considered immediately in view of a major surgery being undertaken and the poor general condition, so that the patient would not require frequent support during the isolation period. In the first 3 weeks of the postoperative period, she was put on T3 substitution and after a 2 weeks gap was given (131)I and whole body diagnostic scan was

  8. 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

  9. Presidential address.

    PubMed

    Vohra, U

    1993-07-01

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

  10. 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

  11. 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…

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

    ERIC Educational Resources Information Center

    Long, Bonita C.

    1998-01-01

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

  13. The Use of Management and Marketing Textbook Multiple-Choice Questions: A Case Study.

    ERIC Educational Resources Information Center

    Hampton, David R.; And Others

    1993-01-01

    Four management and four marketing professors classified multiple-choice questions in four widely adopted introductory textbooks according to the two levels of Bloom's taxonomy of educational objectives: knowledge and intellectual ability and skill. Inaccuracies may cause instructors to select questions that require less thinking than they intend.…

  14. Recommendations for Evaluating Multiple Filters in Ballast Water Management Systems for US Type Approval

    DTIC Science & Technology

    2016-01-01

    Systems specifying multiple filters. ..................................................... 47 Table 15. ASHRAE guidance on minimum efficiency ...Alternative management system ANS Aquatic nusiance species ASHRAE American Society of Heating , Refrigerating, and Air Conditioning Engineers ASTM ASTM...was developed by the American Society of Heating , Refrigerating, and Air Conditioning Engineers (ASHRAE), the minimum efficiency reporting value

  15. 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

  16. Welcome address [to Workshop/Seminar for More Effective Promotion and Management of Integrated Projects (Family Planning and Parasite Control)].

    PubMed

    Aziz, N L

    1979-10-01

    The Project to Integrate Family Planning with Parasite Control was first launched in 1975; currently it has 6 member countries, with several more Asian and Latin American countries planning to develop similar projects. The Integrated Approach has proved beneficial in stimulating further research in parasitology, family planning and related fields. One of the aims of this workshop is to evaluate the administrative/management aspect of the project, particularly in the areas of community participation and mobilization, resource needs, coordination and credibility of the project. Although family planning or fertility regulation is not an end in itself, its importance lies in its role in controlling population growth and hence in its contribution to the betterment of the social and material well-being of the population. Unfortunately, most governments today are faced with many constraints on their administrative efforts and responsibilities, and family planning programs are no exceptions. It is hoped that this workshop will shed new light on how to improve the implementation of family planning projects.

  17. 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.

  18. 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

  19. 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

  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. 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.

  2. Early detection of ecosystem regime shifts: a multiple method evaluation for management application.

    PubMed

    Lindegren, Martin; Dakos, Vasilis; Gröger, Joachim P; Gårdmark, Anna; Kornilovs, Georgs; Otto, Saskia A; Möllmann, Christian

    2012-01-01

    Critical transitions between alternative stable states have been shown to occur across an array of complex systems. While our ability to identify abrupt regime shifts in natural ecosystems has improved, detection of potential early-warning signals previous to such shifts is still very limited. Using real monitoring data of a key ecosystem component, we here apply multiple early-warning indicators in order to assess their ability to forewarn a major ecosystem regime shift in the Central Baltic Sea. We show that some indicators and methods can result in clear early-warning signals, while other methods may have limited utility in ecosystem-based management as they show no or weak potential for early-warning. We therefore propose a multiple method approach for early detection of ecosystem regime shifts in monitoring data that may be useful in informing timely management actions in the face of ecosystem change.

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

    PubMed

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

    2013-12-01

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

  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. A cross-sectional, multicentre study of the therapeutic management of multiple sclerosis relapses in Italy.

    PubMed

    Annovazzi, Pietro; Tomassini, Valentina; Bodini, Benedetta; Boffa, Laura; Calabrese, Massimiliano; Cocco, Eleonora; Cordioli, Cinzia; De Luca, Giovanna; Frisullo, Giovanni; Gallo, Antonio; Malucchi, Simona; Paolicelli, Damiano; Pesci, Ilaria; Radaelli, Marta; Ragonese, Paolo; Roccatagliata, Luca; Tortorella, Carla; Vercellino, Marco; Zipoli, Valentina; Gasperini, Claudio; Rodegher, Mariaemma; Solaro, Claudio

    2013-02-01

    Despite the existence of therapeutic guidelines, management of multiple sclerosis relapse remains heterogeneous. Optimisation of relapse outcome demands an improved understanding of the neurologist's therapeutic attitude towards relapse management, which is the aim of this study. Neurologists from 13 multiple sclerosis centres completed a questionnaire every time they assessed multiple sclerosis relapses. The questionnaire requested a guided description of the relapse's clinical characteristics and an indication of the prescribed therapy, supported with up to 3 out of 20 suggested reasons. Over 3 months, 368 questionnaires were collected. Median percentage (%) of 21 relapses resulting in a prescription was 88.9%. Corticosteroids represented the most frequent prescription. A short-course of high-dose intravenous methylprednisolone was the most used corticosteroid (73.7%). Treatment was administrated mainly in day case unit (80.0%) and at home (13.6%). A tapered therapy was prescribed to 28.8% of patients. Neurologists' therapeutic decisions were driven mainly by relapse severity (45.3%) and symptom evolution (24.2%). Our study confirms the therapeutic attitude of multiple sclerosis specialists in treating relapses with high-dose intravenous corticosteroids in a day hospital setting, with a tapering in a proportion of cases. The main reasons for prescription are relapse severity and symptom evolution.

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

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... management plan, and addition of multiple-site components. (a) Changes in the boundary of a Reserve and major changes to the final management plan, including state laws or regulations promulgated specifically for the... management plan change. Changes in the boundary of a Reserve involving the acquisition of properties...

  8. 15 CFR 921.33 - Boundary changes, amendments to the management plan, and addition of multiple-site components.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... management plan, and addition of multiple-site components. (a) Changes in the boundary of a Reserve and major changes to the final management plan, including state laws or regulations promulgated specifically for the... management plan change. Changes in the boundary of a Reserve involving the acquisition of properties...

  9. 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.

  10. 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

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

    PubMed

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

    2016-05-01

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

  12. 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

  13. 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

  14. 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

  15. Home based management in multiple sclerosis: results of a randomised controlled trial

    PubMed Central

    Pozzilli, C; Brunetti, M; Amicosante, A; Gasperini, C; Ristori, G; Palmisano, L; Battaglia, M

    2002-01-01

    Background: Home based medical care is a popular alternative to standard hospital care but there is uncertainty about its cost-effectiveness. Objectives: To compare the effectiveness and the costs of multidisciplinary home based care in multiple sclerosis with hospital care in a prospective randomised controlled trial with a one year follow up. Methods: 201 patients with clinically definite multiple sclerosis were studied. They were randomised in a ratio 2:1 to an intervention group (133) or a control group (68). They were assessed at baseline and one year after randomisation with validated measures of physical and psychological impairment and quality of life (SF-36 health survey). The costs to the National Health Service over the one year follow up were calculated by a cost minimisation analysis. Results: There were no differences in functional status between the home based care group and the hospital group. There was a significant difference between the two groups favouring home based management in four SF-36 health dimensions—general health, bodily pain, role-emotional, and social functioning (all p ≤ 0.001). The cost of home based care was slightly less (822 euros/patient/year) than hospital care, mainly as a result of a reduction in hospital admissions. Conclusions: Comprehensive planning of home based intervention implemented by an interdisciplinary team and designed specifically for people with multiple sclerosis may provide a cost-effective approach to management and improve the quality of life. PMID:12185154

  16. 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.

  17. The Path to Self-Management: A Qualitative Study Involving Older People with Multiple Sclerosis

    PubMed Central

    Austin, Mark W.; Murdoch, Michelle; Kearney, Anne; Godwin, Marshall; Stefanelli, Mark

    2012-01-01

    ABSTRACT Purpose: This qualitative study sought to explore older people's experience of ageing with multiple sclerosis (MS) and to describe the natural history of self-management from their points of view. Methods: Eighteen people over age 55 and living with MS for at least 20 years were recruited from an MS clinic and rehabilitation outpatient records. Interviews (60–80 min), using open-ended questions, explored participants' lifelong experiences of MS. Following interview transcription, data were coded and analyzed; themes, subthemes, and their relationships were described based on consensus. Results: Participants recounted their diagnosis process, their life experience with MS, and how they eventually accepted their disease, adapted, and moved toward self-management. The findings included vivid descriptions of social relationships, health care interactions, overcoming barriers, and the emotions associated with living with MS. A conceptual model of phases of self-management, from diagnosis to integration of MS into a sense of self, was developed. Conclusions: Study participants valued self-management and described its phases, facilitators, and inhibitors from their points of view. Over years and decades, learning from life experiences, trial and error, and interactions with health care professionals, participants seemed to consolidate MS into their sense of self. Self-determination, social support, strong problem-solving abilities, and collaborative relationships with health professionals aided adaptation and coping. Findings from this study make initial steps toward understanding how MS self-management evolves over the life course and how self-management programmes can help people with MS begin to manage wellness earlier in their lives. PMID:23277680

  18. 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

  19. 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.

  20. [Hemostasis management in multiple trauma patients--value of near-patient diagnostic methods].

    PubMed

    Jámbor, Csilla; Heindl, Bernhard; Spannagl, Michael; Rolfes, Caroline; Dinges, Gerhard Klaus; Frietsch, Thomas

    2009-03-01

    Massively transfused multiple trauma patients commonly develop a complex coagulopathy which needs immediate treatment. Near-patient diagnostic methods are available for the management of this coagulopathy and for the guidance of the therapeutic options with blood products and haemostatic drugs: conventional laboratory analysis methods adapted to the point-of-care (POC) situation (blood gas analysis, point of care PT, APTT and platelet count), and the complex whole blood methods used for near-patient coagulation monitoring (thromboelastometry and platelet function analysis). Based on the new Guidelines of the German Medical Association for the use of blood and plasma derivates, interventions with blood products and haemostatic drugs in multiple trauma patients are suggested. The diagnostic value of near-patient methods for coagulation monitoring is discussed.

  1. 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.

  2. Multiple scales modelling approaches to social interaction in crowd dynamics and crisis management. Comment on "Human behaviours in evacuation crowd dynamics: From modelling to "big data" toward crisis management" by Nicola Bellomo et al.

    NASA Astrophysics Data System (ADS)

    Trucu, Dumitru

    2016-09-01

    In this comprehensive review concerning the modelling of human behaviours in crowd dynamics [3], the authors explore a wide range of mathematical approaches spanning over multiple scales that are suitable to describe emerging crowd behaviours in extreme situations. Focused on deciphering the key aspects leading to emerging crowd patterns evolutions in challenging times such as those requiring an evacuation on a complex venue, the authors address this complex dynamics at both microscale (individual level), mesoscale (probability distributions of interacting individuals), and macroscale (population level), ultimately aiming to gain valuable understanding and knowledge that would inform decision making in managing crisis situations.

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

    SciTech Connect

    Arthur, J. Daniel

    2012-07-01

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

  4. [Emergency room management of multiple trauma : ATLS® and S3 guidelines].

    PubMed

    Bouillon, B; Probst, C; Maegele, M; Wafaisade, A; Helm, P; Mutschler, M; Brockamp, T; Shafizadeh, S; Paffrath, T

    2013-09-01

    Trauma management in the emergency room is an important part of the treatment chain of the severely injured. Important decisions with respect to diagnostics and treatment must be made under time pressure. Successful trauma management in the emergency room requires a hospital tailored treatment protocol. This written protocol needs consent from all participating disciplines and must be known by all members of the resuscitation team. The ATLS® and the recently published clinical practice guidelines on multiple trauma can be of help in order to establish or update such protocols. In order to continuously evaluate and improve performance in the emergency room local quality circles are needed that truly follow that aim. Important factors are reliability of agreement between the different disciplines and continuous communication of results to the team members. In order to be successful such quality circles need people that care.

  5. 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.

  6. Occupational Therapy and Management of Multiple Chronic Conditions in the Context of Health Care Reform

    PubMed Central

    Fogelberg, Donald J.; Halle, Ashley D.; Mroz, Tracy M.

    2017-01-01

    One in four individuals living in the United States has multiple chronic conditions (MCCs), and the already high prevalence of MCCs continues to grow. This population has high rates of health care utilization yet poor outcomes, leading to elevated concerns about fragmented, low-quality care provided within the current health care system. Several national initiatives endeavor to improve care for the population with MCCs, and occupational therapy is uniquely positioned to contribute to these efforts for more efficient, effective, client-centered management of care. By integrating findings from the literature with current policy and practice, we aim to highlight the potential role for occupational therapy in managing MCCs within the evolving health care system. PMID:28027031

  7. Multiple sclerosis disease-modifying therapies: adverse effect surveillance and management.

    PubMed

    Wingerchuk, Dean M

    2006-03-01

    There are five approved, partially effective, parenteral disease-modifying therapies for multiple sclerosis (MS), including three interferon-beta preparations, glatiramer acetate and the antineoplastic agent mitoxantrone. A sixth drug, natalizumab, was withdrawn from the market in 2005 but could return with increased safety measures. Careful surveillance for, and management of, the minor and serious adverse effects associated with these therapies in routine practice provides the best opportunity for maintaining compliance and achieving maximal therapeutic efficacy. This review outlines the strategies for the prevention, identification and management of the complications associated with administration and ongoing use of current MS therapies. These skills will become increasingly important to those caring for MS patients as contemporary treatment regimens become increasingly complex.

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

    NASA Astrophysics Data System (ADS)

    Benedict, K. K.; Scott, S.

    2013-12-01

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

  9. 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

  10. 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.

  11. 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…

  12. The diagnosis and management of multiple-drug-resistant-tuberculosis at the beginning of the new millenium.

    PubMed

    Drobniewski, F A; Balabanova, Yanina M

    2002-03-01

    Multiple-drug-resistant tuberculosis (MDRTB) is more difficult to treat and the treatment is less likely to produce favourable results compared to treatment of drug-sensitive disease. Success requires close co-operation between the laboratory, which defines a case as MDRTB, and the clinical team, who will treat it as well as the public health staff who will address aspects of contact tracing and institutional cross-infection. National surveys have indicated that MDRTB occurs at a higher rate in some countries such as Estonia and Latvia (14.1% and 9% respectively, in 1998) and Russia (although there are only limited validated data). In contrast, in Western Europe and in some countries of Eastern Europe, such as the Czech Republic, Slovenia, Slovakia and Poland with good tuberculosis (TB) prevention and treatment programmes, the combined MDRTB prevalence was 1% or less. The early diagnosis of MDRTB and case management by experienced teams from the outset remains the best hope clinically for these patients. Adequately supervised and prolonged combination chemotherapy is essential, with drug choice governed mainly by quality-controlled in vitro drug susceptibility data. There is a more limited role for surgery, and immunomodulating therapy, such as the use of gamma-interferon, may have a useful adjunct role. Clearly the most important therapeutic modality for MDRTB is to treat drug-sensitive TB correctly in the first instance and prevent the emergence of resistant TB.

  13. 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.

  14. The importance of multiple performance criteria for understanding trust in risk managers.

    PubMed

    Johnson, Branden B; White, Mathew P

    2010-07-01

    Effective risk management requires balancing several, sometimes competing, goals, such as protecting public health and ensuring cost control. Research examining public trust of risk managers has largely focused on trust that is unspecified or for a single goal. Yet it can be reasonable to have a high level of trust in one aspect of a target's performance but not another. Two studies involving redevelopment of contaminated land (Study 1) and drinking water standards (Study 2) present preliminary evidence on the value of distinguishing between performance criteria for understanding of trust. Study 1 assessed perceptions of several trust targets (councilors, developers, scientists, residents) on their competence (capacity to achieve goals) and willingness to take action under uncertainty for four criteria. Study 2 assessed competence, willingness, and trust for five criteria regarding a single government agency. In both studies overall trust in each target was significantly better explained by considering perceptions of their performance on multiple criteria than on the single criterion of public health. In Study 1, the influence of criteria also varied plausibly across trust targets (e.g., willingness to act under uncertainty increased trust in developers on cost control and councilors on local economic improvement, but decreased it for both targets on environmental protection). Study 2 showed that explained variance in trust increased with both dimension- and trust-based measures of criteria. Further conceptual and methodological development of the notion of multiple trust criteria could benefit our understanding of stated trust judgments.

