Environmental Monitoring and the Gas Industry: Program Manager Handbook

DOE Office of Scientific and Technical Information (OSTI.GOV)

Gregory D. Gillispie

1997-12-01

This document has been developed for the nontechnical gas industry manager who has the responsibility for the development of waste or potentially contaminated soil and groundwater data or must make decisions based on such data for the management or remediation of these materials. It explores the pse of common analytical chemistry instrumentation and associated techniques for identification of environmentally hazardous materials. Sufficient detail is given to familiarize the nontechnical reader with the principles behind the operation of each technique. The scope and realm of the techniques and their constituent variations are portrayed through a discussion of crucial details and, wheremore » appropriate, the depiction of real-life data. It is the author's intention to provide an easily understood handbook for gas industry management. Techniques which determine the presence, composition, and quantification of gas industry wastes are discussed. Greater focus is given to traditional techniques which have been the mainstay of modem analytical benchwork. However, with the continual advancement of instrumental principles and design, several techniques have been included which are likely to receive greater attention in fiture considerations for waste-related detection. Definitions and concepts inherent to a thorough understanding of the principles common to analytical chemistry are discussed. It is also crucial that gas industry managers understand the effects of the various actions which take place before, during, and after the actual sampling step. When a series of sample collection, storage, and transport activities occur, new or inexperienced project managers may overlook or misunderstand the importance of the sequence. Each step has an impact on the final results of the measurement process; errors in judgment or decision making can be costly. Specific techniques and methodologies for the collection, storage, and transport of environmental media samples are not described or discussed in detail in thk handbook. However, the underlying philosophy regarding the importance of proper collection, storage, and transport practices, as well as pertinent references, are presented.« less

Acute poisoning: understanding 90% of cases in a nutshell

PubMed Central

Greene, S; Dargan, P; Jones, A

2005-01-01

The acutely poisoned patient remains a common problem facing doctors working in acute medicine in the United Kingdom and worldwide. This review examines the initial management of the acutely poisoned patient. Aspects of general management are reviewed including immediate interventions, investigations, gastrointestinal decontamination techniques, use of antidotes, methods to increase poison elimination, and psychological assessment. More common and serious poisonings caused by paracetamol, salicylates, opioids, tricyclic antidepressants, selective serotonin reuptake inhibitors, benzodiazepines, non-steroidal anti-inflammatory drugs, and cocaine are discussed in detail. Specific aspects of common paediatric poisonings are reviewed. PMID:15811881

Acute poisoning: understanding 90% of cases in a nutshell.

PubMed

Greene, S L; Dargan, P I; Jones, A L

2005-04-01

The acutely poisoned patient remains a common problem facing doctors working in acute medicine in the United Kingdom and worldwide. This review examines the initial management of the acutely poisoned patient. Aspects of general management are reviewed including immediate interventions, investigations, gastrointestinal decontamination techniques, use of antidotes, methods to increase poison elimination, and psychological assessment. More common and serious poisonings caused by paracetamol, salicylates, opioids, tricyclic antidepressants, selective serotonin reuptake inhibitors, benzodiazepines, non-steroidal anti-inflammatory drugs, and cocaine are discussed in detail. Specific aspects of common paediatric poisonings are reviewed.

Awake Craniotomy Anesthesia: A Comparison of the Monitored Anesthesia Care and Asleep-Awake-Asleep Techniques.

PubMed

Eseonu, Chikezie I; ReFaey, Karim; Garcia, Oscar; John, Amballur; Quiñones-Hinojosa, Alfredo; Tripathi, Punita

2017-08-01

Commonly used sedation techniques for an awake craniotomy include monitored anesthesia care (MAC), using an unprotected airway, and the asleep-awake-asleep (AAA) technique, using a partially or totally protected airway. We present a comparative analysis of the MAC and AAA techniques, evaluating anesthetic management, perioperative outcomes, and complications in a consecutive series of patients undergoing the removal of an eloquent brain lesion. Eighty-one patients underwent awake craniotomy for an intracranial lesion over a 9-year period performed by a single-surgeon and a team of anesthesiologists. Fifty patients were treated using the MAC technique, and 31 were treated using the AAA technique. A retrospective analysis evaluated anesthetic management, intraoperative complications, postoperative outcomes, pain management, and complications. The MAC and AAA groups had similar preoperative patient and tumor characteristics. Mean operative time was shorter in the MAC group (283.5 minutes vs. 313.3 minutes; P = 0.038). Hypertension was the most common intraoperative complication seen (8% in the MAC group vs. 9.7% in the AAA group; P = 0.794). Intraoperative seizure occurred at a rate of 4% in the MAC group and 3.2% in the AAA group (P = 0.858). Awake cases were converted to general anesthesia in no patients in the MAC group and in 1 patient (3.2%) in the AAA group (P = 0.201). No cases were aborted in either group. The mean hospital length of stay was 3.98 days in the MAC group and 3.84 days in the AAA group (P = 0.833). Both the MAC and AAA sedation techniques provide an efficacious and safe method for managing awake craniotomy cases and produce similar perioperative outcomes, with the MAC technique associated with shorter operative time. Copyright © 2017 Elsevier Inc. All rights reserved.

Advances in Meniscal Tissue Engineering

PubMed Central

Longo, Umile Giuseppe; Loppini, Mattia; Forriol, Francisco; Romeo, Giovanni; Maffulli, Nicola; Denaro, Vincenzo

2012-01-01

Meniscal tears are the most common knee injuries and have a poor ability of healing. In the last few decades, several techniques have been increasingly used to optimize meniscal healing. Current research efforts of tissue engineering try to combine cell-based therapy, growth factors, gene therapy, and reabsorbable scaffolds to promote healing of meniscal defects. Preliminary studies did not allow to draw definitive conclusions on the use of these techniques for routine management of meniscal lesions. We performed a review of the available literature on current techniques of tissue engineering for the management of meniscal tears. PMID:25098366

Comparison of Two Spectrophotometric Techniques for Nutrients Analyses in Water Samples

NASA Astrophysics Data System (ADS)

Bartošová, Alica; Michalíková, Anna; Sirotiak, Maroš; Soldán, Maroš

2013-01-01

The aim of this contribution is to compare two common techniques for determining the concentrations of nitrate, nitrite, ammonium and phosphates in surface water and groundwater. Excess of these nutrients in water can directly affect human health (e.g. methemoglobinaemia) or indirectly through the products of secondary pollution - eutrophication (e.g. cyanotoxins, emanation of hydrogen sulphide, mercaptanes, methane...). Negative impact of nutrients excess in surface water often causes the destruction of water ecosystems, and therefore, common substances of these elements must be monitored and managed. For these experiments two spectrophotometric techniques - ultraviolet spectrophotometry and nutrient photometry were used. These techniques are commonly used for quick and simple analyses of nutrients in waste water. There are calibration curves for each nutrient and for determination of their concentration.

A Methodology for Inferring the Causes of Observed Impairments in Aquatic Ecosystems (Journal)

EPA Science Inventory

Abstract—Biological surveys have become a common technique for determining whether aquatic communities have been injured. However, their results are not useful for identifying management options until the causes of apparent injuries have been identified. Techniques for determin...

Medical management of male infertility in the absence of a specific etiology.

PubMed

Gudeloglu, Ahmet; Brahmbhatt, Jamin V; Parekattil, Sijo J

2014-07-01

Idiopathic male infertility can be diagnosis in approximately one-third of infertile males. The empirical medical treatment with or without assisted reproductive techniques appears common in male infertility practice. This type of management can be classified as hormonal treatment including gonadotropins, antiestrogens, and aromatase inhibitors and support with antioxidant supplements such as carnitine, lycopene, glutathione, and vitamin E. This review investigates the evidence of commonly used empirical medical management of male infertility when there is no demonstrable diagnosis. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Two-Stage Technique Used to Manage Severe Upper Airway Obstruction and Avoid Surgical Tracheostomy: A Case Report.

PubMed

Onwochei, Desire N; El-Boghdadly, Kariem; Ahmad, Imran

2018-03-01

Severe upper airway obstruction is commonly managed with surgical tracheostomy under local anesthesia. We present a 49-year-old woman with postradiotherapy laryngeal fixation and transglottic stenosis for dilation of a pharyngeal stricture who refused elective tracheostomy. A 2-stage technique was used, which involved an awake fiberoptic intubation, followed by the transtracheal insertion of a Cricath needle and ventilation using an ejector-based Ventrain device. We discuss management aspects of this clinical scenario and the principles by which the Ventrain works.

The pursuit of colostomy continence.

PubMed

Roberts, D J

1997-03-01

The lifelong management required by patients with permanent colostomies leads to dissatisfaction with quality of life for many. Through the years, multiple techniques have been attempted to improve the quality of life by pursuing colostomy continence. Such endeavors include surgical interventions, nonsurgical devices and management, and behavior modification techniques. Efforts in research and development continue, and the desire to achieve continence of the stoma remain common cause among persons with on ostomy and those involved in their care.

Laparoendoscopic management of concomitant gallbladder stones and common bile duct stones: what is the best technique?

PubMed

El-Geidie, Ahmed Abdel-Raouf

2011-08-01

The intraoperative use of endoscopic retrograde cholangiopancreatography (ERCP) during laparoscopic cholecystectomy (LC) is a safe, single-stage option for the management of concomitant gallstones (GS) and common bile duct stones (CBDS). This study aims to compare between 2 techniques of combined laparoendoscopic management, which are laparoendoscopic Rendez-vous (LC/LERV) technique and standard ERCP after the completion of LC intraoperative endoscopic sphincterotomy (IOES). Patients with GS and suspected CBDS were included. They were divided into 2 groups; LC/LERV and LC/IOES. Both groups were compared for failure of endoscopic sphincterotomy/stone extraction, operative time, conversion rate, mortality/morbidity, and length of hospital stay. Between October 2007 and February 2010, 98 patients with GS and CBDS were eligible for inclusion in the study. They were prospectively randomized into 2 groups; LC/LERV (N=45) and LC/IOES (N=53). There were no differences in preoperative parameters between both groups. There was a significant difference in operative time (shorter for LC/IOES). No difference was noted in success/failure rate, post-ERCP pancreatitis. Both Standard ERCP after the completion of LC and LC/LERV are valid single-session management for CBD stones, but LC-ERCP may be preferred.

Managing Conflict.

ERIC Educational Resources Information Center

Lindelow, John; Scott, James J.

Chapter 15 of a revised volume on school leadership, this chapter defines and categorizes conflict and outlines techniques for its management in schools. Conflict, endemic to human existence, exists on many levels and assumes various forms. This chapter focuses on social conflict, or antagonistic interaction between individuals or groups common to…

Hirschsprung disease.

PubMed

Haricharan, Ramanath N; Georgeson, Keith E

2008-11-01

Hirschsprung disease is a relatively common condition managed by pediatric surgeons. Significant advances have been made in understanding its etiologies in the last decade, especially with the explosion of molecular genetic techniques and early diagnosis. The surgical management has progressed from a two- or three-stage procedure to a primary operation. More recently, definitive surgery for Hirschsprung disease through minimally invasive techniques has gained popularity. In neonates, the advancement of treatment strategies for Hirschsprung disease continues with reduced patient morbidity and improved outcomes.

Examining the Results of Podcast Relaxation Techniques in Higher Education

ERIC Educational Resources Information Center

Ricks, Jenny; Naquin, Millie; Vest, Amy; Hurtt, Dee; Cole, Diane

2011-01-01

College students face many stressors such as academic course work, finances, living away from home, and planning for the future. Knowledge of stress management techniques can assist students in coping with such stressors, especially when disseminated through convenient technologies which are increasingly common in their personal and academic…

Microwave and radiofrequency techniques for clinical hyperthermia.

PubMed Central

Cheung, A. Y.

1982-01-01

Biological and practical constraints on the use of clinical hyperthermia for the management of cancer are discussed. Commonly used electromagnetic techniques for producing clinical hyperthermia are reviewed and compared. Innovative engineering designs leading to the realization of an integrated, safe and reliable clinical hyperthermia system are also presented. PMID:6950753

The Leadership Evaluation and Analysis Program (LEAP). Economic Feasibility Report.

DTIC Science & Technology

1979-07-01

data input and retrieval system that generates common solutions to Marine Corps con- cerns and produces leadership/ management training material while...experimental measures to assess the effects of Human Resource Management Cycle intervention aboard Navy ships (Mumford, 1976). Planned future evaluation...some management process or technique. Generally, the entire inter- vention procedure represents an expenditure toward the primary goal of improving

Managerial Behaviors of Elementary School Teachers and Student On-Task Behavior.

ERIC Educational Resources Information Center

Goldstein, Jane McCarthy

The classroom management techniques of elementary school teachers were observed to determine their effectiveness in promoting desirable on-task behavior on the part of pupils. Seven approaches to class management were used as a framework for observation--authoritarian, behavior modification, common sense, group process, instructional emphasis,…

School Management by Wandering Around.

ERIC Educational Resources Information Center

Frase, Larry; Hetzel, Robert

Management by wandering around (MBWA) is the catalyst that brings teachers, aides, parents, and administrators together in the pursuit of excellent schools. This book, based on common sense and hundreds of years of experience, offers specific strategies and techniques for using MBWA to obtain excellence. The building blocks of school excellence,…

An introduction to the processes, problems, and management of urban lakes

USGS Publications Warehouse

Britton, L.J.; Averett, R.C.; Ferreira, R.F.

1975-01-01

As lake studies become more common, sampling techniques for data collection need increased accuracy and consistency, in order to make meaningful comparisons between different lakes. Therefore, the report discusses the main factors involved in conducting lake studies. These factors include the types and frequency of measurements useful in lake reconnaissance studies and a review of literature on sampling equipment and techniques. A glossary of selected terms begins the report, which is intended for guideline use by urban planners and managers.

Mandible Fractures

PubMed Central

Pickrell, Brent B.; Serebrakian, Arman T.; Maricevich, Renata S.

2017-01-01

Mandible fractures account for a significant portion of maxillofacial injuries and the evaluation, diagnosis, and management of these fractures remain challenging despite improved imaging technology and fixation techniques. Understanding appropriate surgical management can prevent complications such as malocclusion, pain, and revision procedures. Depending on the type and location of the fractures, various open and closed surgical reduction techniques can be utilized. In this article, the authors review the diagnostic evaluation, treatment options, and common complications of mandible fractures. Special considerations are described for pediatric and atrophic mandibles. PMID:28496390

Mandible Fractures.

PubMed

Pickrell, Brent B; Serebrakian, Arman T; Maricevich, Renata S

2017-05-01

Mandible fractures account for a significant portion of maxillofacial injuries and the evaluation, diagnosis, and management of these fractures remain challenging despite improved imaging technology and fixation techniques. Understanding appropriate surgical management can prevent complications such as malocclusion, pain, and revision procedures. Depending on the type and location of the fractures, various open and closed surgical reduction techniques can be utilized. In this article, the authors review the diagnostic evaluation, treatment options, and common complications of mandible fractures. Special considerations are described for pediatric and atrophic mandibles.

Definitive airway management of patients presenting with a pre-hospital inserted King LT(S)-D laryngeal tube airway: a historical cohort study.

PubMed

Subramanian, Arun; Garcia-Marcinkiewicz, Annery G; Brown, Daniel R; Brown, Michael J; Diedrich, Daniel A

2016-03-01

The King LT(S)-D laryngeal tube (King LT) has gained popularity as a bridge airway for pre-hospital airway management. In this study, we retrospectively reviewed the use of the King LT and its associated airway outcomes at a single Level 1 trauma centre. The data on all adult patients presenting to the Mayo Clinic in Rochester, Minnesota with a King LT in situ from July 1, 2007 to October 10, 2012 were retrospectively evaluated. Data collected and descriptively analyzed included patient demographics, comorbidities, etiology of respiratory failure, airway complications, subsequent definitive airway management technique, duration of mechanical ventilation, and status at discharge. Forty-eight adult patients met inclusion criteria. The most common etiology for respiratory failure requiring an artificial airway was cardiac arrest [28 (58%) patients] or trauma [9 (19%) patients]. Four of the nine trauma patients had facial trauma. Surgical tracheostomy was the definitive airway management technique in 14 (29%) patients. An airway exchange catheter, direct laryngoscopy, and video laryngoscopy were used in 11 (23%), ten (21%), and ten (21%) cases, respectively. Seven (78%) of the trauma patients underwent surgical tracheostomy compared with seven (18%) of the medical patients. Adverse events associated with King LT use occurred in 13 (27%) patients, with upper airway edema (i.e., tongue engorgement and glottic edema) being most common (19%). In this study of patients presenting to a hospital with a King LT, the majority of airway exchanges required an advanced airway management technique beyond direct laryngoscopy. Upper airway edema was the most common adverse observation associated with King LT use.

Diagnosis and Management of Distal Clavicle Osteolysis.

PubMed

DeFroda, Steven F; Nacca, Christopher; Waryasz, Gregory R; Owens, Brett D

2017-03-01

Distal clavicle osteolysis is an uncommon condition that most commonly affects weight lifters and other athletes who perform repetitive overhead activity. Although this condition most commonly presents in young active men, it is becoming increasing more common in women with the rise in popularity of body building and extreme athletics. Distal clavicle osteolysis can be debilitating, especially in those with rigorous training regimens, preventing exercise because of pain with activities such as bench presses and chest flies. Aside from a careful history and physical examination, radiographic evaluation is essential in distinguishing isolated distal clavicle osteolysis from acromioclavicular joint pathology, despite a potentially similar presentation of the 2 conditions. Nonoperative therapy that includes activity modification, nonsteroidal anti-inflammatory drugs, and cortisone injections is the first-line management for this condition. Patients whose conditions are refractory to nonoperative modalities may benefit from distal clavicle resection via either open or arthroscopic techniques. Arthroscopic techniques typically are favored because of improved cosmesis and the added benefit of the ability to assess the glenohumeral joint during surgery to rule out concomitant pathology. There are varying operative techniques even within arthroscopic management, with pros and cons of a direct and an indirect surgical approach. Patients often do well after such procedures and are able to return to their preinjury level of participation in a relatively short period. [Orthopedics. 2017; 40(2):119-124.]. Copyright 2016, SLACK Incorporated.

Watch for pitfalls of discounted cash flow techniques.

PubMed

Chow, C W; McNamee, A H

1991-04-01

Discounted cash flow (DCF) techniques can enhance the effectiveness of a healthcare organization's capital budgeting decisions. But a financial manager unaware of common misapplications of DCF techniques may make capital decisions with a hidden bias against long-term projects, an inaccurate evaluation of options, or inappropriate estimations of expected inflation and risk. Social and psychological factors also can impede effective decisions on projects already introduced.

Comparison of five canopy cover estimation techniques in the western Oregon Cascades.

Treesearch

Anne C.S. Fiala; Steven L. Garman; Andrew N. Gray

2006-01-01

Estimates of forest canopy cover are widely used in forest research and management, yet methods used to quantify canopy cover and the estimates they provide vary greatly. Four commonly used ground-based techniques for estimating overstory cover - line-intercept, spherical densiometer, moosehorn, and hemispherical photography - and cover estimates generated from crown...

A comparison of cover calculation techniques for relating point-intercept vegetation sampling to remote sensing imagery

USDA-ARS?s Scientific Manuscript database

Accurate and timely spatial predictions of vegetation cover from remote imagery are an important data source for natural resource management. High-quality in situ data are needed to develop and validate these products. Point-intercept sampling techniques are a common method for obtaining quantitativ...

Development and evaluation of the photoload sampling technique

Treesearch

Robert E. Keane; Laura J. Dickinson

2007-01-01

Wildland fire managers need better estimates of fuel loading so they can accurately predict potential fire behavior and effects of alternative fuel and ecosystem restoration treatments. This report presents the development and evaluation of a new fuel sampling method, called the photoload sampling technique, to quickly and accurately estimate loadings for six common...

Tube Thoracostomy: Complications and Its Management

PubMed Central

Kesieme, Emeka B.; Dongo, Andrew; Ezemba, Ndubueze; Irekpita, Eshiobo; Jebbin, Nze; Kesieme, Chinenye

2012-01-01

Background. Tube thoracostomy is widely used throughout the medical, surgical, and critical care specialities. It is generally used to drain pleural collections either as elective or emergency. Complications resulting from tube thoracostomy can occasionally be life threatening. Aim. To present an update on the complications and management of complications of tube thoracostomy. Methods. A review of the publications obtained from Medline search, medical libraries, and Google on tube thoracostomy and its complications was done. Results. Tube thoracostomy is a common surgical procedure which can be performed by either the blunt dissection technique or the trocar technique. Complication rates are increased by the trocar technique. These complications have been broadly classified as either technical or infective. Technical causes include tube malposition, blocked drain, chest drain dislodgement, reexpansion pulmonary edema, subcutaneous emphysema, nerve injuries, cardiac and vascular injuries, oesophageal injuries, residual/postextubation pneumothorax, fistulae, tumor recurrence at insertion site, herniation through the site of thoracostomy, chylothorax, and cardiac dysrhythmias. Infective complications include empyema and surgical site infection. Conclusion. Tube thoracostomy, though commonly performed is not without risk. Blunt dissection technique has lower risk of complications and is hence recommended. PMID:22028963

Unicameral bone cysts: general characteristics and management controversies.

PubMed

Pretell-Mazzini, Juan; Murphy, Robert Francis; Kushare, Indranil; Dormans, John P

2014-05-01

Unicameral bone cysts are benign bone lesions that are often asymptomatic and commonly develop in the proximal humerus and femur of skeletally immature patients. The etiology of these lesions remains unknown. Most patients present with a pathologic fracture, but these cysts can be discovered incidentally, as well. Radiographically, a unicameral bone cyst appears as a radiolucent lesion with cortical thinning and is centrally located within the metaphysis. Although diagnosis is frequently straightforward, management remains controversial. Because the results of various management methods are heterogeneous, no single method has emerged as the standard of care. New minimally invasive techniques involve cyst decompression with bone grafting and instrumentation. These techniques have yielded promising results, with low rates of complications and recurrence reported; however, prospective clinical trials are needed to compare these techniques with current evidence-based treatments.

The aetiology and management of localized anterior tooth wear in the young adult.

PubMed

Bishop, K; Briggs, P; Kelleher, M

1994-05-01

This article reviews the aetiology and clinical features of the increasingly common problem of localized loss of anterior tooth tissue in the young adult. The management of the problem is highlighted, with emphasis placed on preservation of the tooth structure and the use of modern materials and techniques.

Assessing soil erosion on trails: A comparison of techniques

Treesearch

Mark C. Jewell; William E. Hammitt

2000-01-01

Reports of trail degradation have been increasing in different wildernesses. This impact has become a common concern among managers. Deteriorating tread conditions of trails are increasing, as is concern at protected areas worldwide. In order to make objective and timely trail resource decisions, managers need to have effective and efficient methods of assessing trail...

Adult Cancer Pain

PubMed Central

Swarm, Robert A.; Abernethy, Amy Pickar; Anghelescu, Doralina L.; Benedetti, Costantino; Buga, Sorin; Cleeland, Charles; deLeon-Casasola, Oscar A.; Eilers, June G.; Ferrell, Betty; Green, Mark; Janjan, Nora A.; Kamdar, Mihir M.; Levy, Michael H.; Lynch, Maureen; McDowell, Rachel M.; Moryl, Natalie; Nesbit, Suzanne A.; Paice, Judith A.; Rabow, Michael W.; Syrjala, Karen L.; Urba, Susan G.; Weinstein, Sharon M.; Dwyer, Mary; Kumar, Rashmi

2018-01-01

Pain is a common symptom associated with cancer and its treatment. Pain management is an important aspect of oncologic care, and unrelieved pain significantly comprises overall quality of life. These NCCN Guidelines list the principles of management and acknowledge the range of complex decisions faced in the management oncologic pain. In addition to pain assessment techniques, these guidelines provide principles of use, dosing, management of adverse effects, and safe handling procedures of pharmacologic therapies and discuss a multidisciplinary approach for the management of cancer pain. PMID:23946177

Program risk analysis handbook

NASA Technical Reports Server (NTRS)

Batson, R. G.

1987-01-01

NASA regulations specify that formal risk analysis be performed on a program at each of several milestones. Program risk analysis is discussed as a systems analysis approach, an iterative process (identification, assessment, management), and a collection of techniques. These techniques, which range from extremely simple to complex network-based simulation, are described in this handbook in order to provide both analyst and manager with a guide for selection of the most appropriate technique. All program risk assessment techniques are shown to be based on elicitation and encoding of subjective probability estimates from the various area experts on a program. Techniques to encode the five most common distribution types are given. Then, a total of twelve distinct approaches to risk assessment are given. Steps involved, good and bad points, time involved, and degree of computer support needed are listed. Why risk analysis should be used by all NASA program managers is discussed. Tools available at NASA-MSFC are identified, along with commercially available software. Bibliography (150 entries) and a program risk analysis check-list are provided.

Earth Observatory Satellite system definition study. Report no. 4: Management approach recommendations

NASA Technical Reports Server (NTRS)

1974-01-01

A management approach for the Earth Observatory Satellite (EOS) which will meet the challenge of a constrained cost environment is presented. Areas of consideration are contracting techniques, test philosophy, reliability and quality assurance requirements, commonality options, and documentation and control requirements. The various functional areas which were examined for cost reduction possibilities are identified. The recommended management approach is developed to show the primary and alternative methods.

Making Quality Sense: A Guide to Quality, Tools and Techniques, Awards and the Thinking Behind Them.

ERIC Educational Resources Information Center

Owen, Jane

This document is intended to guide further education colleges and work-based learning providers through some of the commonly used tools, techniques, and theories of quality management. The following are among the topics discussed: (1) various ways of defining quality; methods used by organizations to achieve quality (quality control, quality…

[Latest trends in the surgical management of mandibular condyle fractures in France, 2005-2012].

PubMed

Trost, O; Péron, J-M

2013-12-01

The surgical treatment of mandibular condylar fractures is commonly performed. We had for aim to present the latest trends in the surgical management of condylar fractures in France, between 2005 and 2012. A survey was performed among the 49 members of the French college of oral and maxillofacial surgeons between January and September 2012, with a questionnaire sent by email. We analyzed the therapeutic management, the surgical indications; the techniques used according to the fracture, and the postoperative treatment protocols. The data was compared to that of a similar study performed in 2005. The overall reply rate was 86%. Low subcondylar fractures were operated on in all institutions (100%), compared to 76% in 2005. The most popular technique was the high submandibular approach with intraoral miniplate fixation osteosynthesis. High subcondylar and diacapitular fractures were operated on in respectively 82% and 35% of the cases compared to 29% and 10% in 2005 with various surgical techniques and postoperative management. French maxillofacial surgeons operated on more mandibular condylar fractures in 2012 than in 2005. As observed in 2005, the lower and the more dislocated the fractures were, the more they were operated on. The high submandibular approach has become the most popular approach. The use of miniplates for bone fixation has become common. Diacapitular fractures were usually treated functionally. The postoperative management varied greatly from one team to the other. Copyright © 2013. Published by Elsevier Masson SAS.

Management of wetlands for wildlife

USGS Publications Warehouse

Matthew J. Gray,; Heath M. Hagy,; J. Andrew Nyman,; Stafford, Joshua D.

2013-01-01

Wetlands are highly productive ecosystems that provide habitat for a diversity of wildlife species and afford various ecosystem services. Managing wetlands effectively requires an understanding of basic ecosystem processes, animal and plant life history strategies, and principles of wildlife management. Management techniques that are used differ depending on target species, coastal versus interior wetlands, and available infrastructure, resources, and management objectives. Ideally, wetlands are managed as a complex, with many successional stages and hydroperiods represented in close proximity. Managing wetland wildlife typically involves manipulating water levels and vegetation in the wetland, and providing an upland buffer. Commonly, levees and water control structures are used to manipulate wetland hydrology in combination with other management techniques (e.g., disking, burning, herbicide application) to create desired plant and wildlife responses. In the United States, several conservation programs are available to assist landowners in developing wetland management infrastructure on their property. Managing wetlands to increase habitat quality for wildlife is critical, considering this ecosystem is one of the most imperiled in the world.