  15. 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.

  16. 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…

  17. 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.

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

    NASA Astrophysics Data System (ADS)

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

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

  19. 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

  20. 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.

  1. 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.

  2. 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).…

  3. 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.

  4. 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.

  5. 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.

  6. 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

  7. 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

  8. The next generation of novel therapies for the management of relapsed multiple myeloma.

    PubMed

    Gonsalves, Wilson I; Milani, Paolo; Derudas, Daniel; Buadi, Francis K

    2017-01-01

    The advent of various novel therapies such as immunomodulators and proteasome inhibitors has transformed the treatment paradigm for patients with multiple myeloma (MM). As a result, the overall survival has improved dramatically over the last decade. Despite these advances, MM remains mostly incurable and most patients experience disease relapse after enjoying a period of disease control or remission. Fortunately, the scientific community continues to make strides in developing 'next-generation' therapies for the management of patients with relapsed MM. This review will summarize the efficacy of some of the newest therapeutic agents available for the treatment of patients with relapsed MM after their upfront treatment with the original novel agents such as thalidomide, lenalidomide and bortezomib.

  9. The Singapore Myeloma Study Group Consensus Guidelines for the management of patients with multiple myeloma

    PubMed Central

    de Mel, Sanjay; Chen, Yunxin; Gopalakrishnan, Sathish Kumar; Ooi, Melissa; Teo, Constance; Tan, Daryl; Teo, Min Li Claire; Tso, Allison CY; Lee, Lian King; Nagarajan, Chandramouli; Goh, Yeow Tee; Chng, Wee Joo

    2017-01-01

    Multiple myeloma (MM) is an incurable plasma cell neoplasm with an incidence of 100 patients per year in Singapore. Major advances have been made in the diagnosis, risk stratification and treatment of MM in the recent past. The reclassification of a subset of patients with smouldering MM, based on high-risk biomarkers, and the development of the revised international staging system are among the key new developments in diagnosis and staging. The use of novel agent-based treatment has resulted in significant improvements in the survival and quality of life of many patients with MM. Determining the optimal use of proteasome inhibitors, immunomodulators and, more recently, monoclonal antibodies is an area of ongoing investigation. In this guideline, we aim to provide an overview of the management of MM, incorporating the latest developments in diagnosis and treatment. PMID:27609508

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

    PubMed

    Brenton, J Nicholas; Banwell, Brenda L

    2016-01-01

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

  11. Management and Outcomes Among Chinese Hospitalized Patients With Established Cardiovascular Disease or Multiple Risk Factors.

    PubMed

    Yang, Jingang; Yang, Yuejin; Gu, Hongqiu; Li, Wei; Hu, Dayi

    2016-02-01

    We assessed the management and outcomes among hospitalized patients with coronary artery disease (CAD), stroke, peripheral artery disease (PAD), or with multiple (≥ 2) cardiovascular (CV) risk factors (multiple risk factors [MRFs]). We retrospectively studied 3732 hospitalized patients of either CV disease or ≥ 2 risk factors for atherothrombosis from October 2004 to January 2005. Outcomes included CV death, myocardial infarction (MI), stroke, and hospitalization for atherothrombotic events. About one-third had disease involving ≥ 1 vascular bed. Medication was more intense in patients with CAD than in others. The lowest use of statins and antiplatelet treatment was in the PAD-only group. Patients with PAD experienced a higher CV mortality (5.1%) than the patients with CAD (3.73%) or stroke (4.1%), P < .001. Cardiovascular death ranged from 1.2% for patients with MRFs, 2.8% for patients with 1-bed disease, 4.7% for patients with 2-bed disease to 6.4% for patients with 3-bed disease (P for trend <.001). For hospitalized patients with established atherosclerotic arterial disease, a substantial increase in CV event rates occurs with increasing numbers of affected arterial beds. Patients with PAD were at an especially high risk.

  12. Once an Impression Manager, Always an Impression Manager? Antecedents of Honest and Deceptive Impression Management Use and Variability across Multiple Job Interviews

    PubMed Central

    Roulin, Nicolas; Bourdage, Joshua S.

    2017-01-01

    Research has examined the antecedents of applicants' use of impression management (IM) tactics in employment interviews. All existing empirical studies have measured IM in one particular interview. Yet, applicants generally interview multiple times for different positions, and thus have multiple opportunities to engage in IM, before they can secure a job. Similarly, recent theoretical advances in personnel selection and IM research have suggested that applicant behaviors should be considered as dynamic and adaptive in nature. In line with this perspective, the present study is the first to examine the role of individual differences in both applicants' use of IM tactics and the variability in IM use across multiple interviews. It also highlights which honest and deceptive IM tactics remain stable vs. vary in consecutive interviews with different interviewers and organizations. Results suggest that applicants high in Extraversion or core self-evaluations tend to engage in more honest self-promotion but do not adapt their IM approach across interviews. In contrast, applicants who possess more undesirable personality traits (i.e., low on Honesty-Humility and Conscientiousness, but high on Machiavellianism, Narcissism, Psychopathy, or Competitive Worldviews) tend to use more deceptive IM (and especially image creation tactics) and are also more likely to adapt their IM strategy across interviews. Because deceptive IM users can obtain better evaluations from interviewers and the personality profile of those users is often associated with undesirable workplace outcomes, this study provides additional evidence for the claim that deceptive IM (or faking) is a potential threat for organizations. PMID:28174546

  13. Once an Impression Manager, Always an Impression Manager? Antecedents of Honest and Deceptive Impression Management Use and Variability across Multiple Job Interviews.

    PubMed

    Roulin, Nicolas; Bourdage, Joshua S

    2017-01-01

    Research has examined the antecedents of applicants' use of impression management (IM) tactics in employment interviews. All existing empirical studies have measured IM in one particular interview. Yet, applicants generally interview multiple times for different positions, and thus have multiple opportunities to engage in IM, before they can secure a job. Similarly, recent theoretical advances in personnel selection and IM research have suggested that applicant behaviors should be considered as dynamic and adaptive in nature. In line with this perspective, the present study is the first to examine the role of individual differences in both applicants' use of IM tactics and the variability in IM use across multiple interviews. It also highlights which honest and deceptive IM tactics remain stable vs. vary in consecutive interviews with different interviewers and organizations. Results suggest that applicants high in Extraversion or core self-evaluations tend to engage in more honest self-promotion but do not adapt their IM approach across interviews. In contrast, applicants who possess more undesirable personality traits (i.e., low on Honesty-Humility and Conscientiousness, but high on Machiavellianism, Narcissism, Psychopathy, or Competitive Worldviews) tend to use more deceptive IM (and especially image creation tactics) and are also more likely to adapt their IM strategy across interviews. Because deceptive IM users can obtain better evaluations from interviewers and the personality profile of those users is often associated with undesirable workplace outcomes, this study provides additional evidence for the claim that deceptive IM (or faking) is a potential threat for organizations.

  14. Use of Multiple Adjunctive Negative Pressure Wound Therapy Modalities to Manage Diabetic Lower-Extremity Wounds

    PubMed Central

    2016-01-01

    Objective: Various treatment options exist for wound healing; however, clinical assessment of the patient and the wound environment must be considered before determining an optimal wound treatment plan. Negative pressure wound therapy alone and/or with an instilled topical solution can be effective in adjunctive management of acute and chronic wounds. Hyperbaric oxygen therapy has also been shown to contribute to the wound-healing process. A pilot evaluation using a multistep approach of adjunctive negative pressure wound therapy with instillation and a dwell time, standard negative pressure wound therapy, and hyperbaric oxygen therapy was explored to manage postsurgical, diabetic lower-extremity wounds with a significant bioburden. Methods: Three diabetic patients with lower-extremity ulcers were treated after surgical intervention. Multistep wound therapy consisted of (1) negative pressure wound therapy with instillation of normal saline with a 20-minute dwell time, followed by 2 hours of negative pressure at −150 mm Hg for 3 to 4 days; (2) 1 to 3 weeks of continuous negative pressure at −150 mm Hg; and (3) multiple treatments of hyperbaric oxygen therapy. Results: After surgery, wound closure was achieved within 4 weeks postinitiation of multistep wound therapy. All patients regained limb function and recovered with no long-term sequelae. Conclusions: In these 3 cases, a multistep wound therapy approach after surgery resulted in successful outcomes; however, larger prospective studies are needed to demonstrate the potential efficacy of this approach in the postsurgical management of complex, diabetic lower-extremity wounds. PMID:28077984

  15. 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.

  16. 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

  17. Use of Ill-Informed Multiple Attribute Utility Theory for Deciding Which of Two Management Information Systems to Purchase

    DTIC Science & Technology

    1990-05-01

    Processing Equipment (ADPE) Systems. It uses Multi Attribute Utility Theory ( MAUT ) with poorly understood utility functions and probabilities. Linear...most appropriate here was Multiple Attribute Utility Theory ( MAUT ) with incomplete knowledge of probabilities and utility values (hereafter referred to...USAAVSCOM JAD TECHNICAL MEMORANDUM TM-90-F-2 0 N Lq USE OF ILL-INFORMED MULTIPLE 1 ATTRIBUTE UTILITY THEORY FOR DECIDING WHICH OF TWO MANAGEMENT <E

  18. [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.

  19. Clinical management of patients with a history of urticaria/angioedema induced by multiple NSAIDs: an expert panel review.

    PubMed

    Asero, Riccardo; Bavbek, Sevim; Blanca, Miguel; Blanca-Lopez, Natalia; Cortellini, Gabriele; Nizankowska-Mogilnicka, Ewa; Quaratino, Donato; Romano, Antonino; Sanchez-Borges, Mario; Torres-Jaen, Maria Josè

    2013-01-01

    Nonsteroidal anti-inflammatory drugs (NSAIDs) represent one of the most frequent causes of drug-induced urticaria/angioedema worldwide. Recent review articles have classified patients experiencing NSAID-induced urticaria/angioedema into different categories, including single reactors, multiple reactors, and multiple reactors with underlying chronic urticaria. Each of these categories requires a different clinical approach. The present article, written by a panel of experts, reports the main recommendations for the practical clinical management of patients with a history of urticaria/angioedema induced by multiple NSAID based on current knowledge.

  20. 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.

  1. 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

  2. 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

  3. 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

  4. 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.

  5. 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…

  6. Advanced Autonomous Formation Control and Trajectory Management Techniques for Multiple Micro UAV Applications (Controle d’une formation autonome evoluee, et gestion des trajectoires. Techniques d’applications pour micro UAV multiples)

    DTIC Science & Technology

    2008-06-01

    Formation Control and Trajectory Management Techniques for Multiple Micro UAV Applications ( Contrôle d’une formation autonome évoluée, et gestion des...EN-SCI-195 Advanced Autonomous Formation Control and Trajectory Management Techniques for Multiple Micro UAV Applications ( Contrôle d’une formation...autonome évoluée, et gestion des trajectoires. Techniques d’applications pour micro UAV multiples) The material in this publication was

  7. 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.

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

    PubMed

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

    2013-06-01

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

  9. Consensus in the Management of Multiple Myeloma in India at Myeloma State of the Art 2016 Conference.

    PubMed

    Yanamandra, Uday; Khattry, Navin; Kumar, Shaji; Raje, Noopur; Jain, Arihant; Jagannath, Sundar; Menon, Hari; Kumar, Lalit; Varma, Neelam; Varma, Subhash; Saikia, Tapan; Malhotra, Pankaj

    2017-03-01

    The science of multiple myeloma (MM) and related plasma cell disorders is rapidly evolving with increased understanding of the disease biology and recent approval of the newer drugs widening the therapeutic armamentarium. Despite multiple international guidelines regarding the management of this disease, the practice of managing MM is not uniform amongst Indian physicians. There are challenges in management which are unique to the Indian patients. This review discusses these challenges and the consensus of the nation-wide experts in dealing with the same. We also briefly highlighted the perspective of international experts as discussed in the Myeloma State of the Art conference held in September 2016 at PGI, Chandigarh. An Indian Myeloma Academic Groupe (IMAGe) group was formed to strengthen the research, create awareness about myeloma and related disorders and form consensus guidelines/ recommendations that can be adapted to the Indian Scenario.

  10. Utility of bispectral index in the management of multiple trauma patients

    PubMed Central

    Mahmood, Saeed; Parchani, Ashok; El-Menyar, Ayman; Zarour, Ahmad; Al-Thani, Hassan; Latifi, Rifat

    2014-01-01

    Background: Bispectral index (BIS) monitoring in multiple trauma patients has become a common practice in monitoring the sedation levels. We aimed to assess the utility of BIS in the trauma intensive care unit (ICU). Methods: A prospective observational study was conducted in the trauma ICU at Hamad General Hospital in Qatar between 2011 and 2012. Patients were divided in two groups: Group I (without BIS monitoring) and Group II (with BIS monitoring). The depth of sedation was clinically evaluated with Ramsey Sedation Scale, changes in vital signs and Glasgow Coma Scale (GCS) level. Use of sedatives, analgesics, and muscle relaxants were also recorded. Data were compared using Chi-square and Student t-tests. Results: A total of 110 mechanically ventilated trauma patients were enrolled with a mean age of 36 ± 14 years. The rate of head injury was greater in Group I when compared with Group II (94% vs. 81%, P = 0.04). In comparison to Group I, patients in Group II had lower GCS and higher mean Injury Severity Score (ISS) (6.3 ± 2.5 vs. 7.4 ± 2.7 and 25.5 ± 8.5 vs. 21.2 ± 4.7, respectively, P = 0.03). The used midazolam dose was less in Group II in comparison to Group I (5.2 ± 2.3 vs. 6.1 ± 2.1, P = 0.03). Also, fentanyl dose was less in Group II (152 ± 58 vs. 187 ± 59, P = 0.004). The rate of agitation, failure of extubation and tracheostomy in Group II were lower than those in Group I, P = 0.001. The length of stay for patients Group I was longer (14.6 ± 7.1 vs. 10.2 ± 5.9 days) in comparison to group II, P = 0.001. Conclusion: Management of multiple trauma patients in the trauma ICU with BIS monitoring was found to be associated with better outcomes. BIS monitoring is a guide for adjusting the dosage of sedative agents. It can also minimize agitation, failure of extubation, and length of stay in ICU. PMID:25317356

  11. 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

  12. Identifying and addressing vaccine hesitancy.

    PubMed

    Kestenbaum, Lori A; Feemster, Kristen A

    2015-04-01

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

  13. 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

  14. 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.

  15. Management of Multiple Nitrogen Sources during Wine Fermentation by Saccharomyces cerevisiae.

    PubMed

    Crépin, Lucie; Truong, Nhat My; Bloem, Audrey; Sanchez, Isabelle; Dequin, Sylvie; Camarasa, Carole

    2017-03-01

    During fermentative growth in natural and industrial environments, Saccharomyces cerevisiae must redistribute the available nitrogen from multiple exogenous sources to amino acids in order to suitably fulfill anabolic requirements. To exhaustively explore the management of this complex resource, we developed an advanced strategy based on the reconciliation of data from a set of stable isotope tracer experiments with labeled nitrogen sources. Thus, quantifying the partitioning of the N compounds through the metabolism network during fermentation, we demonstrated that, contrary to the generally accepted view, only a limited fraction of most of the consumed amino acids is directly incorporated into proteins. Moreover, substantial catabolism of these molecules allows for efficient redistribution of nitrogen, supporting the operative de novo synthesis of proteinogenic amino acids. In contrast, catabolism of consumed amino acids plays a minor role in the formation of volatile compounds. Another important feature is that the α-keto acid precursors required for the de novo syntheses originate mainly from the catabolism of sugars, with a limited contribution from the anabolism of consumed amino acids. This work provides a comprehensive view of the intracellular fate of consumed nitrogen sources and the metabolic origin of proteinogenic amino acids, highlighting a strategy of distribution of metabolic fluxes implemented by yeast as a means of adapting to environments with changing and scarce nitrogen resources.IMPORTANCE A current challenge for the wine industry, in view of the extensive competition in the worldwide market, is to meet consumer expectations regarding the sensory profile of the product while ensuring an efficient fermentation process. Understanding the intracellular fate of the nitrogen sources available in grape juice is essential to the achievement of these objectives, since nitrogen utilization affects both the fermentative activity of yeasts and the

  16. 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

  17. 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.

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

    PubMed

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

    2016-05-01

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

  19. Multidisciplinary Management of Sexual Dysfunction, Perineal Pain, and Elimination Dysfunction in a Woman with Multiple Sclerosis

    PubMed Central

    Bogliatto, Fabrizio; Bacchio, Leonardo

    2017-01-01

    Background: Multiple sclerosis (MS) is a chronic disease that commonly affects young women and is associated with sexual dysfunction (SD) and lower anourogenital dysfunction, which affect quality of life. We evaluated the importance of an integrated multidisciplinary approach in the Lower Female Ano-Uro-Genital Network (LFAUGN) to manage a variety of complex symptoms. Methods: A 40-year-old woman with MS and primary concerns about perineal pain and SD was treated by a trained midwife from the LFAUGN and a physical therapist after a multidisciplinary diagnostic process that included gynecologic evaluation for perineal pain and SD, physiatric assessment, urologic assessment for bladder retention (BR), and surgical examination for obstructed defecation syndrome (ODS). Physical therapy was integrated with pharmacologic therapy for ODS and with self-catheterization for BR. Results: After 5 months of treatment, the patient reported improvement in functional perineal parameters and perineal pain (visual analogue scale score: 9 at T1 vs. 5 at T2), with resolution of pelvic floor hypertonia. Furthermore, ODS and BR symptoms improved (5-item score: 18 of 20 at T1 vs. 10 of 20 at T2; 1 self-catheterization daily, with postvoid residual volume [PRV] <200 mL at T1 vs. 1 self-catheterization weekly, with PRV <100 mL at T2) and sexual satisfaction increased (Female Sexual Function Index score: 18 of 36 at T1 vs. 23 of 36 at T2). Conclusions: These results suggest that physical therapy, as an integral component of a multidisciplinary approach in a multiprofessional network, may play a pivotal role in improving anourogenital dysfunction and sexual satisfaction. PMID:28243183

  20. Management of Multiple Myeloma and Usage of Bortezomib: Perspective from India and Ukraine

    PubMed Central

    Choudhary, Dharma; Garg, Amit; Morgunskyy, Mykhaylo; Belagali, Yogesh; Gupta, Namita; Akku, Shyam Prasad

    2016-01-01

    Novel treatment strategies have remarkably improved the multiple myeloma (MM) patients’ survival, with associated increased costs. A joint panel meet of international experts from India and Ukraine was held in New Delhi on May 19, 2016 focusing on MM management, bortezomib role, unmet medical needs, and current challenges. The health-care system for oncology in India is majorly private vs. government-based in Ukraine. In India, electrophoresis, serum-free light chain assays, bone marrow tests, and X-rays are available modes of diagnosis. Despite of the numerous cancer centers and stem cell transplant centers, most patients do not prefer transplant owing to its high-cost and social stigma. Majority of the patients are treated with bortezomib or lenalidomide-based regimens. Most patients buy drug themselves. The expanding generic drugs market is a ray of hope for the affordable drugs. In Ukraine, immuno-fixation, bone marrow analysis, and magnetic resonance imaging are common diagnostic modalities. Due to high cost, only few patients undergo transplant. Bortezomib-based regimens are preferred in most of the patients; however, usage is limited due to high costs and lack of funds. Thalidomide-based regimens are used for maintenance therapy due to affordability. In case of relapsed MM, bortezomib is preferred in triple therapy; however, more affordable option is cyclophosphamide, thalidomide, and dexamethasone (CTD). Issues, such as cost containment, common treatment strategies, enhanced collaboration, and improved health-care access, need immediate attention. High-quality generics access will improve outcomes and support health-care cost containment. Pharmacoeconomic studies and head-to-head trials are warranted to determine the cost-effectiveness and benefit of novel therapies in MM. PMID:27917369

  1. 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

  2. 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.

  3. 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…

  4. Development of a multiple-drug delivery implant for intraocular management of proliferative vitreoretinopathy.

    PubMed

    Zhou, T; Lewis, H; Foster, R E; Schwendeman, S P

    1998-11-13

    A prototype multiple-drug delivery implant has been developed for the intraocular management of proliferative vitreoretinopathy (PVR). Because of the recurrent nature of the disease, PVR causes blindness in approximately 7% of patients who have undergone retinal re-attachment surgery. The poly(dl-lactide-co-glycolide) 50/50 (PLGA) implant consists of three cylindrical segments, each of which contains one of the following drugs: 5-fluorouridine (5FUrd, an antimetabolite), triamcinolone (Triam, a corticosteroid), and human recombinant tissue plasminogen activator (t-PA, a thrombolytic agent). The device can be inserted through a 20-gauge syringe needle into the vitreous body of the eye. The implant also possesses a PLGA coating over the t-PA-containing terminal segment, which creates a lag-time to deliver t-PA when most needed and to decrease the risk of postoperative bleeding. Two methods of cylinder fabrication were investigated: heat and solvent extrusion. The release behavior of several drugs was examined as a function of the processing variables including: extrusion method, drug loading, polymer molecular weight, and drug particle size. The presence of either the organic solvent (acetone) during processing or a highly water-soluble drug (5FUrd) in the formulation increased the polymer porosity, which in turn, increased the drug release-rate. Drug loading effects were consistent with percolation concepts, and a low-molecular-weight PLGA (e.g., Mw=42000 for inherent viscosity=0.58 dl/g) was desirable to produce controlled release close to one month. Based on pharmacological and pharmacokinetic data of these compounds and our clinical experience with this disease, several design criteria for a combined implant were devised. Optimal cylindrical segments from the formulation studies were selected and combined in series to form a contiguous implant. After successful combination and coating procedures were developed, prototype implants were prepared. From the 3-drug

  5. 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.

  6. Governance and management dynamics of landscape restoration at multiple scales: Learning from successful environmental managers in Sweden.

    PubMed

    Dawson, Lucas; Elbakidze, Marine; Angelstam, Per; Gordon, Johanna

    2017-03-14

    Due to a long history of intensive land and water use, habitat networks for biodiversity conservation are generally degraded in Sweden. Landscape restoration (LR) is an important strategy for achieving representative and functional green infrastructures. However, outcomes of LR efforts are poorly studied, particularly the dynamics of LR governance and management. We apply systems thinking methods to a series of LR case studies to analyse the causal structures underlying LR governance and management in Sweden. We show that these structures appear to comprise of an interlinked system of at least three sets of drivers and four core processes. This system exhibits many characteristics of a transformative change towards an integrated, adaptive approach to governance and management. Key challenges for Swedish LR projects relate to institutional and regulatory flexibility, the timely availability of sufficient funds, and the management of learning and knowledge production processes. In response, successful project leaders develop several key strategies to manage complexity and risk, and enhance perceptions of the attractiveness of LR projects.

  7. Addressing Asthma Health Disparities: A Multilevel Challenge

    PubMed Central

    Canino, Glorisa; McQuaid, Elizabeth L.; Rand, Cynthia S.

    2009-01-01

    Substantial research has documented pervasive disparities in the prevalence, severity, and morbidity of asthma among minority populations compared to non-Latino whites. The underlying causes of these disparities are not well understood, and as a result, the leverage points to address them remain unclear. A multilevel framework for integrating research in asthma health disparities is proposed in order to advance both future research and clinical practice. The components of the proposed model include health care policies and regulations, operation of the health care system, provider/clinician-level factors, social/environmental factors, and individual/family attitudes and behaviors. The body of research suggests that asthma disparities have multiple, complex and inter-related sources. Disparities occur when individual, environmental, health system, and provider factors interact with one another over time. Given that the causes of asthma disparities are complex and multilevel, clinical strategies to address these disparities must therefore be comparably multilevel and target many aspects of asthma care. Clinical Implications: Several strategies that could be applied in clinical settings to reduce asthma disparities are described including the need for routine assessment of the patient’s beliefs, financial barriers to disease management, and health literacy, and the provision of cultural competence training and communication skills to health care provider groups. PMID:19447484

  8. 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.

  9. 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...

  10. 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...

  11. 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.

  12. Oncology disease management.

    PubMed

    Fetterolf, Donald E; Terry, Rachel

    2007-02-01

    Oncologic conditions are ubiquitous medical illnesses that present a particular challenge for medical management programs designed to address quality and cost issues in patient populations. Disease management strategies represent a reasonable and effective approach for employers and health plans in their arsenal of health management strategies. Multiple reasons exist for the development of specialized disease management programs that deal with cancer patients, some unique to this group of individuals. Health plans and/or employers have solid justification for addressing these issues directly through programs developed specifically to work with cancer patients. Whether developed within a health plan, or "carved out" to an external vendor, proper evaluation of outcomes is essential.

  13. 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.

  14. Self-management of health care: multimethod study of using integrated health care and supportive housing to address systematic barriers for people experiencing homelessness.

    PubMed

    Parsell, Cameron; Ten Have, Charlotte; Denton, Michelle; Walter, Zoe

    2017-04-07

    Objectives The aims of the present study were to examine tenants' experiences of a model of integrated health care and supportive housing and to identify whether integrated health care and supportive housing improved self-reported health and healthcare access.Methods The present study used a mixed-method survey design (n=75) and qualitative interviews (n=20) performed between September 2015 and August 2016. Participants were tenants of permanent supportive housing in Brisbane (Qld, Australia). Qualitative data were analysed thematically.Results Integrated health care and supportive housing were resources for tenants to overcome systematic barriers to accessing mainstream health care experienced when homeless. When homeless, people did not have access to resources required to maintain their health. Homelessness meant not having a voice to influence the health care people received; healthcare practitioners treated symptoms of poverty rather than considering how homelessness makes people sick. Integrated healthcare and supportive housing enabled tenants to receive treatment for health problems that were compounded by the barriers to accessing mainstream healthcare that homelessness represented.Conclusions Extending the evidence about housing as a social determinant of health, the present study shows that integrated health care and supportive housing enabled tenants to take control to self-manage their health care. In addition to homelessness directly contributing to ill health, the present study provides evidence of how the experience of homelessness contributes to exclusions from mainstream healthcare.What is known about the topic? People who are homeless experience poor physical and mental health, have unmet health care needs and use disproportionate rates of emergency health services.What does the paper add? The experience of homelessness creates barriers to accessing adequate health care. The provision of onsite multidisciplinary integrated health care in

  15. Addressing Ozone Layer Depletion

    EPA Pesticide Factsheets

    Access information on EPA's efforts to address ozone layer depletion through regulations, collaborations with stakeholders, international treaties, partnerships with the private sector, and enforcement actions under Title VI of the Clean Air Act.

  16. Self-management in neurological disorders: systematic review of the literature and potential interventions in multiple sclerosis care.

    PubMed

    Rae-Grant, Alex D; Turner, Aaron P; Sloan, Alicia; Miller, Deborah; Hunziker, James; Haselkorn, Jodie K

    2011-01-01

    Our objective was to review the current body of evidence supporting the efficacy of self-management programs in individuals with multiple sclerosis (MS) and other chronic neurological conditions. We reviewed published literature using standardized search terms; examined self-management interventions in a variety of chronic neurological disorders, including MS; and classified studies using the evidence classification established by the American Academy of Neurology. We reviewed 527 abstracts, of which 39 met our inclusion criteria for evaluation. Of the 39 studies, 3 provided class I evidence assessing the efficacy of self-management interventions: a randomized controlled trial of a telephone counseling program for health promotion in MS, a home-based exercise program for reducing falls in people with Parkinson disease, and the comparison of a fitness center program versus a home-based exercise program for people with traumatic brain injury. The remaining studies provided additional support for self-management interventions with a lesser degree of methodologic rigor (class II, class III, or class IV evidence). We concluded that self-management strategies are applicable to chronic neurological diseases, but a need exists for more rigorous studies in this area. We provide recommendations for future intervention study methodologies with a specific emphasis on MS care.

  17. 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.

  18. 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.

  19. 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

  20. 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.

  1. 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…

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

    PubMed

    Ji, Bing; Genever, Paul G; Fagan, Michael J

    2016-03-01

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

  3. Coastal Evolution Modeling at Multiple Scales in Regional Sediment Management Applications

    DTIC Science & Technology

    2011-05-01

    projects typically have lives exceeding their initial 50 years, there is a need for models capable of reliably, robustly, and rapidly calculating coastal...numerous inlets, and multiple coastal engineering activities including inlet dredging, beach fills, ebb-tidal delta mining, jetties, seawalls , and

  4. Management of digital vasculopathy in systemic sclerosis: benefits of multiple courses of endothelin-1 receptor antagonists

    PubMed Central

    Ngcozana, Tanaka; Ong, Voon; Denton, Christopher Paul

    2014-01-01

    Two patients with scleroderma and recurrent digital ulcers (DUs) were treated with bosentan for 6 months. Treatment was associated with a reduction in the number of new DUs; however, DUs recurred on treatment discontinuation. This case report illustrates the positive response of digital vasculopathy to bosentan and describes the benefits of multiple bosentan treatment courses in these patients. PMID:24682137

  5. Extended-release dalfampridine in the management of multiple-sclerosis-related walking impairment.

    PubMed

    Hersh, Carrie; Rae-Grant, Alex

    2012-07-01

    Multiple sclerosis is an inflammatory demyelinating disease of the central nervous system that causes neurological impairment in young adults. As part of the disease, ambulation remains one of the most disabling features of multiple sclerosis. Extended-release dalfampridine is a long-acting form of 4-aminopyridine that has been shown in two phase III trials to increase ambulation speed in a subset of patients with multiple sclerosis (timed walk responders). The primary endpoint of these studies was 'responder status', analyzing difference in the proportion of timed walk responders between extended-release dalfampridine and placebo groups. Extended-release dalfampridine exerts its effects by inhibiting voltage-activated K(+) channels and has been previously demonstrated to improve action potential propagation in demyelinated nerve fibers in vitro. Side effects of extended-release dalfampridine include increased urinary tract infections, insomnia, headache, asthenia, dizziness, back pain, and paresthesias. Rare seizure events are also reported on the approved dose of 10 mg every 12 h. In this review we will summarize the results of key phase II and phase III trials of extended-release dalfampridine, its safety, and potential use in patients with multiple sclerosis.

  6. 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.

  7. 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.

  8. 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

  9. 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.

  10. Multiple stressors threatening the future of the Baltic Sea-Kattegat marine ecosystem: implications for policy and management actions.

    PubMed

    Jutterström, S; Andersson, H C; Omstedt, A; Malmaeus, J M

    2014-09-15

    The paper discusses the combined effects of ocean acidification, eutrophication and climate change on the Baltic Sea and the implications for current management strategies. The scientific basis is built on results gathered in the BONUS+ projects Baltic-C and ECOSUPPORT. Model results indicate that the Baltic Sea is likely to be warmer, more hypoxic and more acidic in the future. At present management strategies are not taking into account temporal trends and potential ecosystem change due to warming and/or acidification, and therefore fulfilling the obligations specified within the Marine Strategy Framework Directive, OSPAR and HELCOM conventions and national environmental objectives may become significantly more difficult. The paper aims to provide a basis for a discussion on the effectiveness of current policy instruments and possible strategies for setting practical environmental objectives in a changing climate and with multiple stressors.

  11. 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.

  12. 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.

  13. “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

  14. Rimonabant: a cannabinoid receptor type 1 blocker for management of multiple cardiometabolic risk factors.

    PubMed

    Gelfand, Eli V; Cannon, Christopher P

    2006-05-16

    Rimonabant is a first selective blocker of the cannabinoid receptor type 1 (CB1) being developed for the treatment of multiple cardiometabolic risk factors, including abdominal obesity and smoking. In four large trials, after one year of treatment, rimonabant 20 mg led to greater weight loss and reduction in waist circumference compared with placebo. Therapy with rimonabant is also associated with favorable changes in serum lipid levels and an improvement in glycemic control in prediabetes patients and in type 2 diabetic patients. At the same dose, rimonabant significantly increased cigarette smoking quit rates as compared with placebo. Rimonabant seems to be well tolerated, with a primary side effect of mild nausea. As an agent with a novel mechanism of action, rimonabant has a potential to be a useful adjunct to lifestyle and behavior modification in treatment of multiple cardiometabolic risk factors, including abdominal obesity and smoking.