Academic Guidance for Undergraduate Students in a South African Medical School: Can We Guide Them All?

ERIC Educational Resources Information Center

Jama, Mpho P.

2016-01-01

Higher education institutions, including medical schools, still grapple with the challenge of poor academic performance of students. Some studies report the positive results of providing academic guidance for common challenges such as poor and/or ineffective time management, study methods, test- and exam-taking techniques and management, and the…

Mineralogical and micromorphological modifications in soil affected by slash pile burn

Treesearch

M. M. Nobles; W. J. Massman; M. Mbila; G. Butters

2010-01-01

Silvicultural practices, such as slash pile burning, are commonly used for fire and ecosystem management. This management technique can drastically alter chemical, physical and biological soil properties due to the high temperatures achieved during the prolonged severe burn. Little is known, however, about the impact of high-temperature slash pile burning on soil...

Airway emergencies presenting to the paediatric emergency department requiring advanced management techniques.

PubMed

Simma, Leopold; Cincotta, Domenic; Sabato, Stefan; Long, Elliot

2017-09-01

Airway emergencies presenting to the emergency department (ED) are usually managed with conventional equipment and techniques. The patient group managed urgently in the operating room (OR) has not been described. This study aims to describe a case series of children presenting to the ED with airway emergencies managed urgently in the OR, particularly the anaesthetic equipment and techniques used and airway findings. A retrospective cohort study undertaken at The Royal Children's Hospital, Melbourne, Australia. All patients presenting to the ED between 1 January 2012 and 30 July 2015 (42 months) with an airway emergency who were subsequently managed in the OR were included. Patient characteristics, anaesthetic equipment and technique and airway findings were recorded. Twenty-two airway emergencies in 21 patients were included over the study period, on average one every 2 months. Median age was 18 months and 43% were male. Inhalational induction was used in 77.3%, combined inhalational and intravenous induction in 9.1%, and intravenous induction alone in 13.6%. The most commonly used inhalational induction agent was sevoflurane, and the most commonly used intravenous induction agents were ketamine and propofol. Ten airway emergencies did not require intubation, seven for removal of inhaled foreign body, two with progressive tracheal stenosis requiring emergent dilatation and one examination under anaesthesia to rule out inhaled foreign body. Of the 12 airway emergencies that required immediate intubation, direct laryngoscopy was used in 9 and fibre-optic intubating bronchoscopy in 3. For intubations performed by direct laryngoscopy, one was difficult (Cormack and Lehane grade 3). First pass success was 83.3%. Adverse events occurred in 3/22 (13.6%) cases. Advanced airway techniques, including inhalational induction and intubation via fibre-optic intubating bronchoscope, are rarely but predictably required in the management of patients presenting to the ED. Institutions caring for children should prepare in advance where such patients should be managed, by whom, and provide equipment and training for their care. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

All-inside, anatomical lateral ankle stabilization for revision and complex primary lateral ankle stabilization: a technique guide.

PubMed

Prissel, Mark A; Roukis, Thomas S

2014-12-01

Lateral ankle instability is a common mechanical problem that often requires surgical management when conservative efforts fail. Historically, myriad open surgical approaches have been proposed. Recently, consideration for arthroscopic management of lateral ankle instability has become popular, with promising results. Unfortunately, recurrent inversion ankle injury following lateral ankle stabilization can occur and require revision surgery. To date, arthroscopic management for revision lateral ankle stabilization has not been described. We present a novel arthroscopic technique combining an arthroscopic lateral ankle stabilization kit with a suture anchor ligament augmentation system for revision as well as complex primary lateral ankle stabilization. © 2014 The Author(s).

Reverse waffle cone technique in management of stent dislodgement into intracranial aneurysms.

PubMed

Luo, Chao-Bao; Lai, Yen-Jun; Teng, Michael Mu-Huo; Chang, Feng-Chi; Lin, Chung-Jung; Guo, Wan-Yuo

2013-09-01

Stent-assisted coil embolization (SACE) is a common method to manage intracranial wide-neck aneurysm. Using this technique, a stent must be successfully deployed into the parent artery to cross the aneurysm neck. We describe the reverse waffle cone technique in management of intra-procedural stent dislodgement during SACE of internal carotid artery (ICA) wide-neck aneurysms. Two patients with unruptured wide-neck ICA aneurysms underwent SACE. Intra-procedural forward stent migration occurred during catheterization with proximal stent dislodgement and migration into the aneurysm sac. Navigation of a second stent to bridge the aneurysm neck failed in one patient because the second stent was impeded by the dislodged stent. Using the reverse waffle cone technique, a microcatheter was navigated into the aneurysm sacs. Coils were safely detached into each aneurysm sac without any device assistance. The two wide-neck aneurysms were successfully treated with preservation of flow to the internal carotid arteries. The complication of intra-procedural distal stent migration and dislodgement, with proximal stent prolapse into an aneurysm sac, may not result in a failure to coil the aneurysm. The reverse waffle cone technique provides an effective treatment in the management of this complication. Copyright © 2013 Elsevier Ltd. All rights reserved.

[Surgical treatment of anal fistula].

PubMed

Zeng, Xiandong; Zhang, Yong

2014-12-01

Anal fistula is a common disease. It is also quite difficult to be solved without recurrence or damage to the anal sphincter. Several techniques have been described for the management of anal fistula, but there is no final conclusion of their application in the treatment. This article summarizes the history of anal fistula management, the current techniques available, and describes new technologies. Internet online searches were performed from the CNKI and Wanfang databases to identify articles about anal fistula management including seton, fistulotomy, fistulectomy, LIFT operation, biomaterial treatment and new technology application. Every fistula surgery technique has its own place, so it is reasonable to give comprehensive individualized treatment to different patients, which may lead to reduced recurrence and avoidance of damage to the anal sphincter. New technologies provide promising alternatives to traditional methods of management. Surgeons still need to focus on the invention and improvement of the minimally invasive techniques. Besides, a new therapeutic idea is worth to explore that the focus of surgical treatment should be transferred to prevention of the formation of anal fistula after perianal abscess.

Financial Analysis: A Review of the Methods and Their Application to Employee Training. Training and Development Research Center Project Number Nine.

ERIC Educational Resources Information Center

Mosier, Nancy R.

Financial analysis techniques are tools that help managers make sound financial decisions that contribute to general corporate objectives. A literature review reveals that the most commonly used financial analysis techniques are payback time, average rate of return, present value or present worth, and internal rate of return. Despite the success…

The photoload sampling technique: estimating surface fuel loadings from downward-looking photographs of synthetic fuelbeds

Treesearch

Robert E. Keane; Laura J. Dickinson

2007-01-01

Fire managers need better estimates of fuel loading so they can more accurately predict the potential fire behavior and effects of alternative fuel and ecosystem restoration treatments. This report presents a new fuel sampling method, called the photoload sampling technique, to quickly and accurately estimate loadings for six common surface fuel components (1 hr, 10 hr...

A short review on a complication of lumbar spine surgery: CSF leak.

PubMed

Menon, Sajesh K; Onyia, Chiazor U

2015-12-01

Cerebrospinal fluid (CSF) leak is a common complication of surgery involving the lumbar spine. Over the past decades, there has been significant advancement in understanding the basis, management and techniques of treatment for post-operative CSF leak following lumbar spine surgery. In this article, we review previous work in the literature on the various factors and technical errors during or after lumbar spine surgery that may lead to this feared complication, the available options of management with focus on the various techniques employed, the outcomes and also to highlight on the current trends. We also discuss the presentation, factors contributing to its development, basic concepts and practical aspects of the management with emphasis on the different techniques of treatment. Different outcomes following various techniques of managing post-operative CSF leak after lumbar spine surgery have been well described in the literature. However, there is currently no most ideal technique among the available options. The choice of which technique to be applied in each case is dependent on each surgeon's cumulative experience as well as a clear understanding of the contributory underlying factors in each patient, the nature and site of the leak, the available facilities and equipment. Copyright © 2015 Elsevier B.V. All rights reserved.

Quantification of transuranic elements by time interval correlation spectroscopy of the detected neutrons

PubMed

Baeten; Bruggeman; Paepen; Carchon

2000-03-01

The non-destructive quantification of transuranic elements in nuclear waste management or in safeguards verifications is commonly performed by passive neutron assay techniques. To minimise the number of unknown sample-dependent parameters, Neutron Multiplicity Counting (NMC) is applied. We developed a new NMC-technique, called Time Interval Correlation Spectroscopy (TICS), which is based on the measurement of Rossi-alpha time interval distributions. Compared to other NMC-techniques, TICS offers several advantages.

Management of toxic substances and hazardous wastes.

PubMed

Niemela, V E

1984-08-01

This paper describes the extent of the hazardous and toxic chemical waste problems in Canada and discusses the management, treatment, and disposal methods commonly used in North America and Europe. The treatment and disposal techniques covered are biological, physical-chemical, incineration technologies, and secure land disposal. Some of the available and emerging technologies for destruction of polychlorinated biphenyls are also described.

Carbon stocks across a chronosequence of thinned and unmanaged red pine (Pinus resinosa) stands

Treesearch

Matthew D. Powers; Randall K. Kolka; John B. Bradford; Brian J. Palik; Shawn Fraver; Martin F. Jurgensen

2012-01-01

Forests function as a major global C sink, and forest management strategies that maximize C stocks offer one possible means of mitigating the impacts of increasing anthropogenic CO2 emissions. We studied the effects of thinning, a common management technique in many forest types, on age-related trends in C stocks using a chronosequence of thinned...

Surgical management of gingival recession: A clinical update

PubMed Central

Alghamdi, Hamdan; Babay, Nadir; Sukumaran, Anil

2009-01-01

Gingival recession is defined as the apical migration of the junctional epithelium with exposure of root surfaces. It is a common condition seen in both dentally aware populations and those with limited access to dental care. The etiology of the condition is multifactorial but is commonly associated with underlying alveolar morphology, tooth brushing, mechanical trauma and periodontal disease. Given the high rate of gingival recession defects among the general population, it is imperative that dental practitioners have an understanding of the etiology, complications and the management of the condition. The following review describes the surgical techniques to treat gingival recession. PMID:23960465

Achilles tendon rupture: physiotherapy and endoscopy-assisted surgical treatment of a common sports injury

PubMed Central

Doral, Mahmut Nedim; Bozkurt, Murat; Turhan, Egemen; Dönmez, Gürhan; Demirel, Murat; Kaya, Defne; Ateşok, Kıvanç; Atay, Özgür Ahmet; Maffulli, Nicola

2010-01-01

Although the Achilles tendon (AT) is the strongest tendon in the human body, rupture of this tendon is one of the most common sports injuries in the athletic population. Despite numerous nonoperative and operative methods that have been described, there is no universal agreement about the optimal management strategy of acute total AT ruptures. The management of AT ruptures should aim to minimize the morbidity of the injury, optimize rapid return to full function, and prevent complications. Since endoscopy-assisted percutaneous AT repair allows direct visualization of the synovia and protects the paratenon that is important in biological healing of the AT, this technique becomes a reasonable treatment option in AT ruptures. Furthermore, Achilles tendoscopy technique may decrease the complications about the sural nerve. Also, early functional postoperative physiotherapy following surgery may improve the surgical outcomes. PMID:24198562

A Concept of Constructing a Common Information Space for High Tech Programs Using Information Analytical Systems

NASA Astrophysics Data System (ADS)

Zakharova, Alexandra A.; Kolegova, Olga A.; Nekrasova, Maria E.

2016-04-01

The paper deals with the issues in program management used for engineering innovative products. The existing project management tools were analyzed. The aim is to develop a decision support system that takes into account the features of program management used for high-tech products: research intensity, a high level of technical risks, unpredictable results due to the impact of various external factors, availability of several implementing agencies. The need for involving experts and using intelligent techniques for information processing is demonstrated. A conceptual model of common information space to support communication between members of the collaboration on high-tech programs has been developed. The structure and objectives of the information analysis system “Geokhod” were formulated with the purpose to implement the conceptual model of common information space in the program “Development and production of new class mining equipment - “Geokhod”.

Combined Endoscopic and Laparoscopic Management of Postcholecystectomy Mirizzi Syndrome from a Remnant Cystic Duct Stone: Case Report and Review of the Literature

PubMed Central

Amin, Arpit; Zhurov, Yuriy; Ibrahim, George; Maffei, Anthony; Giannone, Jonathan; Cerabona, Thomas; Kaul, Ashutosh

2016-01-01

Mirizzi syndrome has been defined in the literature as common bile duct obstruction resulting from calculi within Hartmann's pouch or cystic duct. We present a case of a 78-year-old female, who developed postcholecystectomy Mirizzi syndrome from a remnant cystic duct stone. Diagnosis of postcholecystectomy Mirizzi syndrome was made on endoscopic retrograde cholangiography (ERCP) performed postoperatively. The patient was treated with a novel strategy by combining advanced endoscopic and laparoscopic techniques in three stages as follows: Stage 1 (initial presentation): endoscopic sphincterotomy with common bile duct stent placement; Stage 2 (6 weeks after Stage 1): laparoscopic ultrasonography to locate the remnant cystic duct calculi followed by laparoscopic retrieval of the calculi and intracorporeal closure of cystic duct stump; Stage 3 (6 weeks after Stage 2): endoscopic removal of common bile duct stent along with performance of completion endoscopic retrograde cholangiogram. In addition, we have performed an extensive review of the various endoscopic and laparoscopic management techniques described in the literature for the treatment of postcholecystectomy syndrome occurring from retained cystic duct stones. PMID:27047698

Combined Endoscopic and Laparoscopic Management of Postcholecystectomy Mirizzi Syndrome from a Remnant Cystic Duct Stone: Case Report and Review of the Literature.