  15. Management of multiple sequelaes in permanent dentition: 3 years follow-up.

    PubMed

    Ozdemir, Yasemin; Yasemin, Ozdemir; Akin, Asli; Asli, Akin; Eden, Ece; Ece, Eden

    2011-02-01

    A 12-year-old patient with multiple sequelaes of permanent dentition due to trauma in primary dentition at the age of 8 months, is presented. Clinical and radiographical examinations revealed aesthetical defects, crown-root malformations (#21), hypoplasia (#12, #22), tooth transposition (#13) and odontoma-like malformation (#11). The performed conservative, endo-surgical and prosthetic treatment to gain back the aesthetic and function is reported.

  16. 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.

  17. Hereditary Melanoma: Update on Syndromes and Management - Genetics of familial atypical multiple mole melanoma syndrome

    PubMed Central

    Soura, E.; Eliades, P.; Shannon, K.; Stratigos, A.; Tsao, H.

    2015-01-01

    Malignant melanoma is considered the most lethal skin cancer if not detected and treated at its early stages. About 10% of melanoma patients report a family history of melanoma; however, individuals with features of true hereditary melanoma (i.e. unilateral lineage, multi-generational, 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. Such patients have a high risk of developing multiple primary melanomas and internal organ malignancies especially pancreatic cancer; thus, a multidisciplinary approach is necessary in many cases. The value of dermoscopy 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. But, this must be performed with care and only by qualified individuals trained in cancer risk analysis. PMID:26892650

  18. The diagnosis and management of lower urinary tract symptoms in multiple sclerosis patients.

    PubMed

    Sand, Peter K; Sand, Robert I

    2013-07-01

    Sixty-five percent of multiple sclerosis patients have moderate to severe urinary symptoms and up to 14% initially present with urinary symptomatology. Urinary retention, neurogenic detrusor overactivity, and detrusor sphincter dyssynergia, all increase the risk for urinary tract infections in patients with multiple sclerosis, and these infections may exacerbate their immune response, leading to symptom progression. Fewer than half of the patients with urinary symptoms have seen a specialist and only half have been treated for their neurogenic detrusor overactivity. Several treatments including pelvic floor muscle therapy, pelvic floor electrical stimulation, anticholinergics, desmopressin, sacral nerve neuromodulation, posterior tibial nerve stimulation, cannabinoids, and intravesical therapy with vanniloids, as well as botulinum toxin, have all been shown to be effective in treating urinary symptoms in those with multiple sclerosis. Clean intermittent catheterization is invaluable in patients with persistent urinary retention to avoid infection and upper tract dysfunction. Indwelling transurethral catheterization should be avoided because of the high risk of infection. Identification and successful treatment of these urinary conditions will improve the health and quality of life for these men and women.

  19. Juggling Multiple Accountability Systems: How Three Principals Manage These Tensions in Ontario, Canada

    ERIC Educational Resources Information Center

    Pollock, Katina; Winton, Sue

    2016-01-01

    Accountability in education is not new. Schools have always been accountable in one way or another to the communities they serve, regardless of the policy environment of the time (Elmore, "The Educational Forum," 69:134-142, 2005). This article explores how three principals from Ontario, Canada manage the tensions of multiple…

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

    ERIC Educational Resources Information Center

    Lievens, Ronald

    2015-01-01

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

  1. 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).

  2. 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.…

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

    Technology Transfer Automated Retrieval System (TEKTRAN)

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

  4. A scenario-based modeling approach for emergency evacuation management and risk analysis under multiple uncertainties.

    PubMed

    Lv, Y; Huang, G H; Guo, L; Li, Y P; Dai, C; Wang, X W; Sun, W

    2013-02-15

    Nuclear emergency evacuation is important to prevent radioactive harms by hazardous materials and to limit the accidents' consequences; however, uncertainties are involved in the components and processes of such a management system. In the study, an interval-parameter joint-probabilistic integer programming (IJIP) method is developed for emergency evacuation management under uncertainties. Optimization techniques of interval-parameter programming (IPP) and joint-probabilistic constrained (JPC) programming are incorporated into an integer linear programming framework, so that the approach can deal with uncertainties expressed as joint probability and interval values. The IJIP method can schedule the optimal routes to guarantee the maximum population evacuated away from the effected zone during a finite time. Furthermore, it can also facilitate post optimization analysis to enhance robustness in controlling system violation risk imposed on the joint-probabilistic constraints. The developed method has been applied to a case study of nuclear emergency management; meanwhile, a number of scenarios under different system conditions have been analyzed. It is indicated that the solutions are useful for evacuation management practices. The result of the IJIP method can not only help to raise the capability of disaster responses in a systematic manner, but also provide an insight into complex relationships among evacuation planning, resources utilizations, policy requirements and system risks.

  5. 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…

  6. 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.

  7. 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

  8. Atomic clusters with addressable complexity

    NASA Astrophysics Data System (ADS)

    Wales, David J.

    2017-02-01

    A general formulation for constructing addressable atomic clusters is introduced, based on one or more reference structures. By modifying the well depths in a given interatomic potential in favour of nearest-neighbour interactions that are defined in the reference(s), the potential energy landscape can be biased to make a particular permutational isomer the global minimum. The magnitude of the bias changes the resulting potential energy landscape systematically, providing a framework to produce clusters that should self-organise efficiently into the target structure. These features are illustrated for small systems, where all the relevant local minima and transition states can be identified, and for the low-energy regions of the landscape for larger clusters. For a 55-particle cluster, it is possible to design a target structure from a transition state of the original potential and to retain this structure in a doubly addressable landscape. Disconnectivity graphs based on local minima that have no direct connections to a lower minimum provide a helpful way to visualise the larger databases. These minima correspond to the termini of monotonic sequences, which always proceed downhill in terms of potential energy, and we identify them as a class of biminimum. Multiple copies of the target cluster are treated by adding a repulsive term between particles with the same address to maintain distinguishable targets upon aggregation. By tuning the magnitude of this term, it is possible to create assemblies of the target cluster corresponding to a variety of structures, including rings and chains.

  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. Invitational Addresses, 1965.

    ERIC Educational Resources Information Center

    Gates, Arthur I.; And Others

    The full texts of invitational addresses given at the 1965 International Reading Association (IRA) Convention in Detroit, Michigan, by six recipients of IRA citation awards are presented. Gates suggests steps IRA should take to revive and redirect reading research. McCallister discusses the implications of the changing and expanding vocabulary of…

  11. States Address Achievement Gaps.

    ERIC Educational Resources Information Center

    Christie, Kathy

    2002-01-01

    Summarizes 2 state initiatives to address the achievement gap: North Carolina's report by the Advisory Commission on Raising Achievement and Closing Gaps, containing an 11-point strategy, and Kentucky's legislation putting in place 10 specific processes. The North Carolina report is available at www.dpi.state.nc.us.closingthegap; Kentucky's…

  12. 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…

  13. 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

  14. 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.

  15. Examining occupational stress, sources of stress and stress management strategies through the eyes of management consultants: a multiple correspondence analysis for latent constructs.

    PubMed

    von Humboldt, Sofia; Leal, Isabel; Laneiro, Tito; Tavares, Patrícia

    2013-12-01

    To date, little research has yet focused in broad assessment for management consultancy professionals. This investigation aims to analyse management consultants' self-perceptions of occupational stress (SPoOS), sources of stress (SoS) and stress management strategies (SMS) and to find latent constructs that can work as major determinants in consultants' conceptualization of SPoOS, SoS and SMS. Measures were completed, including demographics and interviews. Complete data were available for 39 management consultants, 53.8% male and aged between 23 and 56 years (M = 38.0; SD = 9.2). The data were subjected to content analysis. Representation of the associations and latent constructs were analysed by a multiple correspondence analysis. Results indicated that 'intellectual disturber' (31.4%) was the most referred SPoOS, 'high workload' (15.1%) was identified as the most prevalent perceived SoS and 'coaching' (19.0%) was the most mentioned SMS. No significant differences between the two gender groups were found regarding the three total scores. SPoOS was explained by a two-factor model: 'organization-oriented' and 'person-oriented'. A three-dimension model formed by 'job concerns', 'organizational constraints' and 'career expectations' was indicated as a best-fit solution for SoS, and SMS was best explained in a three-dimension model by 'group dynamics strategies', 'organizational culture strategies' and 'individual support strategies'. This research makes a unique contribution for a better understanding of what defines SPoOS, SoS and SMS for management consultants.

  16. Multiple myeloma: progress in management aimed at improving QoL.

    PubMed

    Abe, Masahiro

    Despite the major recent strides achieved in myeloma treatment owing to the implementation of new anti-myeloma agents, bone destruction is still a leading cause of deterioration in quality of life (QoL) for affected patients. With improvement of survival, bone management will become more important for maintaining QoL especially in elderly patients; novel treatment modalities with bone anabolic activity are highly anticipated, as a means of restoring bone in bone destructive lesions as well as from the aspect of preventing bone destruction with currently available anti-resorptive agents. Long-term management of myeloma bone disease in the era of these new agents and a perspective on the development of new bone modifying agents will be discussed.

  17. 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

  18. Management of open fractures of the tibial shaft in multiple trauma

    PubMed Central

    Stanisław, Bołtuć Witold; Bogusław, Golec Edward

    2008-01-01

    Background: The work presents the assessment of the results of treatment of open tibial shaft fractures in polytrauma patients. Materials and Methods: The study group comprised 28 patients who underwent surgical treatment of open fractures of the tibial shaft with locked intramedullary nailing. The mean age of the patients was 43 years (range from 19 to 64 years). The criterion for including the patients in the study was concomitant multiple trauma. For the assessment of open tibial fractures, Gustilo classification was used. The most common concomitant multiple trauma included craniocerebral injuries, which were diagnosed in 12 patients. In 14 patients, the surgery was performed within 24 h after the injury. In 14 patients, the surgery was delayed and was performed 8–10 days after the trauma. Results: The assessment of the results at 12 months after the surgery included the following features: time span between the trauma and the surgery and complications in the form of osteomyelitis and delayed union. The efficacy of gait, muscular atrophy, edema of the operated limb and possible disturbances of its axis were also taken under consideration. In patients operated emergently within 24 h after the injury, infected nonunion was observed in three (10.8%) males. These patients had grade III open fractures of the tibial shaft according to Gustilo classification. No infectious complications were observed in patients who underwent a delayed operation. Conclusion: Evaluation of patients with open fractures of the tibial shaft in multiple trauma showed that delayed intramedullary nailing performed 8–10 days after the trauma, resulted in good outcome and avoided development of delayed union and infected nonunion. This approach gives time for stabilization of general condition of the patient and identification of pathogens from wound culture. PMID:19753226

  19. 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

  20. One stone, two birds: managing multiple common warts on hands and face by local hyperthermia.

    PubMed

    Hu, Lanting; Qi, Ruiqun; Hong, Yuxiao; Huo, Wei; Chen, Hong-Duo; Gao, Xing-Hua

    2015-01-01

    A man developed with multiple warts on his hands and the inner canthus of his left eye. We applied local hyperthermia on a single target lesion on his hand at a surface temperature of 44 °C for 30 minutes on Days 1, 2, 3, 17, and 18. All the lesions treated with or without heat cleared 8 weeks after the last treatment. Treatment of a target lesion resolved all other untreated lesions, a fact suggestive that local hyperthermia could induce activation of specific immunity against human papillomavirus on the lesional skin, which lead to resolution of all the warts.

  1. 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.

  2. Addressing hidden financial risk.

    PubMed

    Kruger, Jan; Kruger, Jan

    2014-02-01

    Managing low-dollar, high-volume claim denials associated with outpatient procedures is a challenge for many hospitals because of the expense involved in manually reviewing such denials. These denials often are the source of "hidden loss" for hospitals. For some hospitals, the most practical, cost-effective approach for managing low-dollar, high-volume claim denials will include the use of automated systems to monitor and highlight denials and expose trends.

  3. Management of Monoclonal Gammopathy of Undetermined Significance (MGUS) and Smoldering Multiple Myeloma (SMM)

    PubMed Central

    KYLE, ROBERT A.; BUADI, FRANC IS; RAJKUMAR, S. VINC ENT

    2014-01-01

    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

  4. 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.

  5. Multiple myeloma.

    PubMed

    Peller, Patrick J

    2015-04-01

    This article presents a review of multiple myeloma, precursor states, and related plasma cell disorders. The clinical roles of fluorodeoxyglucose PET/computed tomography (CT) and the potential to improve the management of patients with multiple myeloma are discussed. The clinical and research data supporting the utility of PET/CT use in evaluating myeloma and other plasma cell dyscrasias continues to grow.

  6. 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.

  7. Diagnosis and Management of Multiple Endocrine Neoplasia Type 1 (MEN1)

    PubMed Central

    2005-01-01

    Multiple endocrine neoplasia type 1 (MEN1) is an autosomal dominantly inherited disorder, characterised by the occurrence of tumours of the parathyroid glands, the pancreatic islets, the pituitary gland, the adrenal glands and neuroendocrine carcinoid tumours. Carcinoid tumours of the thymus and pancreatic-duodenal gastrinomas are the most harmful tumour types, since these tumours have malignant potential and curative treatment is difficult to achieve. MEN1 is caused by germline mutations of the MEN1 tumour suppressor gene. Mutation analysis enables mutation carriers to be identified. MEN1 patients and their family members, family members of mutation carriers and patients who are clinically suspected to be carriers of a MEN1 gene mutation are eligible for mutation analysis. MEN1-associated tumours can be detected and treated at an early stage through periodical clinical monitoring of mutation carriers. PMID:20223025

  8. The emerging role of carfilzomib combination therapy in the management of multiple myeloma.

    PubMed

    Moreau, Philippe

    2014-04-01

    Carfilzomib is a proteasome inhibitor that selectively and irreversibly binds to its target, resulting in sustained inhibition absent of off-target effects relative to bortezomib. Single-agent carfilzomib has produced robust and durable responses in clinical trials and it has been approved in the US for treating relapsed and refractory multiple myeloma (MM). Due to its favorable safety profile, carfilzomib is particularly suitable for use in combination strategies. Promising data have been reported from studies that investigated the use of carfilzomib in combination with immunomodulators, alkylating agents, glucocorticoids, histone deacetylase inhibitors and kinesin spindle protein inhibitors. Ongoing pivotal randomized Phase III studies are investigating the efficacy and safety of carfilzomib combinations in patients with relapsed MM and transplant ineligible patients.

  9. Pediatric multiple sclerosis: Conventional first-line treatment and general management.

    PubMed

    Ghezzi, Angelo; Amato, Maria Pia; Makhani, Naila; Shreiner, Teri; Gärtner, Jutta; Tenembaum, Silvia

    2016-08-30

    Many disease-modifying therapies are currently available for adults with relapsing-remitting multiple sclerosis (MS) but none of them has been tested in pediatric MS in randomized placebo-controlled trials. At present, as suggested by observational studies and experts' guidelines, interferon-β and glatiramer acetate continue to be the standard first-line treatments for pediatric MS. Observational studies and some controlled unblinded trials have shown a positive effect of these meditations in reducing relapse rate and delaying disease progression, with an acceptable safety profile. The goal of this article is to provide an overview of current knowledge with regard to safety, tolerability, and efficacy of first-line treatment options for MS in the pediatric age group, with the aim of providing guidance for planning first-line treatment of MS in children and adolescents.

  10. 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

  11. Content-addressable holographic databases

    NASA Astrophysics Data System (ADS)

    Grawert, Felix; Kobras, Sebastian; Burr, Geoffrey W.; Coufal, Hans J.; Hanssen, Holger; Riedel, Marc; Jefferson, C. Michael; Jurich, Mark C.