PubMed

Amin, Arpit; Zhurov, Yuriy; Ibrahim, George; Maffei, Anthony; Giannone, Jonathan; Cerabona, Thomas; Kaul, Ashutosh

2016-01-01

Mirizzi syndrome has been defined in the literature as common bile duct obstruction resulting from calculi within Hartmann's pouch or cystic duct. We present a case of a 78-year-old female, who developed postcholecystectomy Mirizzi syndrome from a remnant cystic duct stone. Diagnosis of postcholecystectomy Mirizzi syndrome was made on endoscopic retrograde cholangiography (ERCP) performed postoperatively. The patient was treated with a novel strategy by combining advanced endoscopic and laparoscopic techniques in three stages as follows: Stage 1 (initial presentation): endoscopic sphincterotomy with common bile duct stent placement; Stage 2 (6 weeks after Stage 1): laparoscopic ultrasonography to locate the remnant cystic duct calculi followed by laparoscopic retrieval of the calculi and intracorporeal closure of cystic duct stump; Stage 3 (6 weeks after Stage 2): endoscopic removal of common bile duct stent along with performance of completion endoscopic retrograde cholangiogram. In addition, we have performed an extensive review of the various endoscopic and laparoscopic management techniques described in the literature for the treatment of postcholecystectomy syndrome occurring from retained cystic duct stones.

Management of pilonidal disease.

PubMed

Kallis, Michelle P; Maloney, Caroline; Lipskar, Aaron M

2018-06-01

Pilonidal disease, and the treatment associated with it, can cause significant morbidity and substantial burden to patients' quality of life. Despite the plethora of surgical techniques that have been developed to treat pilonidal disease, discrepancies in technique, recurrence rates, complications, time to return to work/school and patients' aesthetic satisfaction between treatment options have led to controversy over the best approach to this common acquired disease of young adults. The management of pilonidal disease must strike a balance between recurrence and surgical morbidity. The commonly performed wide excision without closure has prolonged recovery, while flap closures speed recovery time and improve aesthetics at the expense of increased wound complications. Less invasive surgical techniques have recently evolved and are straightforward, with minimal morbidity and satisfactory results. As with any surgical intervention, the ideal treatment for pilonidal disease would be simple and cost-effective, cause minimal pain, have a limited hospital stay, low recurrence rate and require minimal time off from school or work. Less invasive procedures for pilonidal disease may be favourable as an initial approach for these patients reserving complex surgical treatment for refractory disease.

Percutaneous transhepatic cholangiography for choledocholithiasis after laparoscopic gastric bypass surgery

PubMed Central

Milella, Marialessia; Alfa-Wali, Maryam; Leuratti, Luca; McCall, James; Bonanomi, Gianluca

2014-01-01

INTRODUCTION Gallstones are a common condition in bariatric patients after a laparoscopic Roux-en-Y gastric bypass (LRYGB). The management of ductal stones is challenging due to the altered gastrointestinal anatomy. Various techniques have been reported to manage bile duct stones. PRESENTATION OF CASE We present the successful percutaneous trans hepatic management of common bile duct stones after LRYGB. One year after a LRYGB for morbid obesity, a 59-year-old female presented with acute cholecystitis. One month after laparoscopic cholecystectomy a 1 cm calculus was found within the distal CBD and patient underwent a percutaneous trans hepatic cholangiography under local anesthetic. This involved a right sided anterior segmental duct puncture. With the sphincter dilated to 10 mm, a balloon catheter was used to push the stone into the duodenum leaving an internal- external drain. Patient recovered completely at follow up. DISCUSSION Patients with morbid obesity have a higher incidence of gallstones. After LRYGB, the altered anatomy does not allow the conventional endoscopic retrograde cholangiopancreatography (ERCP) for choledocholithiasis. Various techniques have been reported as means of managing bile duct stones in LRYGB patients. These include a double balloon enteroscope-assisted ERCP, laparoscopic transgastric ERCP, laparoscopic or open biliary surgery and interventional radiology. We report a non-surgical approach using percutaneous transhepatic technique under local anesthetic that resulted effective and could be applied more extensively. CONCLUSION Due to the increase of global obesity, bariatric centers need to strategically plan resources such as interventional radiology in order to manage post LRYGB choledocholithiasis safely, efficiently and in a cost effective manner. PMID:24705194

Percutaneous transhepatic cholangiography for choledocholithiasis after laparoscopic gastric bypass surgery.

PubMed

Milella, Marialessia; Alfa-Wali, Maryam; Leuratti, Luca; McCall, James; Bonanomi, Gianluca

2014-01-01

Gallstones are a common condition in bariatric patients after a laparoscopic Roux-en-Y gastric bypass (LRYGB). The management of ductal stones is challenging due to the altered gastrointestinal anatomy. Various techniques have been reported to manage bile duct stones. We present the successful percutaneous trans hepatic management of common bile duct stones after LRYGB. One year after a LRYGB for morbid obesity, a 59-year-old female presented with acute cholecystitis. One month after laparoscopic cholecystectomy a 1cm calculus was found within the distal CBD and patient underwent a percutaneous trans hepatic cholangiography under local anesthetic. This involved a right sided anterior segmental duct puncture. With the sphincter dilated to 10mm, a balloon catheter was used to push the stone into the duodenum leaving an internal- external drain. Patient recovered completely at follow up. Patients with morbid obesity have a higher incidence of gallstones. After LRYGB, the altered anatomy does not allow the conventional endoscopic retrograde cholangiopancreatography (ERCP) for choledocholithiasis. Various techniques have been reported as means of managing bile duct stones in LRYGB patients. These include a double balloon enteroscope-assisted ERCP, laparoscopic transgastric ERCP, laparoscopic or open biliary surgery and interventional radiology. We report a non-surgical approach using percutaneous transhepatic technique under local anesthetic that resulted effective and could be applied more extensively. Due to the increase of global obesity, bariatric centers need to strategically plan resources such as interventional radiology in order to manage post LRYGB choledocholithiasis safely, efficiently and in a cost effective manner. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

A predictive modeling approach to increasing the economic effectiveness of disease management programs.

PubMed

Bayerstadler, Andreas; Benstetter, Franz; Heumann, Christian; Winter, Fabian

2014-09-01

Predictive Modeling (PM) techniques are gaining importance in the worldwide health insurance business. Modern PM methods are used for customer relationship management, risk evaluation or medical management. This article illustrates a PM approach that enables the economic potential of (cost-) effective disease management programs (DMPs) to be fully exploited by optimized candidate selection as an example of successful data-driven business management. The approach is based on a Generalized Linear Model (GLM) that is easy to apply for health insurance companies. By means of a small portfolio from an emerging country, we show that our GLM approach is stable compared to more sophisticated regression techniques in spite of the difficult data environment. Additionally, we demonstrate for this example of a setting that our model can compete with the expensive solutions offered by professional PM vendors and outperforms non-predictive standard approaches for DMP selection commonly used in the market.

The seven habits of highly effective project managers

NASA Astrophysics Data System (ADS)

Warner, Mark; Summers, Richard

2016-08-01

Why do some astronomy projects succeed, while others fail? There are obviously many different factors that can and do influence the outcome of any given project, but one of the most prevalent characteristics among successful projects is the combined skills and qualifications of the project manager (PM) at their helms. But this begs an obvious question: what exactly makes a project manager "skilled and qualified?" Asked another way, are there common traits, philosophies, and/or techniques that the most successful PMs share, and if so, what are they? The short answer is yes, the majority successful engineering project managers have significant skills, habits, and character traits in common. The longer answer is there are at least seven of these key traits, or "habits" that many successful PMs share and, more importantly, implement within their respective projects. This paper presents these key factors, including thoughts on scope and quality management, cost and schedule control, project team structures, risk management strategies, stakeholder management, and general project execution.

Successful Nonsurgical Management of Periapical Lesions of Endodontic Origin: A Conservative Orthograde Approach

PubMed Central

Karunakaran, J. V.; Abraham, Chris Susan; Karthik, A. Kaneesh; Jayaprakash, N.

2017-01-01

Periapical lesions of endodontic origin are common pathological conditions affecting periradicular tissues. Microbial infection of pulpal tissues is primarily responsible for initiation and progression of apical periodontitis. The primary objective of endodontic therapy should be to restore involved teeth to a state of normalcy nonsurgically. Different nonsurgical management techniques, namely, conservative root canal therapy, decompression technique, method using calcium hydroxide, aspiration-irrigation technique, lesion sterilization and tissue repair therapy, active nonsurgical decompression technique, and the apexum procedure have been advocated. New techniques which use drug-loaded injectable scaffolds, simvastatin, and epigallocatechin-3-gallate have been tried. Surgical option should be considered when intra- or extra-radicular infections are persistent. Incidence of nonendodontic periapical lesions has also been reported. An accurate diagnosis of the periapical lesion whether it is of endodontic or nonendodontic origin has to be made. Surgical methods have many disadvantages, and hence should be considered as an option only in the case of failure of nonsurgical techniques. Assessment of healing of periapical lesions has to be done periodically which necessitates a long-term follow-up. Even large periapical lesions and retreatment cases where the lesion is of endodontic origin have been successfully managed nonsurgically with orthograde endodontic therapy. PMID:29284973

Third Ventricular Cerebrospinal Fluid Cysts of Thalamic Origin: Review of Embryologic Origin, Presentation, and Management Strategies with a Case Series.

PubMed

Vasquez, Ciro A; Casey, Michael; Folzenlogen, Zach; Ormond, David R; Lillehei, Kevin; Youssef, A Samy

2017-07-01

Third ventricular cerebrospinal fluid (CSF) cysts of thalamic origin are rare. The objective of this study is to review their possible pathogenesis, clinical presentation, and management strategies with a case series describing management via an endoscopic approach with fenestration using a single burr-hole technique. A systematic literature review of reported cases of thalamic cysts was conducted with further meta-analysis of CSF cysts that involve the third ventricle. The mode of presentation, pathologic analysis, surgical management, and outcomes were analyzed. Twenty-two studies reported between 1990 and 2013 described 42 cases of thalamic cyst. Of those cases, 13 were consistent with CSF cyst that originated in the thalamus and involved the third ventricle. Eight cases (61.5%) were treated via endoscopic fenestration, 2 cases (15.4%) were surgically drained, 2 cases (15.4%) were stereotactically aspirated, and 1 case (7.69%) was observed. The most common presenting symptoms were gait disturbance (26.3%) and headaches (26.3%) followed by tremors (15.8%) and weakness (15.8%). In our series, a single burr-hole technique was a successful definitive treatment, with an average period of 23 months. Third ventricular CSF cysts of thalamic origin most commonly present with hydrocephalus. They can be safely definitively treated via endoscopic fenestration to the CSF circulation using a single burr-hole technique. Long-term follow-up shows lasting improvement in symptoms without reaccumulation of the cyst. Copyright © 2017 Elsevier Inc. All rights reserved.

An exploration of Bureau of Reclamation approaches for managing conflict over diverging science

USGS Publications Warehouse

Burkardt, Nina; Ruell, Emily; Clark, Douglas

2008-01-01

As a major institutional agent supplying Western water resources, the Bureau of Reclamation (Reclamation) provides important leadership, technical, and financial resources in water management, serving as the West's "water broker" (Bowersox 2000; Pisani 2003). In recent years, growing numbers of constituencies using water and the over-allocation of water resources have contributed to conflict over the resource in the American West (National Research Council 2004). Although the conflicts arise from many sources, one common theme is that Reclamation managers often must make decisions about water use and allocation when scientific studies provide uncertain or competing recommendations. We conducted a preliminary study of Reclamation water managers and water scientists to try to understand the approaches or techniques they use or consider useful for dealing with scientific conflicts over water allocation and how these compare to techniques found in the relevant literature. We report the results of (1) an electronic survey of Reclamation senior managers and (2) a panel discussion amongst Reclamation senior managers as to the current institutional capabilities for managing diverging scientific findings in water dispute resolution processes. We conclude with a discussion of the strengths and weaknesses of the different tools and techniques managers reported in the survey and in the panel discussion.

Perioperative Management of the Adult Patient on Venovenous Extracorporeal Membrane Oxygenation Requiring Noncardiac Surgery.

PubMed

Fierro, Michael A; Daneshmand, Mani A; Bartz, Raquel R

2018-01-01

The use of venovenous extracorporeal membrane oxygenation is increasing worldwide. These patients often require noncardiac surgery. In the perioperative period, preoperative assessment, patient transport, choice of anesthetic type, drug dosing, patient monitoring, and intraoperative and postoperative management of common patient problems will be impacted. Furthermore, common monitoring techniques will have unique limitations. Importantly, patients on venovenous extracorporeal membrane oxygenation remain subject to hypoxemia, hypercarbia, and acidemia in the perioperative setting despite extracorporeal support. Treatments of these conditions often require both manipulation of extracorporeal membrane oxygenation settings and physiologic interventions. Perioperative management of anticoagulation, as well as thresholds to transfuse blood products, remain highly controversial and must take into account the specific procedure, extracorporeal membrane oxygenation circuit function, and patient comorbidities. We will review the physiologic management of the patient requiring surgery while on venovenous extracorporeal membrane oxygenation.

Type 2 Endoleaks Post-EVAR: Current Evidence for Rupture Risk, Intervention and Outcomes of Treatment

DOE Office of Scientific and Technical Information (OSTI.GOV)

Chung, Raymond, E-mail: rchung@doctors.org.uk; Morgan, Robert A., E-mail: Robert.Morgan@stgeorges.nhs.uk

Type 2 endoleaks (EL2) are the most commonly encountered endoleaks following EVAR. Despite two decades of experience, there remains considerable variation in the management of EL2 with controversies ranging from if to treat, when to treat and how to treat. Here, we summarise the available evidence, describe the treatment techniques available and offer guidelines for management.

Same Planet, Different Worlds: Why Projects Continue to Fail. A Generalist Review of Project Management with Special Reference to Electronic Research Administration

ERIC Educational Resources Information Center

McCormick, Ian

2006-01-01

Implementation of IT "solutions" in the context of changes to business processes and efficiency is a common trigger for using formalised project management techniques. The trigger may include topical activities such as job evaluation schemes or quality assurance accreditation. This has led to a blurring of the boundary between projects and…

Ontology-based, multi-agent support of production management

NASA Astrophysics Data System (ADS)

Meridou, Despina T.; Inden, Udo; Rückemann, Claus-Peter; Patrikakis, Charalampos Z.; Kaklamani, Dimitra-Theodora I.; Venieris, Iakovos S.

2016-06-01

Over the recent years, the reported incidents on failed aircraft ramp-ups or the delayed production in small-lots have increased substantially. In this paper, we present a production management platform that combines agent-based techniques with the Service Oriented Architecture paradigm. This platform takes advantage of the functionality offered by the semantic web language OWL, which allows the users and services of the platform to speak a common language and, at the same time, facilitates risk management and decision making.

Intramedullary Fixation of Midshaft Clavicle Fractures.

PubMed

Fritz, Erik M; van der Meijden, Olivier A; Hussain, Zaamin B; Pogorzelski, Jonas; Millett, Peter J

2017-08-01

Clavicle fractures are among the most common fractures occurring in the general population, and the vast majority are localized in the midshaft portion of the bone. Management of midshaft clavicle fractures remains controversial. Although many can be managed nonoperatively, certain patient populations and fracture patterns, such as completely displaced and shortened fractures, are at risk of less optimal outcomes with nonoperative management; surgical intervention should be considered in such cases. The purpose of this article is to demonstrate our technique of midshaft clavicle fixation using minimally invasive intramedullary fixation.

[Blood culture negative endocarditis: a diagnostic challenge].

PubMed

Wälli, F; Chuard, C; Regamey, C

2005-10-12

Blood culture negative endocarditis (BCNE) account for about 5% of all cases of endocarditis. Diagnosis and initiation of antimicrobial therapy may be delayed, with a negative impact on clinical outcome. The most common cause of BCNE is antimicrobial drug therapy before blood sampling. Other common causes include slow growing and non cultivable organisms. Identification of the etiologic agent is critical in the management of BCNE and molecular tools such as broad range 16SrRNA PCR technique followed by direct automated sequencing and microorganism-specific PCR are promising. Some authors have proposed to include these techniques among major Duke's criteria for the diagnosis of BCNE.

Endoscopic Debridement for Treatment of Chronic Plantar Fasciitis: An Innovative Surgical Technique.

PubMed

Cottom, James M; Maker, Jared M

2016-01-01

Plantar fasciitis is one the most common pathologies seen by foot and ankle surgeons. When nonoperative therapy fails, surgical intervention is warranted. Various surgical procedures are available for the treatment of recalcitrant plantar fasciitis. The most common surgical management typically consists of open versus endoscopic plantar fascia release. The documented comorbidities associated with the release of the plantar fascia include lateral column overload and metatarsalgia. We present a new technique for this painful condition that is minimally invasive, allows visualization of the plantar fascia, and maintains the integrity of this fascia. Our hypothesis was that the use of endoscopic debridement of the plantar fascia would provide a minimally invasive technique with acceptable patient outcomes. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

MNE7 Access to the Global Commons Outcome 3 Cyber Domain. Objective 3.5 Cyber Situational Awareness. Concept of Employment for Cyber Situational Awareness Within the Global Commons Version 1.0

DTIC Science & Technology

2013-02-25

such as authentication , protocols, and ‘signature’ management exist but the imposition of such techniques must be balan 15p the legal requirements...gulation, mation face onflicting pressures to keep this data secure and yet allow access by authorised users. in the sharing network should be

Cosmetic medicine: facial resurfacing and injectables.

PubMed

Nguyen, Alexander T; Ahmad, Jamil; Fagien, Steven; Rohrich, Rod J

2012-01-01

After studying this article, the participant should be able to: 1. Describe the most common options available for minimally invasive facial rejuvenation. 2. Identify key elements essential to each treatment option. 3. Know how to avoid and manage complications for these procedures. Minimally invasive cosmetic procedures continue to increase in popularity. This article is intended to provide a broad and practical overview of common minimally invasive cosmetic techniques available to the plastic surgeon.

Surgical management of the left superior vena cava draining into the left atrium: a novel off-pump technique using the left atrial appendage

PubMed Central

Boutayeb, Alaae; Marmade, Lahcen; Bensouda, Adil; Moughil, Said

2012-01-01

The left superior vena cava is the most common congenital venous anomaly in the chest; however, its drainage into the left atrium is exceptional. The aim of the paper is to describe our novel technique to connect the left superior vena cava to the right cavities using the left atrial appendage, without cardiopulmonary bypass. PMID:22802356

Adverse Effects of Electroconvulsive Therapy.

PubMed

Andrade, Chittaranjan; Arumugham, Shyam Sundar; Thirthalli, Jagadisha

2016-09-01

Electroconvulsive therapy (ECT) is an effective treatment commonly used for depression and other major psychiatric disorders. We discuss potential adverse effects (AEs) associated with ECT and strategies for their prevention and management. Common acute AEs include headache, nausea, myalgia, and confusion; these are self-limiting and are managed symptomatically. Serious but uncommon AEs include cardiovascular, pulmonary, and cerebrovascular events; these may be minimized with screening for risk factors and by physiologic monitoring. Although most cognitive AEs of ECT are short-lasting, troublesome retrograde amnesia may rarely persist. Modifications of and improvements in treatment techniques minimize cognitive and other AEs. Copyright © 2016 Elsevier Inc. All rights reserved.

Parotitis and Sialendoscopy of the Parotid Gland.

PubMed

Hernandez, Stephen; Busso, Carlos; Walvekar, Rohan R

2016-04-01

Nonneoplastic disorders of the salivary glands involve inflammatory processes. These disorders have been managed conservatively with antibiotics, warm compresses, massage, sialogogues, and adequate hydration. Up to 40% of patients may have an inadequate response or persistent symptoms. When conservative techniques fail, the next step is operative intervention. Sialendoscopy offers a minimally invasive option for the diagnosis and management of chronic inflammatory disorders of the salivary glands and offers the option of gland and function preservation. In this article, we review some of the more common nonneoplastic disorders of the parotid gland, indications for diagnostic and interventional sialendoscopy, and operative techniques. Copyright © 2016 Elsevier Inc. All rights reserved.

Advances in facial reanimation.

PubMed

Tate, James R; Tollefson, Travis T

2006-08-01

Facial paralysis often has a significant emotional impact on patients. Along with the myriad of new surgical techniques in managing facial paralysis comes the challenge of selecting the most effective procedure for the patient. This review delineates common surgical techniques and reviews state-of-the-art techniques. The options for dynamic reanimation of the paralyzed face must be examined in the context of several patient factors, including age, overall health, and patient desires. The best functional results are obtained with direct facial nerve anastomosis and interpositional nerve grafts. In long-standing facial paralysis, temporalis muscle transfer gives a dependable and quick result. Microvascular free tissue transfer is a reliable technique with reanimation potential whose results continue to improve as microsurgical expertise increases. Postoperative results can be improved with ancillary soft tissue procedures, as well as botulinum toxin. The paper provides an overview of recent advances in facial reanimation, including preoperative assessment, surgical reconstruction options, and postoperative management.

Treatment acceptability among mexican american parents.

PubMed

Borrego, Joaquin; Ibanez, Elizabeth S; Spendlove, Stuart J; Pemberton, Joy R

2007-09-01

There is a void in the literature with regard to Hispanic parents' views about common interventions for children with behavior problems. The purpose of this study was to examine the treatment acceptability of child management techniques in a Mexican American sample. Parents' acculturation was also examined to determine if it would account for differences in treatment acceptability. Mexican American parents found response cost, a punishment-based technique, more acceptable than positive reinforcement-based techniques (e.g., differential attention). Results suggest that Mexican American parents' acculturation has little impact on acceptability of child management interventions. No association was found between mothers' acculturation and treatment acceptability. However, more acculturated Mexican American fathers viewed token economy as more acceptable than less acculturated fathers. Results are discussed in the context of clinical work and research with Mexican Americans.

Children's Problem Behaviour and Techniques to Classroom Management: A Case Study of a Preschool Classroom in Klang Valley

ERIC Educational Resources Information Center

Kamarulzaman, Wirawani binti; Zhi Siew, Pang

2015-01-01

Classroom management is a skill that every teacher should be equipped well with. Although it is common for children to misbehave once in a while in classrooms, inability for teachers to handle the situation will make the problem behaviour worsen. The study explores some of the problem behaviour that occurred in a classroom in a preschool at Klang…

The Development of Educational Environment Suited to the Japan-Specific Educational Service Using Requirements Engineering Techniques: Case Study of Running Sakai with PostgreSQL

ERIC Educational Resources Information Center

Terawaki, Yuki; Takahashi, Yuichi; Kodama, Yasushi; Yana, Kazuo

2011-01-01

This paper describes an integration of different Relational Database Management System (RDBMS) of two Course Management Systems (CMS) called Sakai and the Common Factory for Inspiration and Value in Education (CFIVE). First, when the service of CMS is provided campus-wide, the problems of user support, CMS operation and customization of CMS are…

Energy Conservation at Worcester Polytechnic Institute

ERIC Educational Resources Information Center

Pierce, Gardner T.

1976-01-01

Responding to the need for reduced energy consumption, administrators at Worcester Polytechnic Institute have discovered since 1973 that common sense and good management techniques, and the cooperation of an involved campus community, could lead to significant savings without disruption of college routines. (Editor/LBH)

A simulation-based approach to evaluate safety impacts of increased traffic signal density.

DOT National Transportation Integrated Search

2002-01-01

One of the most controversial access management techniques practitioners face is also one of the most common: restricting signal density. Increased signal density can improve access for minor approaches to a corridor; however, it can also increase de...

Managing the computational chemistry big data problem: the ioChem-BD platform.

PubMed

Álvarez-Moreno, M; de Graaf, C; López, N; Maseras, F; Poblet, J M; Bo, C

2015-01-26

We present the ioChem-BD platform ( www.iochem-bd.org ) as a multiheaded tool aimed to manage large volumes of quantum chemistry results from a diverse group of already common simulation packages. The platform has an extensible structure. The key modules managing the main tasks are to (i) upload of output files from common computational chemistry packages, (ii) extract meaningful data from the results, and (iii) generate output summaries in user-friendly formats. A heavy use of the Chemical Mark-up Language (CML) is made in the intermediate files used by ioChem-BD. From them and using XSL techniques, we manipulate and transform such chemical data sets to fulfill researchers' needs in the form of HTML5 reports, supporting information, and other research media.

Management of severe skeletal Class III malocclusion with bimaxillary orthognathic surgery

PubMed Central

Haryani, Jitesh; Nagar, Amit; Mehrotra, Divya; Ranabhatt, Rani

2016-01-01

Orthognathic surgery in conjunction with fixed orthodontics is a common indication for interdisciplinary management of severe skeletal Class III malocclusion. A thorough analysis of pretreatment investigations and development of a surgical visual treatment objective is essential to plan the type of surgical technique required. Bimaxillary orthognathic surgery is the most common type of surgical procedure for severe skeletal discrepancies. The present case report is a combined ortho-surgical team management of a skeletally Class III patient. The severity of the case required bilateral upper first premolar extraction for dentoalveolar decompensation and simultaneous “Two-jaw surgery” with maxillary advancement of 4 mm and mandibular setback of 7 mm. Postsurgery, a pleasing good facial profile was achieved with Class II molar relation and positive overjet. PMID:27994433

The quality management journey: the progress of health facilities in Australia.

PubMed

Carr, B J

1994-12-01

Many facilities in Australia have taken the Total Quality Management (TQM) step. The objective of this study was to examine progress of adopted formal quality systems in health. Sixty per cent of organizations surveyed have adopted formal systems. Of these, Deming adherents are the most common, followed by eclectic choices. Only 35% considered the quality transition as reasonably easy. There was no relationship between accreditation and formal quality systems identified. The most common improvement techniques were: flow charts, histograms, and cause and effect diagrams. Quality practitioners are happy to use several tools exceptionally well rather than have many tools at their disposal. The greatest impediment to the adoption of quality was the lack of top management support. This study did not support the view that clinicians are not readily actively supporting quality initiatives. Total Quality Management is not a mature concept; however, Chief Executive Officers are assured that rewards will be realized over time.

Iatrogenic-Related Transplant Injuries: The Role of the Interventional Radiologist

PubMed Central

Copelan, Alexander; George, Daniel; Kapoor, Baljendra; Nghiem, Hahn Vu; Lorenz, Jonathan M.; Erly, Brian; Wang, Weiping

2015-01-01

As advances in surgical techniques and postoperative care continue to improve outcomes, the use of solid organ transplants as a treatment for end-stage organ disease is increasing. With the growing population of transplant patients, there is an increasing need for radiologic diagnosis and minimally invasive procedures for the management of posttransplant complications. Typical complications may be vascular or nonvascular. Vascular complications include arterial stenosis, graft thrombosis, and development of fistulae. Common nonvascular complications consist of leaks, abscess formation, and stricture development. The use of interventional radiology in the management of these problems has led to better graft survival and lower patient morbidity and mortality. An understanding of surgical techniques, postoperative anatomy, radiologic findings, and management options for complications is critical for proficient management of complex transplant cases. This article reviews these factors for kidney, liver, pancreas, islet cell, lung, and small bowel transplants. PMID:26038621

Primary and secondary management of pediatric soft tissue injuries.

PubMed

Hogg, Nicholas J V

2012-08-01

Injury is the most common cause of death in pediatric patients, with a large proportion related to head injury. The craniofacial region in children develops rapidly and at an early age, making the area more prominent compared with the remainder of the body, increasing the likelihood of injury. This article reviews the primary management of pediatric soft tissue injuries, including assessment, cleansing, surgical technique, anesthesia, and considerations for special wounds. The secondary management of pediatric facial injury is also discussed, including scar revision, management of scar hypertrophy/keloids, and staged surgical correction. Copyright © 2012 Elsevier Inc. All rights reserved.