    2000-11-01

    Holographic data storage allows the simultaneous search of an entire database by performing multiple optical correlations between stored data pages and a search argument. We have recently developed fuzzy encoding techniques for this fast parallel search and demonstrated a holographic data storage system that searches digital data records with high fidelity. This content-addressable retrieval is based on the ability to take the two-dimensional inner product between the search page and each stored data page. We show that this ability is lost when the correlator is defocussed to avoid material oversaturation, but can be regained by the combination of a random phase mask and beam confinement through total internal reflection. Finally, we propose an architecture in which spatially multiplexed holograms are distributed along the path of the search beam, allowing parallel search of large databases.

  12. A core-multiple shell nanostructure enabling concurrent upconversion and quantum cutting for photon management.

    PubMed

    Shao, Wei; Chen, Guanying; Ohulchanskyy, Tymish Y; Yang, Chunhui; Ågren, Hans; Prasad, Paras N

    2017-02-02

    Photon management enables the manipulation of the number of input photons by conversion of two or more light quanta into one (upconversion) or vice versa (quantum cutting). Simultaneous realization of both these processes in a single unit provides unique opportunities of efficient utilization of photons throughout a broad spectral range. Yet, concurrent realization of these two parallel optical processes in one single unit remains elusive, limiting its impact on many existing or possible future applications such as for panchromatic photovoltaics. Here, we describe an epitaxial active core/inert shell/active shell/inert shell fluoride nanostructure to implement upconversion and quantum cutting within spatially confined and isolated rare-earth-doped active domains. The core area transforms infrared photons through trivalent erbium (Er(3+)) ions into three- and two-photon upconverted visible and near infrared luminescence, while the second shell domain splits an excitation photon into two near infrared photons through cooperative quantum cutting from one trivalent terbium ion (Tb(3+)) to two trivalent ytterbium ions (Yb(3+)). The inert layer in between the active domains is able to effectively suppress the destructive interference between upconversion and quantum cutting, while the outermost inert shell is able to eliminate surface-related quenching. This design enables the colloidal core/multishell nanoparticles to have an upconversion quantum yield of ∼1.6%, and to have a luminescence yield of the quantum cutting process as high as ∼130%. This work constitutes a solid step for flexible photon management in a single nanostructure, and has an implication for photonic applications beyond photovoltaics.

  13. Addressing ketamine bladder syndrome.

    PubMed

    Logan, Karen

    The rise in ketamine misuse means more health professionals will need to diagnose, refer and treat ketamine bladder syndrome. Prevention and raising awareness of the problem among multidisciplinary teams will help limit damage to the bladder as well as making treatment and management more effective.

  14. 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

  15. 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.

  16. 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.

  17. Multiple biomarkers in molecular oncology. II. Molecular diagnostics applications in breast cancer management.

    PubMed

    Malinowski, Douglas P

    2007-05-01

    In recent years, the application of genomic and proteomic technologies to the problem of breast cancer prognosis and the prediction of therapy response have begun to yield encouraging results. Independent studies employing transcriptional profiling of primary breast cancer specimens using DNA microarrays have identified gene expression profiles that correlate with clinical outcome in primary breast biopsy specimens. Recent advances in microarray technology have demonstrated reproducibility, making clinical applications more achievable. In this regard, one such DNA microarray device based upon a 70-gene expression signature was recently cleared by the US FDA for application to breast cancer prognosis. These DNA microarrays often employ at least 70 gene targets for transcriptional profiling and prognostic assessment in breast cancer. The use of PCR-based methods utilizing a small subset of genes has recently demonstrated the ability to predict the clinical outcome in early-stage breast cancer. Furthermore, protein-based immunohistochemistry methods have progressed from using gene clusters and gene expression profiling to smaller subsets of expressed proteins to predict prognosis in early-stage breast cancer. Beyond prognostic applications, DNA microarray-based transcriptional profiling has demonstrated the ability to predict response to chemotherapy in early-stage breast cancer patients. In this review, recent advances in the use of multiple markers for prognosis of disease recurrence in early-stage breast cancer and the prediction of therapy response will be discussed.

  18. 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.

  19. Sativex in the Management of Multiple Sclerosis-Related Spasticity: Role of the Corticospinal Modulation

    PubMed Central

    Calabrò, Rocco Salvatore; Naro, Antonino; Sessa, Edoardo; D'Aleo, Giangaetano; Leo, Antonino; De Luca, Rosaria; Quartarone, Angelo

    2015-01-01

    Sativex is an emergent treatment option for spasticity in patients affected by multiple sclerosis (MS). This oromucosal spray, acting as a partial agonist at cannabinoid receptors, may modulate the balance between excitatory and inhibitory neurotransmitters, leading to muscle relaxation that is in turn responsible for spasticity improvement. Nevertheless, since the clinical assessment may not be sensitive enough to detect spasticity changes, other more objective tools should be tested to better define the real drug effect. The aim of our study was to investigate the role of Sativex in improving spasticity and related symptomatology in MS patients by means of an extensive neurophysiological assessment of sensory-motor circuits. To this end, 30 MS patients underwent a complete clinical and neurophysiological examination, including the following electrophysiological parameters: motor threshold, motor evoked potentials amplitude, intracortical excitability, sensory-motor integration, and Hmax/Mmax ratio. The same assessment was applied before and after one month of continuous treatment. Our data showed an increase of intracortical inhibition, a significant reduction of spinal excitability, and an improvement in spasticity and associated symptoms. Thus, we can speculate that Sativex could be effective in reducing spasticity by means of a double effect on intracortical and spinal excitability. PMID:25699191

  20. 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.

  1. 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

  2. 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.

  3. 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

  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.

  5. Ensuring comparability of data generated by multiple analytical laboratories for environmental decision making at the Fernald Environmental Management Project

    SciTech Connect

    Sutton, C.; Campbell, B.A.; Danahy, R.J.; Dugan, T.A.; Tomlinson, F.K.

    1994-09-01

    The Fernald Environmental Management Project is a US Department of Energy (DOE)-owned facility located 17 miles northwest of Cincinnati, Ohio. From 1952 until 1989, the Fernald site provided high-purity uranium metal products to support US defense programs. In 1989 the mission of Fernald changed from one of uranium production to one of environmental restoration. At Fernald, multiple functional programs require analytical data. Inorganic and organic data for these programs are currently generated by seven laboratories, while radiochemical data are being obtained from six laboratories. Quality Assurance (QA) and Quality Control (QC) programs have been established to help ensure comparability of data generated by multiple laboratories at different times. The quality assurance program for organic and inorganic measurements specifies which analytical methodologies and sample preparation procedures are to be used based on analyte class, sample matrix, and data quality requirements. In contrast, performance specifications have been established for radiochemical analyses. A blind performance evaluation program for all laboratories, both on-site and subcontracted commercial laboratories, provides continuous feedback on data quality. The necessity for subcontractor laboratories to participate in the performance evaluation program is a contractual requirement. Similarly, subcontract laboratories are contractually required to generate data which meet radiochemical performance specifications. The Fernald on-site laboratory must also fulfill these requirements.

  6. 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.

  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. Supporting self-managed leisure engagement and communication in post-coma persons with multiple disabilities.

    PubMed

    Lancioni, Giulio E; Singh, Nirbhay N; O'Reilly, Mark F; Sigafoos, Jeff; Belardinelli, Marta Olivetti; Buonocunto, Francesca; D'Amico, Fiora; Navarro, Jorge; Lanzilotti, Crocifissa; Denitto, Floriana; De Tommaso, Marina; Megna, Marisa

    2015-03-01

    Post-coma persons affected by extensive motor impairment and lack of speech, with or without disorders of consciousness, need special support to manage leisure engagement and communication. These two studies extended research efforts aimed at assessing basic technology-aided programs to provide such support. Specifically, Study I assessed a program for promoting independent stimulation choice in four post-coma persons who combined motor and speech disabilities with disorders of consciousness (i.e., were rated between the minimally conscious state and the emergence from such state). Study II assessed a program for promoting independent television operation and basic communication in three post-coma participants who, contrary to those involved in Study I, did not have disorders of consciousness (i.e., had emerged from a minimally conscious state). The results of the studies were largely positive with substantial levels of independent stimulation choice and access for the participants of Study I and independent television operation and communication for the participants of Study II. The results were analyzed in relation to previous data in the area and in terms of their implications for daily contexts dealing with these persons.

  9. Multiple attractors of host-parasitoid models with integrated pest management strategies: eradication, persistence and outbreak.

    PubMed

    Tang, Sanyi; Xiao, Yanni; Cheke, Robert A

    2008-03-01

    Host-parasitoid models including integrated pest management (IPM) interventions with impulsive effects at both fixed and unfixed times were analyzed with regard to host-eradication, host-parasitoid persistence and host-outbreak solutions. The host-eradication periodic solution with fixed moments is globally stable if the host's intrinsic growth rate is less than the summation of the mean host-killing rate and the mean parasitization rate during the impulsive period. Solutions for all three categories can coexist, with switch-like transitions among their attractors showing that varying dosages and frequencies of insecticide applications and the numbers of parasitoids released are crucial. Periodic solutions also exist for models with unfixed moments for which the maximum amplitude of the host is less than the economic threshold. The dosages and frequencies of IPM interventions for these solutions are much reduced in comparison with the pest-eradication periodic solution. Our results, which are robust to inclusion of stochastic effects and with a wide range of parameter values, confirm that IPM is more effective than any single control tactic.

  10. 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.

  11. Relation of stable hand-use preferences to the development of skill for managing multiple objects from 7 to 13 months of age.

    PubMed

    Kotwica, Kathleen A; Ferre, Claudio L; Michel, George F

    2008-07-01

    Expression of multiple object management skills (manual acquisition and storage of objects) was examined longitudinally at 7, 9, 11, and 13 months for 38 infants (19 females) whose hand use preference was either stable (consistently right or left across the ages) or nonstable (either no hand-use preference exhibited or inconsistent preference across the ages). Four separate sets of four distinctive objects each were presented singly to the infant's right and left side, with the presentation of each subsequent object contingent on the infant manipulating the previous object. Expression of multiple object management skills significantly increased with age. Infants with stable hand-use preferences produced more object acquisition and storage acts than those without a stable hand-use preference. Older infants with stable hand-use preferences exhibited more "sophisticated" sequences of multiple object management acts than those without. The role of stable hand-use preference in the development of manual skill and cognition is discussed.

  12. [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.

  13. Cytogenetics in the management of multiple myeloma: an update by the Groupe francophone de cytogénétique hématologique (GFCH).

    PubMed

    Daudignon, Agnès; Quilichini, Benoît; Ameye, Geneviève; Poirel, Hélène; Bastard, Christian; Terré, Christine

    2016-10-01

    Cytogenetics of multiple myeloma has evolved in recent years by the emergence of Interphasic fluorescence in situ hybridization (FISH) performed on sorted plasma cells detecting abnormalities independently of a proliferative and infiltrative index. Cytogenetic analysis plays a major part in the risk stratification of myeloma diagnosis due to prognostic impact of various cytogenetic abnormalities as well as to the association between emerging therapeutic approaches in MM. Thus, practice guidelines now recommend interphasic FISH or alternative molecular technics as the initial analysis for multiple myeloma. The Groupe francophone de cytogénétique hématologique (GFCH) proposes in this issue an update of managing multiple myeloma cytogenetics.

  14. 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

  15. 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

  16. 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.

  17. 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.

  18. 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…

  19. The Part-Time Student Role: Implications for the Emotional Experience of Managing Multiple Roles amongst Hong Kong Public Health Nurses.

    ERIC Educational Resources Information Center

    Shiu, Ann Tak-Ying

    1999-01-01

    Nine public-health nurses studying part time and 11 other nurses sampled their mood states randomly over seven days. The part-time student role created additional strain for nurses with children. The stress of managing multiple roles was greatest when both work and nonwork role responsibilities were heavy. (SK)

  20. Clinical utility of biochemical markers of bone metabolism for improving the management of patients with advanced multiple myeloma.

    PubMed

    Lipton, Allan; Cook, Richard J; Coleman, Robert E; Smith, Matthew R; Major, Pierre; Terpos, Evangelos; Berenson, James R

    2007-03-01

    Osteolytic bone lesions from advanced multiple myeloma (MM) result in significant skeletal morbidity. Therefore, biochemical markers of bone metabolism, such as the N-terminal and C-terminal telopeptides of type I collagen, bone-specific alkaline phosphatase, and osteocalcin, have been investigated as tools for evaluating the extent of bone disease, risk of skeletal morbidity, and response to antiresorptive treatment. Several studies have shown that the majority of biochemical markers of bone metabolism are increased in patients with MM with osteolytic bone lesions, thus reflecting changes in bone metabolism associated with tumor growth. There is also a growing body of evidence that markers of bone metabolism correlate with the risk of skeletal complications, disease progression, and death. In addition, bone markers could potentially be used as a tool for early diagnosis of bone lesions. The aim of this review is to improve our understanding of bone markers as a clinical tool for the management of malignant bone disease in patients with MM.

  1. [Multiple Salvage Radiotherapies for Metachronous Lymph Node Metastasis from Gastric Cancer Contributed to Long-Term Management of Disease].

    PubMed

    Hori, Naoto; Kagawa, Shunsuke; Kikuchi, Satoru; Kuroda, Shinji; Watanabe, Megumi; Sakamoto, Shuichi; Kagawa, Tetsuya; Kuwada, Kazuya; Kubota, Tetsushi; Kishimoto, Hiroyuki; Nishizaki, Masahiko; Katayama, Norihisa; Fujiwara, Toshiyoshi

    2017-02-01

    A 70-year-old man who underwent gastrectomy for Stage III C gastric cancer developed lymph node(LN)metastasis posterior to the pancreatic head 3 years after the radical surgery.He was first treated with radiotherapy(RT)followed by chemotherapy.The irradiated tumor regressed completely.However, the cancer relapsed in a single para-aortic LN and he was treated with RT to the lesion followed by chemotherapy.Although it completely regressed, later, lung metastasis was observed.The lung lesions were well suppressed by switching to docetaxel; however, the cancer relapsed again in a mediastinal LN, and it was not responsive to docetaxel.The growing mediastinal lesion was irradiated again, which resulted in stable disease.The patient has been treated for 4 years and 7 months with all lesions being well-managed, and chemotherapy is being continued.Recurrent gastric cancer after surgery tends to present as multiple lesions; therefore, the principle therapy is systemic chemotherapy and RT is unlikely to be suitable.However, especially in cases of a solitary lesion that is chemo-resistant, RT could be an optimal option and contribute to long-term survival even in patients with recurrent gastric cancer.

  2. 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.

  3. 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.