Congenital Adrenal Hyperplasia: Review from a Surgeon’s Perspective in the Beginning of the Twenty-First Century

PubMed Central

Piaggio, Lisandro Ariel

2013-01-01

Congenital adrenal hyperplasia (CAH) most commonly due to 21-hydroxylase deficiency is the most common type of disorder of sex development. This review will focus on CAH addressing historical and current surgical techniques with their anatomical foundations, with special attention to long-term results and outcomes on sexual function, patient satisfaction, patient attitude toward surgery, and ongoing controversies in management of these patients. PMID:24400298

Ultrasound-guided peripheral nerve interventions for common pain disorders

PubMed Central

Krishna Prasad, B P; Joy, Binu; Raghavendra, Vijayakumar A; Toms, Ajith; George, Danny; Ray, Brijesh

2018-01-01

There are a number of common pain disorders that can be managed effectively by injections around or ablation of peripheral nerves. Ultrasound is a universally available imaging tool, is safe, cost-effective, and is excellent in imaging many peripheral nerves and guiding needles to the site of the nerves. This article aims to present an overview of indications and techniques of such procedures that can be effectively performed by a radiologist. PMID:29692534

Role of prostate artery embolization in the management of refractory haematuria of prostatic origin.

PubMed

Pereira, Keith; Halpern, Joshua A; McClure, Timothy D; Lewis, Nicholas A; Kably, Isaam; Bhatia, Shivank; Hu, Jim C

2016-09-01

Prostatic haematuria is among the most common genitourinary complaints of emergency room visits, distressing and troublesome to men and a challenging clinical problem to the treating physician. The most common aetiologies of prostatic haematuria include benign prostatic hyperplasia and prostate cancer. Prostatic haematuria usually resolves with conservative and medical methods; failure of these interventions results in refractory haematuria of prostatic origin (RHPO), a potentially life-threatening scenario. Several different treatments have been described, with varying degrees of success. Patients with RHPO are often elderly and unfit for radical surgery. Prostate artery embolization (PAE) has evolved as a safe and effective technique in the management of RHPO. Use of a superselective approach optimizes clinical success while minimizing complications. This minimally invasive approach improves patients with haemodynamic instability, serves as a bridge to elective surgery, and is a highly effective treatment for RHPO. It may obviate the need for more invasive and morbid surgical therapies. The aim of the present review was to describe the current management of RHPO and the technique of PAE and to review its efficacy and associated morbidity. © 2016 The Authors BJU International © 2016 BJU International Published by John Wiley & Sons Ltd.

A nurse-led ambulatory care pathway for patients with deep venous thrombosis in an acute teaching hospital.

PubMed

Deagle, Jennifer; Allen, James; Mani, Raj

2005-06-01

This article describes the management of deep vein thrombosis (DVT) using an ambulatory nurse-led pathway and the compression technique using duplex ultrasound. This pathway permits the management of the "walking wounded" as well as other patients at varying risks of having DVT and in so doing has changed the approach toward the management of this common clinical event. The success of the described pathway is attributed to the development of low molecular weight heparin and the reliability of diagnostics.

The brain injury case management taxonomy (BICM-T); a classification of community-based case management interventions for a common language.

PubMed

Lukersmith, Sue; Fernandez, Ana; Millington, Michael; Salvador-Carulla, Luis

2016-04-01

Case management is a complex intervention. Complexity arises from the interaction of different components: the model (theoretical basis), implementation context (service), population and health condition, focus for the intervention (client and/or their family), case manager's actions (interventions) and the target of case management (integrated care and support, client's community participation). There is a lack of understanding and a common language. To our knowledge there is no classification (taxonomy) for community-based case management. To develop a community-based case management in brain injury taxonomy (BICM-T), as a common language and understanding of case management for use in quality analysis, policy, planning and practice. The mixed qualitative methods used multiple sources of knowledge including scoping, framing and a nominal group technique to iteratively develop the Beta version (draft) of the taxonomy. A two part developmental evaluation involving case studies and mapping to international frameworks assessed the applicability and acceptability (feasibility) before finalization of the BICM-T. The BICM-T includes a definition of community-based case management, taxonomy trees, tables and a glossary. The interventions domain tree has 9 main actions (parent category): engagement, holistic assessment, planning, education, training and skills development, emotional and motivational support, advising, coordination, monitoring; 17 linked actions (children category); 8 related actions; 63 relevant terms defined in the glossary. The BICM-T provides a knowledge map with the definitions and relationships between the core actions (interventions domain). Use of the taxonomy as a common language will benefit practice, quality analysis, evaluation, policy, planning and resource allocation. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

Stress: The Special Educator's Perspective.

ERIC Educational Resources Information Center

Raschke, Donna; And Others

1988-01-01

The article describes approaches special education teachers can take to reduce stress including diet and exercise, relaxation techniques, use of social support systems, goal setting, time management, and networking. A survey of special education teachers found the use of humor the most common strategy for coping with stress. (DB)

The Effect of Age and Task Difficulty

ERIC Educational Resources Information Center

Mallo, Jason; Nordstrom, Cynthia R.; Bartels, Lynn K.; Traxler, Anthony

2007-01-01

Electronic Performance Monitoring (EPM) is a common technique used to record employee performance. EPM may include counting computer keystrokes, monitoring employees' phone calls or internet activity, or documenting time spent on work activities. Despite EPM's prevalence, no studies have examined how this management tool affects older workers--a…

Unique Phrenic Nerve-Sparing Regional Anesthetic Technique for Pain Management after Shoulder Surgery

PubMed Central

Olsen, David A.; Amundson, Adam W.

2017-01-01

Background Ipsilateral phrenic nerve blockade is a common adverse event after an interscalene brachial plexus block, which can result in respiratory deterioration in patients with preexisting pulmonary conditions. Diaphragm-sparing nerve block techniques are continuing to evolve, with the intention of providing satisfactory postoperative analgesia while minimizing hemidiaphragmatic paralysis after shoulder surgery. Case Report We report the successful application of a combined ultrasound-guided infraclavicular brachial plexus block and suprascapular nerve block in a patient with a complicated pulmonary history undergoing a total shoulder replacement. Conclusion This case report briefly reviews the important innervations to the shoulder joint and examines the utility of the infraclavicular brachial plexus block for postoperative pain management. PMID:29410922

MO-B-201-00: Motion Management in Current Stereotactic Body Radiation Therapy (SBRT) Practice

DOE Office of Scientific and Technical Information (OSTI.GOV)

NONE

The motion management in stereotactic body radiation therapy (SBRT) is a key to success for a SBRT program, and still an on-going challenging task. A major factor is that moving structures behave differently than standing structures when examined by imaging modalities, and thus require special considerations and employments. Understanding the motion effects to these different imaging processes is a prerequisite for a decent motion management program. The commonly used motion control techniques to physically restrict tumor motion, if adopted correctly, effectively increase the conformity and accuracy of hypofractionated treatment. The effective application of such requires one to understand the mechanicsmore » of the application and the related physiology especially related to respiration. The image-guided radiation beam control, or tumor tracking, further realized the endeavor for precision-targeting. During tumor tracking, the respiratory motion is often constantly monitored by non-ionizing beam sources using the body surface as its surrogate. This then has to synchronize with the actual internal tumor motion. The latter is often accomplished by stereo X-ray imaging or similar techniques. With these advanced technologies, one may drastically reduce the treated volume and increase the clinicians’ confidence for a high fractional ablative radiation dose. However, the challenges in implementing the motion management may not be trivial and is dependent on each clinic case. This session of presentations is intended to provide an overview of the current techniques used in managing the tumor motion in SBRT, specifically for routine lung SBRT, proton based treatments, and newly-developed MR guided RT. Learning Objectives: Through this presentation, the audience will understand basic roles of commonly used imaging modalities for lung cancer studies; familiarize the major advantages and limitations of each discussed motion control methods; familiarize the major advantages and limitations of each discussed radiation beam control methodology and tumor tacking method; understand the key points in motion management for a high quality SBRT program.« less

MO-B-201-01: Overcoming the Challenges of Motion Management in Current Lung SBRT Practice

DOE Office of Scientific and Technical Information (OSTI.GOV)

Shang, C.

The motion management in stereotactic body radiation therapy (SBRT) is a key to success for a SBRT program, and still an on-going challenging task. A major factor is that moving structures behave differently than standing structures when examined by imaging modalities, and thus require special considerations and employments. Understanding the motion effects to these different imaging processes is a prerequisite for a decent motion management program. The commonly used motion control techniques to physically restrict tumor motion, if adopted correctly, effectively increase the conformity and accuracy of hypofractionated treatment. The effective application of such requires one to understand the mechanicsmore » of the application and the related physiology especially related to respiration. The image-guided radiation beam control, or tumor tracking, further realized the endeavor for precision-targeting. During tumor tracking, the respiratory motion is often constantly monitored by non-ionizing beam sources using the body surface as its surrogate. This then has to synchronize with the actual internal tumor motion. The latter is often accomplished by stereo X-ray imaging or similar techniques. With these advanced technologies, one may drastically reduce the treated volume and increase the clinicians’ confidence for a high fractional ablative radiation dose. However, the challenges in implementing the motion management may not be trivial and is dependent on each clinic case. This session of presentations is intended to provide an overview of the current techniques used in managing the tumor motion in SBRT, specifically for routine lung SBRT, proton based treatments, and newly-developed MR guided RT. Learning Objectives: Through this presentation, the audience will understand basic roles of commonly used imaging modalities for lung cancer studies; familiarize the major advantages and limitations of each discussed motion control methods; familiarize the major advantages and limitations of each discussed radiation beam control methodology and tumor tacking method; understand the key points in motion management for a high quality SBRT program.« less

MO-B-201-02: Motion Management for Proton Lung SBR

DOE Office of Scientific and Technical Information (OSTI.GOV)

Flampouri, S.

The motion management in stereotactic body radiation therapy (SBRT) is a key to success for a SBRT program, and still an on-going challenging task. A major factor is that moving structures behave differently than standing structures when examined by imaging modalities, and thus require special considerations and employments. Understanding the motion effects to these different imaging processes is a prerequisite for a decent motion management program. The commonly used motion control techniques to physically restrict tumor motion, if adopted correctly, effectively increase the conformity and accuracy of hypofractionated treatment. The effective application of such requires one to understand the mechanicsmore » of the application and the related physiology especially related to respiration. The image-guided radiation beam control, or tumor tracking, further realized the endeavor for precision-targeting. During tumor tracking, the respiratory motion is often constantly monitored by non-ionizing beam sources using the body surface as its surrogate. This then has to synchronize with the actual internal tumor motion. The latter is often accomplished by stereo X-ray imaging or similar techniques. With these advanced technologies, one may drastically reduce the treated volume and increase the clinicians’ confidence for a high fractional ablative radiation dose. However, the challenges in implementing the motion management may not be trivial and is dependent on each clinic case. This session of presentations is intended to provide an overview of the current techniques used in managing the tumor motion in SBRT, specifically for routine lung SBRT, proton based treatments, and newly-developed MR guided RT. Learning Objectives: Through this presentation, the audience will understand basic roles of commonly used imaging modalities for lung cancer studies; familiarize the major advantages and limitations of each discussed motion control methods; familiarize the major advantages and limitations of each discussed radiation beam control methodology and tumor tacking method; understand the key points in motion management for a high quality SBRT program.« less

Sampling Plans for the Thrips Frankliniella schultzei (Thysanoptera: Thripidae) in Three Lettuce Varieties.

PubMed

Silva, Alisson R; Rodrigues-Silva, Nilson; Pereira, Poliana S; Sarmento, Renato A; Costa, Thiago L; Galdino, Tarcísio V S; Picanço, Marcelo C

2017-12-05

The common blossom thrips, Frankliniella schultzei Trybom (Thysanoptera: Thripidae), is an important lettuce pest worldwide. Conventional sampling plans are the first step in implementing decision-making systems into integrated pest management programs. However, this tool is not available for F. schultzei infesting lettuce crops. Thus, the objective of this work was to develop a conventional sampling plan for F. schultzei in lettuce crops. Two sampling techniques (direct counting and leaf beating on a white plastic tray) were compared in crisphead, looseleaf, and Boston lettuce varieties before and during head formation. The frequency distributions of F. schultzei densities in lettuce crops were assessed, and the number of samples required to compose the sampling plan was determined. Leaf beating on a white plastic tray was the best sampling technique. F. schultzei densities obtained with this technique were fitted to the negative binomial distribution with a common aggregation parameter (common K = 0.3143). The developed sampling plan is composed of 91 samples per field and presents low errors in its estimates (up to 20%), fast execution time (up to 47 min), and low cost (up to US $1.67 per sampling area). This sampling plan can be used as a tool for integrated pest management in lettuce crops, assisting with reliable decision making in different lettuce varieties before and during head formation. © The Author(s) 2017. Published by Oxford University Press on behalf of Entomological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Cross-Cutting Risk Framework: Mining Data for Common Risks Across the Portfolio

NASA Technical Reports Server (NTRS)

Klein, Gerald A., Jr.; Ruark, Valerie

2017-01-01

The National Aeronautics and Space Administration (NASA) defines risk management as an integrated framework, combining risk-informed decision making and continuous risk management to foster forward-thinking and decision making from an integrated risk perspective. Therefore, decision makers must have access to risks outside of their own project to gain the knowledge that provides the integrated risk perspective. Through the Goddard Space Flight Center (GSFC) Flight Projects Directorate (FPD) Business Change Initiative (BCI), risks were integrated into one repository to facilitate access to risk data between projects. With the centralized repository, communications between the FPD, project managers, and risk managers improved and GSFC created the cross-cutting risk framework (CCRF) team. The creation of the consolidated risk repository, in parallel with the initiation of monthly FPD risk managers and risk governance board meetings, are now providing a complete risk management picture spanning the entire directorate. This paper will describe the challenges, methodologies, tools, and techniques used to develop the CCRF, and the lessons learned as the team collectively worked to identify risks that FPD programs projects had in common, both past and present.

Metacarpal Neck Fractures: A Review of Surgical Indications and Techniques

PubMed Central

Padegimas, Eric M.; Warrender, William J.; Jones, Christopher M.; Ilyas, Asif M.