  4. Interprofessional, multiple step simulation course improves pediatric resident and nursing staff management of pediatric patients with diabetic ketoacidosis

    PubMed Central

    Larson-Williams, Linnea M; Youngblood, Amber Q; Peterson, Dawn Taylor; Zinkan, J Lynn; White, Marjorie L; Abdul-Latif, Hussein; Matalka, Leen; Epps, Stephen N; Tofil, Nancy M

    2016-01-01

    AIM To investigate the use of a multidisciplinary, longitudinal simulation to educate pediatric residents and nurses on management of pediatric diabetic ketoacidosis. METHODS A multidisciplinary, multiple step simulation course was developed by faculty and staff using a modified Delphi method from the Pediatric Simulation Center and pediatric endocrinology department. Effectiveness of the simulation for the residents was measured with a pre- and post-test and a reference group not exposed to simulation. A follow up post-test was completed 3-6 mo after the simulation. Nurses completed a survey regarding the education activity. RESULTS Pediatric and medicine-pediatric residents (n = 20) and pediatric nurses (n = 25) completed the simulation course. Graduating residents (n = 16) were used as reference group. Pretest results were similar in the control and intervention group (74% ± 10% vs 76% ± 15%, P = 0.658). After completing the intervention, participants improved in the immediate post-test in comparison to themselves and the control group (84% ± 12% post study; P < 0.05). The 3-6 mo follow up post-test results demonstrated knowledge decay when compared to their immediate post-test results (78% ± 14%, P = 0.761). Residents and nurses felt the interdisciplinary and longitudinal nature of the simulation helped with learning. CONCLUSION Results suggest a multidisciplinary, longitudinal simulation improves immediate post-intervention knowledge but important knowledge decay occurs, future studies are needed to determine ways to decrease this decay. PMID:27896145

  5. Managing Multiple Risk Factors.

    DTIC Science & Technology

    1998-09-01

    cardiovascular disease among black women can be better controlled through the use of a stress reduction intervention that reduces the sympathetic nervous...All participants will have high normal (130/80) or mild hypertension and at least two additional risk factors for cardiovascular disease (e.g

  6. Workplace Motivation and Addressing Sexual Harassment in the Organization

    DTIC Science & Technology

    2010-07-01

    Motivation & Addressing Sexual Harassment, 17 orientation . From a total organization perspective, self-determination theory may be embraced by a...Workplace Motivation & Addressing Sexual Harassment in the Organization Major Rachel Castellon Defense Equal Opportunity Management Institute...Director of Research July 2010 Technical Report No. 02-11 Workplace Motivation & Addressing Sexual Harassment, 2 Abstract This paper

  7. 41 CFR 101-26.203 - Activity address codes.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 41 Public Contracts and Property Management 2 2010-07-01 2010-07-01 true Activity address codes... PROGRAM 26.2-Federal Requisitioning System § 101-26.203 Activity address codes. To obtain items through the FEDSTRIP system, each ordering activity is required to have an activity address code. The...

  8. 76 FR 60525 - Final Wilderness and Backcountry Management Plan and Environmental Impact Statement for Isle...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-29

    ... Water Zones. This Plan/EIS addresses a wide array of management issues, and identifies specific goals... multiple alternatives for goals and management actions, which were developed with extensive public input... intention of creating one cohesive management program, with management goals for each of several...

  9. The Reach Address Database (RAD)

    EPA Pesticide Factsheets

    The Reach Address Database (RAD) stores reach address information for each Water Program feature that has been linked to the underlying surface water features (streams, lakes, etc) in the National Hydrology Database (NHD) Plus dataset.

  10. 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

  11. 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

  12. 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…

  13. Addressing the Challenges of Families with Multiple Risks.

    ERIC Educational Resources Information Center

    Hanson, Marci J.; Carta, Judith J.

    1996-01-01

    This article reviews the changing structures and characteristics of the American family and discusses the increased influence of several societal concerns, including poverty, substance abuse, and exposure to violence. These issues are considered in light of their potentially deleterious effects on child and family development and functioning,…

  14. Addressing the Underrepresentation of Women in Physics at Multiple Levels

    NASA Astrophysics Data System (ADS)

    Greco, Shannon; Dominguez, Arturo; Ortiz, Deedee; Zwicker, Andrew

    2016-10-01

    APS provides support to several universities and research institutions to host Conferences for Undergraduate Women in Physics (CUWiP). The goal of these Conferences is to provide practical tools and a community to help women persist in physics and STEM careers. This is particularly relevant for the DPP where women make up only 7% of the membership. In January 2017, Princeton University and the Princeton Plasma Physics Laboratory (PPPL) will host a CUWiP. CUWiP and the Science Undergraduate Laboratory Internship (SULI) program expose undergraduates to the variety of possible careers in plasma physics and fusion energy in academia, government labs or private industry. We will report on the success of a number of PPPL programs to engage women at all levels in physics and highlight how programs such as CUWiP and SULI contribute to this goal. Special thanks to the Department of Energy for supporting PPPL's education programs and to APS for supporting the Conference for Undergraduate Women in Physics.

  15. CONTENT-ADDRESSABLE MEMORY SYSTEMS,

    DTIC Science & Technology

    The utility of content -addressable memories (CAM’s) within a general purpose computing system is investigated. Word cells within CAM may be...addressed by the character of all or a part of cell contents . Multimembered sets of word cells may be addressed simultaneously. The distributed logical...package is developed which allows simulation of CAM commands within job programs run on the IBM 7090 and derives tallies of execution times corresponding to a particular realization of a CAM system . (Author)

  16. The 2006 ACTER Presidential Address: The Premier Educational Delivery System

    ERIC Educational Resources Information Center

    Elliot, Jack

    2007-01-01

    In this address, ACTER President Jack Elliot states that Career and Technical Education (CTE) is the premier educational delivery system in the world. It addresses all learning styles by employing pedagogical strategies that embrace all of the multiple intelligence areas and incorporate the current knowledge in brain-based research. He discusses…

  17. 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

  18. 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.

  19. 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…

  20. 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

  1. Optically addressed asymmetric Fabry-Perot modulator

    NASA Technical Reports Server (NTRS)

    Larsson, A.; Maserjian, J.

    1991-01-01

    A low power, high contrast optically addressed modulator, operating with normal incidence, has been fabricated. Optically controlled reflection modulation is achieved through optically induced absorption modulation in a periodically delta-doped InGaAs/GaAs multiple quantum well structure inserted in an integrated asymmetric Fabry-Perot resonator. A contrast ratio over 60:1 was measured using a spectrally matched low power InGaAs/GaAs quantum well laser to generate the write (control) signal. The insertion loss for the normally off modulator is 4.6 dB at the highest write signal power (30 mW) used. The device lends itself to the fabrication of arrays for optically addressed spatial light modulation.

  2. Name-Based Address Mapping for Virtual Private Networks

    NASA Astrophysics Data System (ADS)

    Surányi, Péter; Shinjo, Yasushi; Kato, Kazuhiko

    IPv4 private addresses are commonly used in local area networks (LANs). With the increasing popularity of virtual private networks (VPNs), it has become common that a user connects to multiple LANs at the same time. However, private address ranges for LANs frequently overlap. In such cases, existing systems do not allow the user to access the resources on all LANs at the same time. In this paper, we propose name-based address mapping for VPNs, a novel method that allows connecting to hosts through multiple VPNs at the same time, even when the address ranges of the VPNs overlap. In name-based address mapping, rather than using the IP addresses used on the LANs (the real addresses), we assign a unique virtual address to each remote host based on its domain name. The local host uses the virtual addresses to communicate with remote hosts. We have implemented name-based address mapping for layer 3 OpenVPN connections on Linux and measured its performance. The communication overhead of our system is less than 1.5% for throughput and less than 0.2ms for each name resolution.

  3. Address tracing for parallel machines

    NASA Technical Reports Server (NTRS)

    Stunkel, Craig B.; Janssens, Bob; Fuchs, W. Kent

    1991-01-01

    Recently implemented parallel system address-tracing methods based on several metrics are surveyed. The issues specific to collection of traces for both shared and distributed memory parallel computers are highlighted. Five general categories of address-trace collection methods are examined: hardware-captured, interrupt-based, simulation-based, altered microcode-based, and instrumented program-based traces. The problems unique to shared memory and distributed memory multiprocessors are examined separately.

  4. 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

  5. Advancing efforts to address youth violence involvement.

    PubMed

    Weist, M D; Cooley-Quille, M

    2001-06-01

    Discusses the increased public attention on violence-related problems among youth and the concomitant increased diversity in research. Youth violence involvement is a complex construct that includes violence experienced in multiple settings (home, school, neighborhood) and in multiple forms (as victims, witnesses, perpetrators, and through family members, friends, and the media). Potential impacts of such violence involvement are considerable, including increased internalizing and externalizing behaviors among youth and future problems in school adjustment and life-course development. This introductory article reviews key dimensions of youth-related violence, describes an American Psychological Association Task Force (Division 12) developed to advance relevant research, and presents examples of national resources and efforts that attempt to address this critical public health issue.

  6. Forest management and economics

    SciTech Connect

    Buongiorno, J.; Gilless, J.K.

    1987-01-01

    This volume provides a survey of quantitative methods, guiding the reader through formulation and analysis of models that address forest management problems. The authors use simple mathematics, graphics, and short computer programs to explain each method. Emphasizing applications, they discuss linear, integer, dynamic, and goal programming; simulation; network modeling; and econometrics, as these relate to problems of determining economic harvest schedules in even-aged and uneven-aged forests, the evaluation of forest policies, multiple-objective decision making, and more.

  7. Treating multiple sclerosis with natalizumab.

    PubMed

    Iaffaldano, Pietro; Lucchese, Guglielmo; Trojano, Maria

    2011-12-01

    Natalizumab is the first monoclonal antibody approved for the treatment of relapsing multiple sclerosis. Pivotal trials demonstrated the efficacy of natalizumab on clinical and paraclinical measures of disease activity and disability progression. Although a direct comparison has not been performed yet, natalizumab seems to be more efficacious than the currently available immunomodulant drugs, such as IFN-β and glatiramer acetate. Despite its efficacy, the occurrence of an increased risk of progressive multifocal leukoencephalopathy with the treatment, raises concerns about its widespread use in multiple sclerosis patients. This paper provides an overview of the most relevant results from the Phase I-IV studies on natalizumab and highlights the challenges addressed to minimize and manage its adverse events in clinical practice.

  8. Planning and Implementing Total Quality Management in the Royal Australian Air Force: A Multiple Case Study Analysis

    DTIC Science & Technology

    1990-09-01

    Theory of Constraints. Goldratt has developed a continuous improvement process model called the Theory of Constraints (TOC). Goldratt suggests using...management philosophy; however, in the context of this discussion, TOC will be referred to as a continuous improvement model. Actually, Goldratt does...not distinguish between TQM and TOC, but views these approaches as having identical goals and promoting a similar management philosophy ( Goldratt , 1990

  9. 41 CFR 109-26.203 - Activity address codes.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false Activity address codes...-PROCUREMENT SOURCES AND PROGRAM 26.2-Federal Requisitioning System § 109-26.203 Activity address codes. (a) DOE field organizations designated by OCMA are responsible for processing routine activity...

  10. Nutrition interventions to address cardiovascular outcomes in chronic kidney disease.

    PubMed

    Beto, Judith A; Bansal, Vinod K

    2004-10-01

    The high mortality in chronic kidney disease has been linked to cardiovascular risk and these patients are considered at high risk. Dietary intervention can directly address nutritional risk factors in lipid management, calcium-phorphorus balance, and body composition to reduce risk of cardiovascular disease. Nutrient intake can also indirectly address less overt risks of dental health, nutritional supplements, and compliance issues.

  11. Mechanisms of action of adrenocorticotropic hormone and other melanocortins relevant to the clinical management of patients with multiple sclerosis

    PubMed Central

    Berkovich, Regina; Catania, Anna; Lisak, Robert P; Zaidi, Mone

    2013-01-01

    The therapeutic benefits of adrenocorticotropic hormone in multiple sclerosis are usually ascribed to its corticotropic actions. Evidence is presented that adrenocorticotropic hormone, approved for multiple sclerosis relapses, acts via corticosteroid-independent melanocortin pathways to engender down-modulating actions on immune-system cells and the cytokines they synthesize. Immune response-dampening effects are also brought about by agent-induced neurotransmitters that inhibit immunocytes. The likelihood that adrenocorticotropic hormone promotes microglial quiescence and counteracts glucocorticoid-mediated bone resorption is discussed. PMID:23034287

  12. Mechanisms of action of adrenocorticotropic hormone and other melanocortins relevant to the clinical management of patients with multiple sclerosis.

    PubMed

    Arnason, Barry G; Berkovich, Regina; Catania, Anna; Lisak, Robert P; Zaidi, Mone

    2013-02-01

    The therapeutic benefits of adrenocorticotropic hormone in multiple sclerosis are usually ascribed to its corticotropic actions. Evidence is presented that adrenocorticotropic hormone, approved for multiple sclerosis relapses, acts via corticosteroid-independent melanocortin pathways to engender down-modulating actions on immune-system cells and the cytokines they synthesize. Immune response-dampening effects are also brought about by agent-induced neurotransmitters that inhibit immunocytes. The likelihood that adrenocorticotropic hormone promotes microglial quiescence and counteracts glucocorticoid-mediated bone resorption is discussed.

  13. The importance of quality-of-life assessment in the management of patients with multiple sclerosis. Recommendations from the Middle East MS Advisory Group.

    PubMed

    Al-Tahan, Abdelrahman M; Al-Jumah, Mohammed A; Bohlega, Saeed M; Al-Shammari, Suhail N; Al-Sharoqi, Isa A; Dahdaleh, Maurice P; Hosny, Hassan M; Yamout, Bassem I

    2011-04-01

    Multiple sclerosis (MS) has a major negative impact on patients` health-related quality of life (QoL). A group of MS experts in the Middle East met to develop recommendations for the routine assessment of QoL in patients with MS. The group recommended that patients need to be assessed once a year using the multiple sclerosis international QoL questionnaire (MusiQoL), which is available in Arabic. Assessments should be made when patients are relapse-free to avoid confounding factors. At other clinic visits, patients` QoL should also be monitored, alongside their physical assessment, using open and structured questions on disease features that are likely to affect their QoL. This approach should allow long-term monitoring of key features of MS that are important to patients` well being, and aid decision-making regarding their management, including the use of disease-modifying drugs.

  14. Addressing Medical Errors in Hand Surgery

    PubMed Central

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

    2014-01-01

    Influential think-tank such as the Institute of Medicine has raised awareness about the implications of medical errors. In response, organizations, medical societies, and institutions have initiated programs to decrease the incidence and 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 is difficult, but a transparent environment where patients are notified of errors and offered consolation and compensation is essential to maintain trust. Further, equipping hand surgeons with a guide for addressing medical errors will promote compassionate patient interaction, help identify system failures, provide learning points for safety improvement, and demonstrate a commitment to ethically responsible medical care. PMID:25154576

  15. 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...

  16. 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…

  17. 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…

  18. Orthodontic Management with Traction and Asymmetric Extraction for Multiple Impacted Permanent Maxillary Teeth – A Case Report

    PubMed Central

    Niu, Qiannan; Zhang, Liang; Dai, Juan; Li, Feifei; Feng, Xue

    2016-01-01

    Multiple impacted teeth are a rare eruption disturbance that increases the case complexity. In this article, we described a 13-year-old boy whose 5 permanent maxillary teeth were not erupted although their root formation was complete. The orthodontic treatment with traction and asymmetric extraction was performed to achieve a significantly improved functional and esthetic result. PMID:27857816

  19. Multiple muscle tear after fall on buttock-role of conservative management and exercise for early recovery and return to play

    PubMed Central

    Adhau, Rajesh; Angrish, Piyush; Ahuja, Ashok; Sandhu, Avtar Singh

    2014-01-01

    Summary Background: to describe role of alternative management as an approach to management and rehabilitation of multiple hip muscles tears by the use of 1 RM (Repetition Maximum) testing and hip muscle strengthening program along with the use of sports specific drills for rehabilitation and recovery. There is very limited literature describing multiple hip muscle tears and the conservative management of the same. 1RM testing and strengthening of hip muscles is an approach that is able to help in the return to sports of an athlete without surgical intervention. Methods: the patient, is a 21-year-old male hockey player who presented with pain right buttock, right lower leg and a limp on the right side while walking. Physical examination revealed a positive Trendelenburg sign both in stance and gait phase. Hip rotational movements showed a normal range of motion, there was a severe pain in the right buttock on movements which he described at 8/10 on VAS (Visual Analogue Scale). Strength assessment revealed weakness of the right hip flexors and extensors and also of the abductor and external hip rotator muscles. Treatment protocol followed was based on 1 RM testing of muscles and hip strengthening exercises and sports specific drills. Results: following the intervention, the patient reported pain at 0/10 VAS while doing all activities and also showed good muscle control with no limp. Conclusions: this highlights an alternative protocol for treating multiple hip muscle tears and illustrates the importance of 1 RM testing as a part of examination and sports medicine intervention. PMID:25332927

  20. 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.

  1. 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

  2. The multiple market-exposure of waste management companies: a case study of two Swedish municipally owned companies.

    PubMed

    Corvellec, Hervé; Bramryd, Torleif

    2012-09-01

    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.

  3. Addressing tomorrow's DMO technical challenges today

    NASA Astrophysics Data System (ADS)

    Milligan, James R.