2016-01-01

Context Hand injuries are a common emergency department presentation. Metacarpal fractures account for 40% of all hand fractures and can be seen in the setting of low or high energy trauma. The most common injury pattern is a metacarpal neck fracture. In this study, the authors aim to review the surgical indications for metacarpal neck fractures, the fixation options available along with the risk and benefits of each. Evidence Acquisition Literature review of the different treatment modalities for metacarpal neck fractures. Review focuses on surgical indications and the risks and benefits of different operative techniques. Results The indications for surgery are based on the amount of dorsal angulation of the distal fragment. The ulnar digits can tolerate greater angulation as the radial digits more easily lose grip strength. The most widely utilized fixation techniques are pinning with k-wires, dorsal plating, or intramedullary fixation. There is currently no consensus on an optimal fixation technique as surgical management has been found to have a complication rate up to 36%. Plate and screw fixation demonstrated especially high complication rates. Conclusions Metacarpal neck fractures are a common injury in young and active patients that results in substantial missed time from work. While the surgical indications are well-described, there is no consensus on the optimal treatment modality because of high complication rates. Dorsal plating has higher complication rates than closed reduction and percutaneous pinning, but is necessary in comminuted fractures. The lack of an ideal fixation construct suggests that further study of the commonly utilized techniques as well as novel techniques is necessary. PMID:27800460

Clinical management of renal cell carcinoma with venous tumor thrombus.

PubMed

Agochukwu, Nnenaya; Shuch, Brian

2014-06-01

Venous invasion is common in advanced renal cell carcinoma (RCC) due to the unique biology of this cancer. The presence of a tumor thrombus often makes clinical management challenging. In this review, we detail specific preoperative, perioperative, and surgical strategies involving the care of the complex kidney cancer patient with venous tumor involvement. We performed a comprehensive review of selected peer-reviewed publications regarding RCC tumor thrombus biology, medical and surgical management techniques, and immediate and long-term outcomes. The perioperative management may require special imaging techniques, preoperative testing, very recent imaging, and consultation with other surgical services. There are various approaches to these patients as the clinical presentation, stage of disease, primary tumor size, level of thrombus, degree of venous occlusion, presence of bland thrombus, and primary tumor laterality influence management. Select patients with metastatic disease can do well with cytoreductive nephrectomy and thrombectomy. Those with localized disease have a high risk of recurrence; however, some patients can exhibit durable survival with surgery alone. The evolving surgical and medical treatments are discussed. Even when these surgeries are performed in high volume centers, significant perioperative complications are common and greater complications are seen with higher thrombus extent. If surgery is attempted, it is important for urologic oncologists to follow strict attention to specific surgical principles. These general principles include complete vascular control, avoidance of thrombus embolization, close hemodynamic monitoring, and institutional resources for caval resection/replacement and venous bypass if necessary.

Carrier account utilization at the Goddard Space Flight Center

NASA Technical Reports Server (NTRS)

Mathis, W. E.; Langmead, J. T.

1972-01-01

The system in use at Goddard Space Flight Center for the utilization of the Common Use Service Carrier Account and the R&D Inventory Carrier Account technique for budgeting, accounting, financial control, and management reporting, both for the individual functional area and on a Center-wide basis, is documented.

Coalition Network Defence Common Operational Picture

DTIC Science & Technology

2010-11-01

27000 .org/ iso -27005.htm [26] ISO 8601:2004, Data elements and interchange formats - Information interchange - Representation of dates and times, http://ww.iso.org, http://en.wikipedia.org/wiki/ISO_8601 ...Regular_expression [25] ISO /IEC 27005:2008, Information technology -- Security techniques -- Information security risk management, http://ww.iso.org,; http://www

Common-Sense Classroom Management: Surviving September and Beyond in the Elementary Classroom.

ERIC Educational Resources Information Center

Lindberg, Jill A.; Swick, April M.

This manual contains techniques for creating successful teaching and learning environments in diverse elementary classrooms. Using humor, drawings, and a conversational tone, it provides suggestions for teaching effectively and efficiently. Special highlights include five-steps-or-less strategies that can be adapted into any classroom, an outline…

Treatment Acceptability among Mexican American Parents

ERIC Educational Resources Information Center

Borrego, Joaquin, Jr.; Ibanez, Elizabeth S.; Spendlove, Stuart J.; Pemberton, Joy R.

2007-01-01

There is a void in the literature with regard to Hispanic parents' views about common interventions for children with behavior problems. The purpose of this study was to examine the treatment acceptability of child management techniques in a Mexican American sample. Parents' acculturation was also examined to determine if it would account for…

Development of guidelines for operationally effective raised medians and the use of alternative movements on urban roadways.

DOT National Transportation Integrated Search

2012-10-01

The development of raised medians is an important access management technique commonly used in urban settings. It : can be used to control or restrict mid-block left turns, U-turns or crossing maneuvers for implementing of alternative : left-turn/U-t...

Management of Surfing Injuries: A Plastic Surgeon's Viewpoint. Case Reports.

ERIC Educational Resources Information Center

Rudolph, Ross

1989-01-01

Describes plastic surgery techniques used to irrigate, debride, and close lacerations caused by surfboards. Head lacerations and nose fractures are the most common injuries. According to a survey, lacerations may be deeper than expected from their surface appearance and wounds may contain surfboard fragments. Injury prevention is discussed. (SM)

Update on the Ophthalmic Management of Facial Paralysis.

PubMed

MacIntosh, Peter W; Fay, Aaron M

2018-06-07

Bell palsy is the most common neurologic condition affecting the cranial nerves. Lagophthalmos, exposure keratopathy, and corneal ulceration are potential complications. In this review, we evaluate various causes of facial paralysis as well as the level 1 evidence supporting the use of a short course of oral steroids for idiopathic Bell palsy to improve functional outcomes. Various surgical and nonsurgical techniques are also discussed for the management of residual facial dysfunction. Copyright © 2018. Published by Elsevier Inc.

Lumen apposing metal stents for pancreatic fluid collections: Recognition and management of complications.

PubMed

DeSimone, Michael L; Asombang, Akwi W; Berzin, Tyler M

2017-09-16

For patients recovering from acute pancreatitis, the development of a pancreatic fluid collection (PFC) predicts a more complex course of recovery, and introduces difficult management decisions with regard to when, whether, and how the collection should be drained. Most PFCs resolve spontaneously and drainage is indicated only in pseudocysts and walled-off pancreatic necrosis when the collections are causing symptoms and/or local complications such as biliary obstruction. Historical approaches to PFC drainage have included surgical (open or laparoscopic cystgastrostomy or pancreatic debridement), and the placement of percutaneous drains. Endoscopic drainage techniques have emerged in the last several years as the preferred approach for most patients, when local expertise is available. Lumen-apposing metal stents (LAMS) have recently been developed as a tool to facilitate potentially safer and easier endoscopic drainage of pancreatic fluid collections, and less commonly, for other indications, such as gallbladder drainage. Physicians considering LAMS placement must be aware of the complications most commonly associated with LAMS including bleeding, migration, buried stent, stent occlusion, and perforation. Because of the patient complexity associated with severe pancreatitis, management of pancreatic fluid collections can be a complex and multidisciplinary endeavor. Successful and safe use of LAMS for patients with pancreatic fluid collections requires that the endoscopist have a full understanding of the potential complications of LAMS techniques, including how to recognize and manage expected complications.

Selected techniques for monitoring water movement through unsaturated alluvium during managed aquifer recharge

USGS Publications Warehouse

Nawikas, Joseph M.; O'Leary, David R.; Izbicki, John A.; Burgess, Matthew K.

2016-10-21

Managed aquifer recharge is used to augment natural recharge to aquifers. It can be used to replenish aquifers depleted by pumping or to store water during wetter years for withdrawal during drier years. Infiltration from ponds is a commonly used, inexpensive approach for managed aquifer recharge.At some managed aquifer-recharge sites, the time when infiltrated water arrives at the water table is not always clearly shown by water-level data. As part of site characterization and operation, it can be desirable to track downward movement of infiltrated water through the unsaturated zone to identify when it arrives at the water table.

Central polydactyly of the foot: surgical management with plantar and dorsal advancement flaps.

PubMed

Osborn, Emily J; Davids, Jon R; Leffler, Lauren C; Gibson, Thomas W; Pugh, Linda I

2014-01-01

Central polydactyly is the least common form of foot polydactyly, and the intercalary location of the duplicated ray makes the surgical exposure, excision, and closure more complex. For these reasons there is little consensus concerning the optimal technique for surgical management. A retrospective case series of 22 patients with 27 feet with central polydactyly, treated surgically by the dorsal and plantar advancement flap technique, was performed. Change in width of the forefoot was measured from radiographs by the metatarsal gap ratio. Functional outcomes were assessed by the Foot and Ankle Ability Measure. Signficant narrowing of the forefoot, as measured radiographically by the metatarsal gap ratio, was achieved after surgery (P<0.0001). This radiographic narrowing was maintained with growth after a mean follow-up of 8 years (P=0.0001). In 7 of the unilateral cases, the mean forefoot radiographic width of the affected side, after surgical resection and reconstruction of the central polydactyly, was 2% greater than the contralateral, uninvolved side. Persistent clinical widening of the forefoot after surgery was reported in the majority (82%) of cases. The Foot and Ankle Ability Measure results showed near-normal functional outcomes in itemized activities of daily living, itemized sports, and overall function categories. The few reports of less than normal foot function were related to shoe wear issues and incisional scarring that was painful or cosmetically unappealing. The radiographic and functional outcomes after surgical management of central polydactyly with the dorsal and plantar advancement flap technique are excellent. The technique successfully narrows the forefoot on radiographs, and this narrowing is maintained with growth over time. However, families should be advised that persistent perceived widening of the forefoot relative to normal is common, despite successful radiographic narrowing after surgery. IV.

Evaluation of the Next-Gen Exercise Software Interface in the NEEMO Analog

NASA Technical Reports Server (NTRS)

Hanson, Andrea; Kalogera, Kent; Sandor, Aniko; Hardy, Marc; Frank, Andrew; English, Kirk; Williams, Thomas; Perera, Jeevan; Amonette, William

2017-01-01

NSBRI (National Space Biomedical Research Institute) funded research grant to develop the 'NextGen' exercise software for the NEEMO (NASA Extreme Environment Mission Operations) analog. Develop a software architecture to integrate instructional, motivational and socialization techniques into a common portal to enhance exercise countermeasures in remote environments. Increase user efficiency and satisfaction, and institute commonality across multiple exercise systems. Utilized GUI (Graphical User Interface) design principals focused on intuitive ease of use to minimize training time and realize early user efficiency. Project requirement to test the software in an analog environment. Top Level Project Aims: 1) Improve the usability of crew interface software to exercise CMS (Crew Management System) through common app-like interfaces. 2) Introduce virtual instructional motion training. 3) Use virtual environment to provide remote socialization with family and friends, improve exercise technique, adherence, motivation and ultimately performance outcomes.

Endoscopic Debridement for Treatment of Chronic Plantar Fasciitis: An Innovative Technique and Prospective Study of 46 Consecutive Patients.

PubMed

Cottom, James M; Maker, Jared M; Richardson, Phillip; Baker, Joseph S

2016-01-01

Plantar fasciitis is one the most common pathologies treated by foot and ankle surgeons. When nonoperative therapy fails, surgical intervention might be warranted. Various surgical procedures are available for the treatment of recalcitrant plantar fasciitis. The most common surgical management typically consists of open versus endoscopic plantar fascia release. Comorbidities associated with the release of the plantar fascia have been documented, including lateral column overload and metatarsalgia. We present an innovative technique for this painful condition that is minimally invasive, allows visualization of the plantar fascia, and maintains the integrity of the fascia. Our hypothesis was that the use of endoscopic debridement of the plantar fascia with or without heel spur resection would provide a minimally invasive technique with acceptable patient outcomes. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Postoperative pain management in the postanesthesia care unit: an update

PubMed Central

Luo, Jie; Min, Su

2017-01-01

Acute postoperative pain remains a major problem, resulting in multiple undesirable outcomes if inadequately controlled. Most surgical patients spend their immediate postoperative period in the postanesthesia care unit (PACU), where pain management, being unsatisfactory and requiring improvements, affects further recovery. Recent studies on postoperative pain management in the PACU were reviewed for the advances in assessments and treatments. More objective assessments of pain being independent of patients’ participation may be potentially appropriate in the PACU, including photoplethysmography-derived parameters, analgesia nociception index, skin conductance, and pupillometry, although further studies are needed to confirm their utilities. Multimodal analgesia with different analgesics and techniques has been widely used. With theoretical basis of preventing central sensitization, preventive analgesia is increasingly common. New opioids are being developed with minimization of adverse effects of traditional opioids. More intravenous nonopioid analgesics and adjuncts (such as dexmedetomidine and dexamethasone) are introduced for their opioid-sparing effects. Current evidence suggests that regional analgesic techniques are effective in the reduction of pain and stay in the PACU. Being available alternatives to epidural analgesia, perineural techniques and infiltrative techniques including wound infiltration, transversus abdominis plane block, local infiltration analgesia, and intraperitoneal administration have played a more important role for their effectiveness and safety. PMID:29180895

[Relaxation techniques for chronic pain].

PubMed

Diezemann, A

2011-08-01

Relaxation techniques are an integral part of the psychological therapy of chronic pain and follow very different objectives. These techniques lead to muscular and vegetative stabilization, serve as distraction from pain, to build up the internal focus of control and thus to improve self-efficacy. Additional targets are improvement of body awareness and stress management, shielding from sensory stimuli and recurrence prevention of migraine as well a sleeping aid. The most commonly used and best studied method is progressive muscle relaxation which has a good compliance because it is easy to learn and has a high plausibility for patients.

Ultrasound-guided venous access for pacemakers and defibrillators.