    2009-05-01

    Distributed Mission Operations (DMO) is essentially a type of networked training that pulls in participants from all the armed services and, increasingly, allies to permit them to "game" and rehearse highly complex campaigns, using a mix of local, distant, and virtual players. The United States Air Force Research Laboratory (AFRL) is pursuing Science and Technology (S&T) solutions to address technical challenges associated with distributed communications and information management as DMO continues to progressively scale up the number, diversity, and geographic dispersal of participants in training and rehearsal exercises.

  4. 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.

  5. 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.

  6. Effect of a Self-Management and Follow-Up Program on Self-Efficacy in Patients With Multiple Sclerosis: A Randomized Clinical Trial

    PubMed Central

    Hemmati Maslakpak, Masomeh; Raiesi, Zahra

    2014-01-01

    Background: Multiple sclerosis (MS) is the most common autoimmune disorder of the central nervous system with profound effects on patients’ independence and self-efficacy. Then, it is still questionable whether self-management programs in patients with MS affect the patients’ self-efficacy. Objectives: The present study aimed to investigate the effect of a self-management program plus regular follow-up on self-efficacy in patients with MS. Patients and Methods: A quasi-experimental study was performed on 80 patients with relapsing remitting MS who were randomly allocated to an intervention (n = 40) and a control group (n = 40). The MS self-efficacy scale was completed before and after the intervention. The intervention group was divided into four small subgroups of ten. Then, each subgroup was invited to participate in four training sessions about self-management. During the two months after the self-management sessions, a weekly telephone follow-up was conducted for each patient in the intervention group. The control group did not receive any intervention other than routine care. Data were analyzed using SPSS 11.5. Descriptive statistics, Chi-square, and independent-samples t-testes were used to analyze the data. Results: No significant difference in mean scores of baseline self-efficacy was found between the control (52.90 ± 8.03) and the intervention groups (54.90 ± 9.51) (P = 0.313). However, a significant difference was observed between the control (50.90 ± 5.71) and the intervention groups (59.80 ± 5.27) regarding mean scores of self-efficacy at the end of the study (P < 0.001). Conclusions: Implementing the self-management program plus regular follow-up increased the perception of self-efficacy in patients with MS. Similar self-management programs are recommended to be integrated in the regular caring of patients with MS. PMID:25741519

  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. Scripted Collaboration in Serious Gaming for Complex Learning: Effects of Multiple Perspectives when Acquiring Water Management Skills

    ERIC Educational Resources Information Center

    Hummel, Hans G. K.; van Houcke, Jasper; Nadolski, Rob J.; van der Hiele, Tony; Kurvers, Hub; Lohr, Ansje

    2011-01-01

    This paper examines how learning outcomes from playing serious games can be enhanced by including scripted collaboration in the game play. We compared the quality of advisory reports, that students in the domain of water management had to draw up for an authentic case problem, both before and after collaborating on the problem with (virtual) peer…

  9. 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.

  10. 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 ...

  11. 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.

  12. 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…

  13. Agenda to address climate change

    SciTech Connect

    1998-10-01

    This document looks at addressing climate change in the 21st century. Topics covered are: Responding to climate change; exploring new avenues in energy efficiency; energy efficiency and alternative energy; residential sector; commercial sector; industrial sector; transportation sector; communities; renewable energy; understanding forests to mitigate and adapt to climate change; the Forest Carbon budget; mitigation and adaptation.

  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. Keynote Address: Rev. Mark Massa

    ERIC Educational Resources Information Center

    Massa, Mark S.

    2011-01-01

    Rev. Mark S. Massa, S.J., is the dean and professor of Church history at the School of Theology and Ministry at Boston College. He was invited to give a keynote to begin the third Catholic Higher Education Collaborative Conference (CHEC), cosponsored by Boston College and Fordham University. Fr. Massa's address posed critical questions about…

  16. State of the Lab Address

    ScienceCinema

    King, Alex

    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.

  17. Research strategies for addressing uncertainties

    USGS Publications Warehouse

    Busch, David E.; Brekke, Levi D.; Averyt, Kristen; Jardine, Angela; Welling, Leigh; Garfin, Gregg; Jardine, Angela; Merideth, Robert; Black, Mary; LeRoy, Sarah

    2013-01-01

    Research Strategies for Addressing Uncertainties builds on descriptions of research needs presented elsewhere in the book; describes current research efforts and the challenges and opportunities to reduce the uncertainties of climate change; explores ways to improve the understanding of changes in climate and hydrology; and emphasizes the use of research to inform decision making.

  18. Randomized controlled trial of a teleconference fatigue management plus physical activity intervention in adults with multiple sclerosis: rationale and research protocol

    PubMed Central

    2012-01-01

    Background Chronic fatigue and inactivity are prevalent problems among individuals with multiple sclerosis (MS) and may independently or interactively have detrimental effects on quality of life and ability to participate in life roles. However, no studies to date have systematically evaluated the benefits of an intervention for both managing fatigue and promoting physical activity in individuals with MS. This study involves a randomized controlled trial to examine the effectiveness of a telehealth intervention that supports individuals with MS in managing fatigue and increasing physical activity levels. Methods/Design A randomly-allocated, three-parallel group, time-series design with a social support program serving as the control group will be used to accomplish the purpose of the study. Our goal is to recruit 189 ambulatory individuals with MS who will be randomized into one of three telehealth interventions: (1) a contact-control social support intervention, (2) a physical activity-only intervention, and (3) a physical activity plus fatigue management intervention. All interventions will last 12 weeks and will be delivered entirely over the phone. Our hypothesis is that, in comparison to the contact-control condition, both the physical activity-only intervention and the physical activity plus fatigue management intervention will yield significant increases in physical activity levels as well as improve fatigue and health and function, with the physical activity plus fatigue management intervention yielding significantly larger improvements. To test this hypothesis, outcome measures will be administered at Weeks 1, 12, and 24. Primary outcomes will be the Fatigue Impact Scale, the Godin Leisure-Time Exercise Questionnaire (GLTEQ), and Actigraph accelerometers. Secondary outcomes will include the SF-12 Survey, Mental Health Inventory, Multiple Sclerosis Impact Scale, the Community Participation Indicator, and psychosocial constructs (e.g., self

  19. Exploring Content Management Issues in Air Force On-Line Communities of Practice: A Multiple Case Study Approach

    DTIC Science & Technology

    2006-05-31

    better, best practices, and lessons learned about any process” (O’Dell et al, 2002). Michael Polanyi argues “we can know more than we can tell... Polanyi , 1967). Polanyi describes a 8 distinction between tacit and explicit knowledge ( Polanyi , 1967). Following on Polanyi’s distinction of tacit...Knowledge Management: Knowledge Matters, Volume 2, (pp. 411-441). New York: Springer. Polanyi , M. (1967). The Tacit Dimension. New York: Anchor. 59

  20. Managing multiple funding streams and agendas to achieve local and global health and research objectives: lessons from the field

    PubMed Central

    Holmes, Charles B.; Sikazwe, Izukanji; Raelly, Roselyne; Freeman, Bethany; Wambulawae, Inonge; Silwizya, Geoffrey; Topp, Stephanie; Chilengi, Roma; Henostroza, German; Kapambwe, Sharon; Simbeye, Darius; Sibajene, Sheila; Chi, Harmony; Godfrey, Katy; Chi, Benjamin; Moore, Carolyn Bolton

    2014-01-01

    Multiple funding sources provide research and program implementation organizations a broader base of funding and facilitate synergy, but also entail challenges that include varying stakeholder expectations, unaligned grant cycles, and highly variable reporting requirements. Strong governance and strategic planning are essential to ensure alignment of goals and agendas. Systems to track budgets and outputs as well as procurement and human resources are required. A major goal is to transition leadership and operations to local ownership. This article details successful approaches used by the newly independent non-governmental organization, the Centre for Infectious Disease Research in Zambia (CIDRZ). PMID:24321983

  1. Managing multiple funding streams and agendas to achieve local and global health and research objectives: lessons from the field.

    PubMed

    Holmes, Charles B; Sikazwe, Izukanji; Raelly, Roselyne L; Freeman, Bethany L; Wambulawae, Inonge; Silwizya, Geoffrey; Topp, Stephanie M; Chilengi, Roma; Henostroza, German; Kapambwe, Sharon; Simbeye, Darius; Sibajene, Sheila; Chi, Harmony; Godfrey, Katy; Chi, Benjamin; Moore, Carolyn Bolton

    2014-01-01

    Multiple funding sources provide research and program implementation organizations a broader base of funding and facilitate synergy, but also entail challenges that include varying stakeholder expectations, unaligned grant cycles, and highly variable reporting requirements. Strong governance and strategic planning are essential to ensure alignment of goals and agendas. Systems to track budgets and outputs, as well as procurement and human resources are required. A major goal of funders is to transition leadership and operations to local ownership. This article details successful approaches used by the newly independent nongovernmental organization, the Centre for Infectious Disease Research in Zambia.

  2. Relative contribution of soil, management and traits to co-variations of multiple ecosystem properties in grasslands.

    PubMed

    Gos, Pierre; Loucougaray, Grégory; Colace, Marie-Pascale; Arnoldi, Cindy; Gaucherand, Stéphanie; Dumazel, Daphné; Girard, Lucie; Delorme, Sarah; Lavorel, Sandra

    2016-04-01

    Ecological intensification promotes the better use of ecosystem functioning for agricultural production and as a provider of additional regulation and cultural services. We investigated the mechanisms underpinning potential ecological intensification of livestock production in the Vercors mountains (France). We quantified the variations in seven ecosystem properties associated with key ecosystem services: above-ground biomass production at first harvest, fodder digestibility, plant species richness, soil organic matter content, soil carbon content, total microbial biomass and soil bacteria:fungi ratio across 39 grassland plots representing varying management types and intensity. Our analyses confirmed joint effects of management, traits and soil abiotic parameters on variations in ecosystem properties, with the combination of management and traits being most influential. The variations explained by traits were consistent with the leaf economics spectrum model and its implications for ecosystem functioning. The observed independence between ecosystem properties relevant to production (forage biomass, digestibility and nutrient turnover) on the one hand and soil stocks (organic matter, carbon and microbial stocks) on the other hand suggests that an intensification of fodder production might be compatible with the preservation of the soil capital. We highlight that appropriate choices regarding various practices, such as the first date of grazing or mowing being dependent on soil moisture, have important consequences on a number of ecosystem properties relevant for ecosystem services and may influence biodiversity patterns. Such avenues for ecological intensification should be considered as part of further landscape- and farm-scale analyses of the relationships between farm functioning and ecosystem services.

  3. The evolution of computed tomography from organ-selective to whole-body scanning in managing unconscious patients with multiple trauma: A retrospective cohort study.

    PubMed

    Hong, Zhi-Jie; Chen, Cheng-Jueng; Yu, Jyh-Cherng; Chan, De-Chuan; Chou, Yu-Ching; Liang, Chia-Ming; Hsu, Sheng-Der

    2016-09-01

    We aimed to evaluate the benefit of whole-body computed tomography (WBCT) scanning for unconscious adult patients suffering from high-energy multiple trauma compared with the conventional stepwise approach of organ-selective CT.Totally, 144 unconscious patients with high-energy multiple trauma from single level I trauma center in North Taiwan were enrolled from January 2009 to December 2013. All patients were managed by a well-trained trauma team and were suitable for CT examination. The enrolled patients are all transferred directly from the scene of an accident, not from other medical institutions with a definitive diagnosis. The scanning regions of WBCT include head, neck, chest, abdomen, and pelvis. We analyzed differences between non-WBCT and WBCT groups, including gender, age, hospital stay, Injury Severity Score, Glasgow Coma Scale, Revised Trauma Score, time in emergency department (ED), medical cost, and survival outcome.Fifty-five patients received the conventional approach for treating trauma, and 89 patients received immediate WBCT scanning after an initial examination. Patients' time in ED was significantly shorter in the WBCT group in comparison with the non-WBCT group (158.62 ± 80.13 vs 216.56 ± 168.32 min, P = 0.02). After adjusting for all possible confounding factors, we also found that survival outcome of the WBCT group was better than that of the non-WBCT group (odds ratio: 0.21, 95% confidence interval: 0.06-0.75, P = 0.016).Early performing WBCT during initial trauma management is a better approach for treating unconscious patients with high-energy multiple trauma.

  4. Incidence and management of adverse events in patients with relapsed and/or refractory multiple myeloma receiving single-agent carfilzomib.

    PubMed

    Harvey, R Donald

    2014-01-01

    Carfilzomib, a selective proteasome inhibitor approved in the USA in 2012, is a single agent for relapsed and refractory multiple myeloma. Carfilzomib is administered as a 2-10-minute infusion on days 1, 2, 8, 9, 15, and 16 of a 28-day cycle at a starting dose of 20 mg/m(2) for cycle 1 and a target dose of 27 mg/m(2) thereafter. In the pivotal Phase II study (PX-171-003-A1), carfilzomib 20/27 mg/m(2) provided durable responses in a heavily pretreated population with relapsed and refractory multiple myeloma (n=266), with an overall response rate of 22.9% and a median duration of response of 7.8 months. In an integrated safety analysis of four Phase II studies, common adverse events (32.7%-55.5%) included fatigue, anemia, nausea, thrombocytopenia, dyspnea, and diarrhea. Grade 3/4 adverse events were generally hematologic and included thrombocytopenia (23.4%), anemia (22.4%), and lymphopenia (18.1%). Serious adverse events included pneumonia (9.9%), acute renal failure (4.2%), pyrexia (3.4%), and congestive heart failure (3.4%). New or worsening peripheral neuropathy was infrequent (13.9% overall, 1.3% grade 3, no grade 4). This review discusses findings of the integrated safety analysis and provides practical experience from a single institution in managing treatment-related and disease-related adverse events. Individualized treatment with proactive management of side effects and complications allows patients with advanced multiple myeloma to remain on carfilzomib for extended periods.

  5. Multiple sclerosis.

    PubMed

    Files, Daniel Kane; Jausurawong, Tani; Katrajian, Ruba; Danoff, Robert

    2015-06-01

    Multiple sclerosis (MS) is a chronic, debilitating disease that can have devastating effects. Presentation varies widely in symptoms, pace, and progression. In addition to a thorough history and physical examination, diagnostic tools required to diagnose MS and exclude other diagnoses include MRI, evoked potential testing, and cerebrospinal fluid analysis. Although the disease is not curable presently, quality of life can be improved by minimizing the frequency and severity of disease burden. Disease modification, symptom management, preservation of function, and treatment of psychosocial issues are paramount to enhance the quality of life for the patient affected with MS.

  6. The Quality of Pre-hospital Circulatory Management in Patients With Multiple Trauma Referred to the Trauma Center of Shahid Beheshti Hospital in Kashan, Iran, in the First Six Months of 2013

    PubMed Central

    Maghaminejad, Farzaneh; Adib-Hajbaghery, Mohsen

    2016-01-01

    Background Circulatory management is a critical issue in pre-hospital transportation phase of multiple trauma patients. However, the quality of this important care did not receive enough attention. Objectives The aim of this study was to investigate the quality of pre-hospital circulatory management in patients with multiple trauma. Patients and Methods This was a cross-sectional study conducted in 2013. The study population consisted of all patients with multiple trauma who had been transferred by emergency medical services (EMS) to the central trauma department in Kashan Shahid Beheshti medical center, Kashan, Iran. We recruited a convenience sample of 400 patients with multiple trauma. Data were collected using the circulatory assessment questionnaire and controlling hemorrhage (CAQCH) that were designed by the researchers and were described by using frequency tabulations, central tendency measures, and variability indices. The chi-square test was used to analyze the data. Results The study sample consisted of 263 males (75.2%); 57.75% had lower levels of education and 28.75% were workers. The most common mechanism of trauma was traffic accident (85.4%). We found that the quality of circulatory management was unfavorable in 61% of the cases. A significant relationship was observed between the quality of circulatory management and type of trauma and staff’s employment status. Conclusions The quality of pre-hospital circulatory management provided to patients with multiple trauma was unfavorable. Therefore, establishment of in-service training programs on circulatory management is recommended. PMID:27556056

  7. Development of a concept for a personalized approach in the perioperative antiplatelet therapy administration/discontinuation management based on multiple electrode aggregometry in patients undergoing coronary artery surgery.

    PubMed

    Petricevic, Mate; Milicic, Davor; White, Alexandra; Boban, Marko; Mihaljevic, Martina Zrno; Piljic, Dragan; Rotim, Ante; Buca, Ante; Mihalj, Mario; Biocina, Bojan

    2015-10-01

    In patients undergoing coronary artery surgery, improvements in clinical outcomes currently rely on continued refinements of the surgical technique and modulation of adjuvant pharmacotherapy. Despite medical and technological advances, negligible rate of bleeding and ischemic events still persist necessitating further improvements in patient management. Platelet function testing (PFT) might play an important role in meticulous balancing between the risk of bleeding and thrombotic events. A suitable balance can be achieved by implementing a personalized, PFT based approach in antiplatelet therapy (APT) administration/discontinuation management. Despite emerging evidence on the widespread variability in platelet inhibitory response to APT, numerous PFT devices and heterogeneity in reporting study results hamper pooling of the evidence which in turn results with a lack of consensus in "on treatment" platelet reactivity associated with ischemic and bleeding events in perioperative phase. The literature on multiple electrode aggregometry (Multiplate(®); Roche Diagnostics, Mannheim, Germany) in coronary artery disease patients was reviewed systematically. Based on the evidence evaluating the relationship between "drug specific" PFT and bleeding or adverse ischemic events, we sought to define therapeutic window for the most commonly administered antiplatelet drugs such as aspirin (ASPI test) and adenosine-diphosphate receptor blockers (ADP test). Preoperatively, APT administration was primarily focused to avoid bleeding complications. ASPI test value of 20 AUC and ADP test value of <73 AUC were set as cut-off values that delineate bleeding tendency. Postoperatively, "therapeutic window" was set to avoid both bleeding and adverse ischemic events. Therapeutic ranges were as follows: 20 AUC < ASPItest ≤ 30 AUC and 19AUC < ADP ≤ 46AUC, respectively. This is the first attempt to define PFT based "therapeutic window" according to, perioperative APT administration

  8. The management of multiple sclerosis by reference centers in south of Italy: a 2011 survey on health demands and needs in Campania region.

    PubMed

    de Waure, Chiara; Di Nardo, Francesco; Mazzucco, Walter; Nedovic, Darko; Battaglia, Mario Alberto; Busillo, Vincenzo; Di Iorio, Walter; Gallo, Antonio; Lanzillo, Roberta; Lombardi, Emilio; Maniscalco, Giorgia Teresa; Orefice, Giuseppe; Petracca, Maria; Romano, Felice; Sinisi, Leonardo; Spadera, Anna Pia; Spitaleri, Daniele; Vivo, Pasquale; Ricciardi, Walter

    2016-02-01

    This cross-sectional study has investigated the diagnostic and therapeutic management of patients suffering from multiple sclerosis (MS) in the Campania Region (Italy). A survey involving all the reference centers for MS in Campania Region was conducted from March to August 2011. Centers responded to a web-administered questionnaire on management and clinical characteristics of MS patients. In the study period, 3263 patients (mean age 37 years, 66 % females) accessed the centers. Patients received a first diagnosis of MS in 161 cases (4.9 %). About 37 % of the subjects without a previous diagnosis came to the centers on their own initiative. All patients underwent a complete neurological examination and expanded disability status scale. The other most common investigations were magnetic resonance imaging (44.0 %) and evoked potentials (22.1 %). The number of treated patients was 2797 (87.1 %). The most used drugs were interferon β and glatiramer acetate. The time between diagnosis and initiation of therapy exceeded 6 months in 32 % of cases. Second-line drugs were under-used: 16 % of patients who might benefit from them show high clinical and radiological disease activity despite treatment with immunomodulant drugs. The MS care management of the surveyed centers showed consistent margins for improvement in 2011. Even though these data do not represent the current situation, they can be used to monitor improvements in MS care.

  9. Spack: the Supercomputing Package Manager

    SciTech Connect

    Gamblin, T.

    2013-11-09

    The HPC software ecosystem is growing larger and more complex, but software distribution mechanisms have not kept up with this trend. Tools, Libraries, and applications need to run on multiple platforms and build with multiple compliers. Increasingly, packages leverage common software components, and building any one component requires building all of its dependencies. In HPC environments, ABI-incompatible interfaces (likeMPI), binary-incompatible compilers, and cross-compiled environments converge to make the build process a combinatoric nightmare. This obstacle deters many users from adopting useful tools, and others waste countless hours building and rebuilding tools. Many package managers exist to solve these problems for typical desktop environments, but none suits the unique needs of supercomputing facilities or users. To address these problems, we have Spack, a package manager that eases the task of managing software for end-users, across multiple platforms, package versions, compilers, and ABI incompatibilities.

  10. Design of oral agents for the management of multiple sclerosis: benefit and risk assessment for dimethyl fumarate.

    PubMed

    Nicholas, Jacqueline Ann; Boster, Aaron Lee; Imitola, Jaime; O'Connell, Colleen; Racke, Michael Karl

    2014-01-01

    Dimethyl fumarate (DMF) is the most recent oral disease-modifying therapy approved by the US Food and Drug Administration and is indicated for the treatment of relapsing forms of multiple sclerosis (MS). Prior to approval for use in MS, DMF and its active metabolite, monomethyl fumarate, had been used for decades as two of the fumaric acid esters in Fumaderm, a medication used in Europe for the treatment of psoriasis. The unique mechanism of action of DMF remains under evaluation; however, it has been shown to act through multiple pathways leading to shifts away from the Th1 proinflammatory response to the less inflammatory Th2 response. Preliminary data suggest that DMF may induce neuroprotective effects in central nervous system white matter, although further studies are needed to demonstrate these effects on inflammatory demyelination. The DMF Phase III clinical trials demonstrated its efficacy with regard to a reduction in the annualized relapse rate and reductions in new or enlarging T2 lesions and numbers of gadolinium-enhancing lesions on magnetic resonance imaging. DMF has a well-defined safety profile, given the experience with its use in the treatment of psoriasis, and more recently from the DMF clinical trials program and post-marketing era for treatment of MS. The safety profile and oral mode of administration of DMF place it as an attractive first-line therapy option for the treatment of relapsing forms of MS. Long-term observational studies will be needed to determine the effects of DMF on progression of disability in MS.

  11. How can we exploit above–belowground interactions to assist in addressing the challenges of food security?

    PubMed Central

    Orrell, Peter; Bennett, Alison E.

    2013-01-01

    Can above–belowground interactions help address issues of food security? We address this question in this manuscript, and review the intersection of above–belowground interactions and food security. We propose that above–belowground interactions could address two strategies identified by Godfray etal. (2010): reducing the Yield Gap, and Increasing Production Limits. In particular, to minimize the difference between potential and realized production (The Yield Gap) above–belowground interactions could be manipulated to reduce losses to pests and increase crop growth (and therefore yields). To Increase Production Limits we propose two mechanisms: utilizing intercropping (which uses multiple aspects of above–belowground interactions) and breeding for traits that promote beneficial above–belowground interactions, as well as breeding mutualistic organisms to improve their provided benefit. As a result, if they are managed correctly, there is great potential for above–belowground interactions to contribute to food security. PMID:24198821

  12. [Multiple apheresis].

    PubMed

    Coffe, C

    2007-05-01

    Multiple apheresis makes it possible to obtain at least two labile blood components from a single donor using a cell separator. It can be either multicomponent apheresis leading to the preparation of at least two different blood component types or red blood cell apheresis providing two identical red blood cell concentrates. These techniques available in addition to whole blood donation, are modifying collection strategies in many Etablissements Français du Sang and will contribute to improve stock logistics in the future. In areas with insufficient stock, these procedures will help achieve blood component self-sufficiency. The author first describes the principle underlying different--current or future--techniques as well as their advantages and drawbacks. He finally addresses the potential impact of these processes on the evolution of blood collection and the advantages to be gained.

  13. SIG: Multiple Views on Safety-Critical Automation: Aircraft, Autonomous Vehicles, Air Traffic Management and Satellite Ground Segments Perspectives

    NASA Technical Reports Server (NTRS)

    Feary, Michael; Palanque, Philippe; Martinie, Célia; Tscheligi, Manfred

    2016-01-01

    This SIG focuses on the engineering of automation in interactive critical systems. Automation has already been studied in a number of (sub-) disciplines and application fields: design, human factors, psychology, (software) engineering, aviation, health care, games. One distinguishing feature of the area we are focusing on is that in the field of interactive critical systems properties such as reliability, dependability, fault tolerance are as important as usability, user experience or overall acceptance issues. The SIG targets at two problem areas: first the engineering of the user interaction with (partly-) autonomous systems: how to design, build and assess autonomous behavior, especially in cases where there is a need to represent on the user interface both autonomous and interactive objects. An example of such integration is the representation of an unmanned aerial vehicle (UAV) (where no direct interaction is possible), together with aircrafts (that have to be instructed by an air traffic controller to avoid the UAV). Second the design and engineering of user interaction in general for autonomous objects/systems (for example a cruise control in a car or an autopilot in an aircraft). The goal of the SIG is to raise interest in the CHI community on the general aspects of automation and to identify a community of researchers and practitioners interested in those increasingly prominent issues of interfaces towards (semi)-autonomous systems. The expected audience should be interested in addressing the issues of integration of mainly unconnected research domains to formulate a new joint research agenda.

  14. Multiple Views on Safety-Critical Automation: Aircraft, Autonomous Vehicles, Air Traffic Management and Satellite Ground Segments Perspectives

    NASA Technical Reports Server (NTRS)

    Feary, Michael S.; Palanque, Philippe Andre Rolan; Martinie, De Almeida; Tscheligi, Manfred

    2016-01-01

    This SIG focuses on the engineering of automation in interactive critical systems. Automation has already been studied in a number of (sub-) disciplines and application fields: design, human factors, psychology, (software) engineering, aviation, health care, games. One distinguishing feature of the area we are focusing on is that in the field of interactive critical systems properties such as reliability, dependability, fault-tolerance are as important as usability, user experience or overall acceptance issues. The SIG targets at two problem areas: first the engineering of the user interaction with (partly-) autonomous systems: how to design, build and assess autonomous behavior, especially in cases where there is a need to represent on the user interface both autonomous and interactive objects. An example of such integration is the representation of an unmanned aerial vehicle (UAV) (where no direct interaction is possible), together with aircrafts (that have to be instructed by an air traffic controller to avoid the UAV). Second the design and engineering of user interaction in general for autonomous objects systems (for example a cruise control in a car or an autopilot in an aircraft). The goal of the SIG is to raise interest in the CHI community on the general aspects of automation and to identify a community of researchers and practitioners interested in those increasingly prominent issues of interfaces towards (semi)-autonomous systems. The expected audience should be interested in addressing the issues of integration of mainly unconnected research domains to formulate a new joint research agenda.

  15. Addressing inequities in healthy eating.

    PubMed

    Friel, Sharon; Hattersley, Libby; Ford, Laura; O'Rourke, Kerryn

    2015-09-01

    What, when, where and how much people eat is influenced by a complex mix of factors at societal, community and individual levels. These influences operate both directly through the food system and indirectly through political, economic, social and cultural pathways that cause social stratification and influence the quality of conditions in which people live their lives. These factors are the social determinants of inequities in healthy eating. This paper provides an overview of the current evidence base for addressing these determinants and for the promotion of equity in healthy eating.

  16. Addressing the workforce pipeline challenge

    SciTech Connect

    Leonard Bond; Kevin Kostelnik; Richard Holman

    2006-11-01

    A secure and affordable energy supply is essential for achieving U.S. national security, in continuing U.S. prosperity and in laying the foundations to enable future economic growth. To meet this goal the next generation energy workforce in the U.S., in particular those needed to support instrumentation, controls and advanced operations and maintenance, is a critical element. The workforce is aging and a new workforce pipeline, to support both current generation and new build has yet to be established. The paper reviews the challenges and some actions being taken to address this need.

  17. Cadmium contamination in American lobster, Homarus americanus, near a coastal lead smelter: use of multiple linear regression for management

    SciTech Connect

    Uthe, J.F.; Scott, D.P.; Chou, C.L.

    1987-04-01

    In 1980 cadmium (Cd) concentrations in digestive gland from American Lobster (Homarus americanus), captured at Belledune Harbour, New Brunswick, Canada were found to range 47.6-372 mg/kg wet weight. Since the digestive gland is commonly eaten the harbor fishery was closed. The adjacent area was decreed a controlled fishery zone. The cadmium source was a lead smelter on the harbor shore. The company installed an aqueous effluent treatment plant and improved handling procedures within the plant area. Aqueous Cd discharges were subsequently reduced by more than 95%. Cadmium levels in lobsters have been monitored annually since 1980 by sampling in early spring, immediately after the lobsters emerged from their overwintering locations. The results from the 1981-1985 monitoring program were used to model the system, analyze the data and predict the years in which certain changes to the management plan might be implemented.

  18. 5 CFR 9901.410 - Addressing performance that does not meet expectations.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... MANAGEMENT AND LABOR RELATIONS SYSTEMS (DEPARTMENT OF DEFENSE-OFFICE OF PERSONNEL MANAGEMENT) DEPARTMENT OF DEFENSE NATIONAL SECURITY PERSONNEL SYSTEM (NSPS) Performance Management § 9901.410 Addressing performance... 5 Administrative Personnel 3 2011-01-01 2011-01-01 false Addressing performance that does not...

  19. The role of bortezomib, thalidomide and lenalidomide in the management of multiple myeloma: an overview of clinical and economic information.

    PubMed

    Messori, Andrea; Maratea, Dario; Nozzoli, Chiara; Bosi, Alberto

    2011-04-01

    Bortezomib, thalidomide and lenalidomide can be aimed at treating patients with newly diagnosed multiple myeloma (both eligible and ineligible for transplantation) as well as those with relapsed or refractory disease. This review analysed the available clinical and economic data on these three drugs. Irrespective of which of the three agents is considered, the magnitude of the benefit in newly diagnosed cases (transplanted or non-transplanted) tends to be between 10 and 20 months per patient in terms of progression-free survival or survival; the survival benefit is smaller in relapsed or refractory disease. In addition, a single-institution observational analysis evaluated the outcomes in nearly 3000 consecutive patients examined between 1971 and 2006. The survival in patients diagnosed between 2001 and 2006 was longer than that observed in patients diagnosed between 1994 and 2000. This finding supports the conclusion that novel agents provide a survival improvement compared with traditional therapy. Formal cost-effectiveness studies on these three agents are still lacking. A MEDLINE search retrieved only four short papers or letters and no full-length analysis. Hence, the cost effectiveness of these agents needs further investigation, with separate assessments of the different therapeutic settings. In a simplified analysis, we tried to contrast the average cost of treatment for each of the novel agents versus their respective benefit, expressed in quality-adjusted survival. Despite its preliminary nature, our assessment indicates that the cost effectiveness of these three agents is likely to be within commonly accepted pharmacoeconomic thresholds.

  20. The MoSt Project--more steps in multiple sclerosis: a Delphi method consensus initiative for the evaluation of mobility management of MS patients in Italy.

    PubMed

    Capra, Ruggero; Battaglia, Mario Alberto; Gaudioso, Antonio; Lopes, Laura; Paolicelli, Damiano; Paoloni, Marco; Pozzilli, Carlo; Santilli, Valter; Solaro, Claudio; Trojano, Maria

    2014-03-01

    The aim of the study was to identify the main factors that impact mobility impairment in multiple sclerosis (MS) patients in Italy. Clinicians from a large number of Italian MS centers took part in a Delphi process aimed at obtaining consensus statements among the participants. Large consensus was obtained for statements grouped under the following main MS themes: identification of the most useful scales to evaluate mobility, integration of objective evaluation with patient perceptions, impact of walking impairment on daily life, management of the disabled patient using a rehabilitative and pharmacological approach. The consensus statements developed by a large number of experts may be used as a practical reference tool to help physicians treat MS patients with motor impairment.