PubMed

Seto, Arnold H; Jolly, Aaron; Salcedo, Jonathan

2013-03-01

Ultrasound guidance is widely recommended to reduce the risk of complications during central venous catheter placement. However, ultrasound guidance is not commonly utilized for implanting leads for cardiac rhythm management devices. We describe our technique of ultrasound-guided pacemaker implantation, including a novel pull-through technique that allows percutaneous guidewire insertion prior to the first incision. We review the literature and recent advances in ultrasound imaging technology that may facilitate the adoption of ultrasound guidance. Ultrasound guidance provides a safe and rapid technique for extrathoracic subclavian or axillary venous lead placement. © 2012 Wiley Periodicals, Inc.

Protecting Against Faults in JPL Spacecraft

NASA Technical Reports Server (NTRS)

Morgan, Paula

2007-01-01

A paper discusses techniques for protecting against faults in spacecraft designed and operated by NASA s Jet Propulsion Laboratory (JPL). The paper addresses, more specifically, fault-protection requirements and techniques common to most JPL spacecraft (in contradistinction to unique, mission specific techniques), standard practices in the implementation of these techniques, and fault-protection software architectures. Common requirements include those to protect onboard command, data-processing, and control computers; protect against loss of Earth/spacecraft radio communication; maintain safe temperatures; and recover from power overloads. The paper describes fault-protection techniques as part of a fault-management strategy that also includes functional redundancy, redundant hardware, and autonomous monitoring of (1) the operational and health statuses of spacecraft components, (2) temperatures inside and outside the spacecraft, and (3) allocation of power. The strategy also provides for preprogrammed automated responses to anomalous conditions. In addition, the software running in almost every JPL spacecraft incorporates a general-purpose "Safe Mode" response algorithm that configures the spacecraft in a lower-power state that is safe and predictable, thereby facilitating diagnosis of more complex faults by a team of human experts on Earth.

Domino: Extracting, Comparing, and Manipulating Subsets across Multiple Tabular Datasets

PubMed Central

Gratzl, Samuel; Gehlenborg, Nils; Lex, Alexander; Pfister, Hanspeter; Streit, Marc

2016-01-01

Answering questions about complex issues often requires analysts to take into account information contained in multiple interconnected datasets. A common strategy in analyzing and visualizing large and heterogeneous data is dividing it into meaningful subsets. Interesting subsets can then be selected and the associated data and the relationships between the subsets visualized. However, neither the extraction and manipulation nor the comparison of subsets is well supported by state-of-the-art techniques. In this paper we present Domino, a novel multiform visualization technique for effectively representing subsets and the relationships between them. By providing comprehensive tools to arrange, combine, and extract subsets, Domino allows users to create both common visualization techniques and advanced visualizations tailored to specific use cases. In addition to the novel technique, we present an implementation that enables analysts to manage the wide range of options that our approach offers. Innovative interactive features such as placeholders and live previews support rapid creation of complex analysis setups. We introduce the technique and the implementation using a simple example and demonstrate scalability and effectiveness in a use case from the field of cancer genomics. PMID:26356916

Laparoscopic managment of common bile duct stones: our initial experience.

PubMed Central

Aroori, S.; Bell, J. C.

2002-01-01

The management of choledocholithiasis has changed radically since the introduction of laparoscopic cholecystectomy. However, perceived technical difficulties have deterred many surgeons from treating common bile duct stones laparoscopically at the time of cholecystectomy. This has lead to reliance on endoscopic retrograde cholangiopancreatography followed by endoscopic sphincterotomy to deal with common bile duct stones. We retrospectively reviewed the charts of patients who had laparoscopic common bile duct exploration at Downe Hospital between December 1999 and August 2001. Among 149 laparoscopic cholecystectomies done by our group in this period, 10 patients (6.7%) underwent laparoscopic CBD exploration, three by the transcystic technique and seven by choledochotomy. Three patients (2%) had unsuspected stones found on routine per- operative cholangiogram. The mean operative time was 2.34hrs (range 1.50-3.30hrs). The mean hospital post- operative stay was 3 days (range 1-6 days). Post-operative morbidity was zero. Stone clearance was achieved in all cases. We conclude, laparoscopic exploration of the common bile duct is relatively safe and straightforward method. The key skill required is the ability to perform laparoscopic suturing with confidence. PMID:12137159

Laparoscopic managment of common bile duct stones: our initial experience.

PubMed

Aroori, S; Bell, J C

2002-05-01

The management of choledocholithiasis has changed radically since the introduction of laparoscopic cholecystectomy. However, perceived technical difficulties have deterred many surgeons from treating common bile duct stones laparoscopically at the time of cholecystectomy. This has lead to reliance on endoscopic retrograde cholangiopancreatography followed by endoscopic sphincterotomy to deal with common bile duct stones. We retrospectively reviewed the charts of patients who had laparoscopic common bile duct exploration at Downe Hospital between December 1999 and August 2001. Among 149 laparoscopic cholecystectomies done by our group in this period, 10 patients (6.7%) underwent laparoscopic CBD exploration, three by the transcystic technique and seven by choledochotomy. Three patients (2%) had unsuspected stones found on routine per- operative cholangiogram. The mean operative time was 2.34hrs (range 1.50-3.30hrs). The mean hospital post- operative stay was 3 days (range 1-6 days). Post-operative morbidity was zero. Stone clearance was achieved in all cases. We conclude, laparoscopic exploration of the common bile duct is relatively safe and straightforward method. The key skill required is the ability to perform laparoscopic suturing with confidence.

Management of combat-related urological trauma in the modern era.

PubMed

Williams, Molly; Jezior, James

2013-09-01

Complex genitourinary injuries--associated with lower-extremity amputation as well as pelvic and abdominal wounding--have emerged as common occurrences in current military combat operations. The nature of combat injuries of the genitourinary tract is varied, as are the strategies used in their management. For example, 5% of all combat injuries include wounds of the urinary system or genitalia. For injuries that are predominantly penetrating in nature, immediate care requires the judicious preservation of viable tissue. Once the patient is stable, urethral, corporal and testicular lacerations are closed primarily, whereas soft tissue injuries are re-approximated in a delayed fashion. Negative-pressure dressings have been a useful aid in wound management; wound coverage is most commonly completed with split-thickness skin grafts and local flaps. Complex penile and urethral reconstructions are often delayed so orthopaedic injuries can heal and the patient can manage activities of daily living. Final reconstruction requires a urologist with a full understanding of reconstructive techniques.

A review of surgical repair methods and patient outcomes for gluteal tendon tears.

PubMed

Ebert, Jay R; Bucher, Thomas A; Ball, Simon V; Janes, Gregory C

2015-01-01

Advanced hip imaging and surgical findings have demonstrated that a common cause of greater trochanteric pain syndrome (GTPS) is gluteal tendon tears. Conservative measures are initially employed to treat GTPS and manage gluteal tears, though patients frequently undergo multiple courses of non-operative treatment with only temporary pain relief. Therefore, a number of surgical treatment options for recalcitrant GTPS associated with gluteal tears have been reported. These have included open trans-osseous or bone anchored suture techniques, endoscopic methods and the use of tendon augmentation for repair reinforcement. This review describes the anatomy, pathophysiology and clinical presentation of gluteal tendon tears. Surgical techniques and patient reported outcomes are presented. This review demonstrates that surgical repair can result in improved patient outcomes, irrespective of tear aetiology, and suggests that the patient with "trochanteric bursitis" should be carefully assessed as newer surgical techniques show promise for a condition that historically has been managed conservatively.

Agent-Based Simulations for Project Management

NASA Technical Reports Server (NTRS)

White, J. Chris; Sholtes, Robert M.

2011-01-01

Currently, the most common approach used in project planning tools is the Critical Path Method (CPM). While this method was a great improvement over the basic Gantt chart technique being used at the time, it now suffers from three primary flaws: (1) task duration is an input, (2) productivity impacts are not considered , and (3) management corrective actions are not included. Today, computers have exceptional computational power to handle complex simulations of task e)(eculion and project management activities (e.g ., dynamically changing the number of resources assigned to a task when it is behind schedule). Through research under a Department of Defense contract, the author and the ViaSim team have developed a project simulation tool that enables more realistic cost and schedule estimates by using a resource-based model that literally turns the current duration-based CPM approach "on its head." The approach represents a fundamental paradigm shift in estimating projects, managing schedules, and reducing risk through innovative predictive techniques.

Percutaneous reduction and fixation of an intra-articular calcaneal fracture using an inflatable bone tamp: description of a novel and safe technique

PubMed Central

2012-01-01

Calcaneal fractures are common injuries involving the hind foot and often a source of significant long-term morbidity. Treatment options have changed throughout the ages from periods of preferred nonoperative management to closed reduction with a mallet, and more recently, open reduction and anatomic internal fixation. The current treatment of choice; however, is often debated, as open management of these fractures carries many risks to include wound breakdown and infection. A less invasive form of surgical management through small incisions, while maintaining the ability to obtain joint congruency, anatomic alignment, and restore calcaneal height and width would be ideal. We propose a novel form of fracture reduction using an inflatable bone tamp and percutaneous fracture fixation. Preoperative planning and experienced fluoroscopy is crucial to successful management using this method. Although we achieved successful radiographic outcome in this case, long-term functional outcome of this technique are yet to be published. PMID:22420710

Characteristics of health plans that treat psychiatric patients.

PubMed

Zarin, D A; West, J C; Pincus, H A; Tanielian, T L

1999-01-01

Nationally representative data regarding the organizational, financial, and procedural features of health plans in which psychiatric patients receive treatment indicate that fewer privately insured, Medicaid, and Medicare managed care enrollees receive care from a psychiatrist than is true for "nonmanaged" enrollees. Financial considerations were reported to adversely affect treatment for one-third of all patients. Although utilization management techniques and financial/resource constraints commonly applied to patients in both managed and nonmanaged plans, performance-based incentives were rare in nonmanaged plans. The traditional health plan categories provide limited information to identify salient plan characteristics and guide policy decisions regarding the provision of care.

Portal vein thrombosis: a clinician-oriented and practical review.

PubMed

Handa, Pankaj; Crowther, Mark; Douketis, James D

2014-07-01

With advances in modern imaging techniques, portal vein thrombosis (PVT) is being increasingly diagnosed. It has a wide ranging clinical spectrum from being an asymptomatic state to a potentially life-threatening situation. It is not unusual to find it as an incidental finding in the abdominal imagings done for other reasons. It is commonly associated with cirrhosis and abdominal malignancies and also has a strong association with prothrombotic disorders. It is often difficult for the clinicians to decide whether PVT is acute or chronic. This poses great challenges to its management strategies that include anticoagulants, thrombolysis, and surgical options. Timely diagnosis and appropriate management have great bearings on its outcomes of morbidity and mortality. In this clinician-oriented review, we have provided a concise review of clinical aspects of PVT and discussed various management strategies while addressing the common questions that come to a physician's mind dealing with such a patient. © The Author(s) 2013.

Surgical perspectives in the management of atrial fibrillation

PubMed Central

Kyprianou, Katerina; Pericleous, Agamemnon; Stavrou, Antonio; Dimitrakaki, Inetzi A; Challoumas, Dimitrios; Dimitrakakis, Georgios

2016-01-01

Atrial fibrillation (AF) is the most common cardiac arrhythmia and a huge public health burden associated with significant morbidity and mortality. For decades an increasing number of patients have undergone surgical treatment of AF, mainly during concomitant cardiac surgery. This has sparked a drive for conducting further studies and researching this field. With the cornerstone Cox-Maze III “cut and sew” procedure being technically challenging, the focus in current literature has turned towards less invasive techniques. The introduction of ablative devices has revolutionised the surgical management of AF, moving away from the traditional surgical lesions. The hybrid procedure, a combination of catheter and surgical ablation is another promising new technique aiming to improve outcomes. Despite the increasing number of studies looking at various aspects of the surgical management of AF, the literature would benefit from more uniformly conducted randomised control trials. PMID:26839656

Enhanced recovery in total hip replacement: a clinical review.

PubMed

Ibrahim, M S; Twaij, H; Giebaly, D E; Nizam, I; Haddad, F S

2013-12-01

The outcome after total hip replacement has improved with the development of surgical techniques, better pain management and the introduction of enhanced recovery pathways. These pathways require a multidisciplinary team to manage pre-operative education, multimodal pain control and accelerated rehabilitation. The current economic climate and restricted budgets favour brief hospitalisation while minimising costs. This has put considerable pressure on hospitals to combine excellent results, early functional recovery and shorter admissions. In this review we present an evidence-based summary of some common interventions and methods, including pre-operative patient education, pre-emptive analgesia, local infiltration analgesia, pre-operative nutrition, the use of pulsed electromagnetic fields, peri-operative rehabilitation, wound dressings, different surgical techniques, minimally invasive surgery and fast-track joint replacement units.

Pediatric Enteric Feeding Techniques: Insertion, Maintenance, and Management of Problems

DOE Office of Scientific and Technical Information (OSTI.GOV)

Nijs, Els L. F., E-mail: nijs@email.chop.ed; Cahill, Anne Marie, E-mail: cahill@email.chop.ed

Enteral feeding is considered a widespread, well-accepted means of delivering nutrition to adults and children who are unable to consume food by mouth or who need support in maintaining adequate nutrition for a variety of reasons, including acute and chronic disease states. Delivery of enteral feeding to nutritionally deprived patients may be achieved by several means. In this article, the indications and insertion of enteral access in children will be reviewed. In addition, common complications and management of problems will be discussed.

Resource Management In Peer-To-Peer Networks: A Nadse Approach

NASA Astrophysics Data System (ADS)

Patel, R. B.; Garg, Vishal

2011-12-01

This article presents a common solution to Peer-to-Peer (P2P) network problems and distributed computing with the help of "Neighbor Assisted Distributed and Scalable Environment" (NADSE). NADSE supports both device and code mobility. In this article mainly we focus on the NADSE based resource management technique. How information dissemination and searching is speedup when using the NADSE service provider node in large network. Results show that performance of the NADSE network is better in comparison to Gnutella, and Freenet.

Spine Trauma-What Are the Current Controversies?

PubMed

Oner, Cumhur; Rajasekaran, Shanmuganathan; Chapman, Jens R; Fehlings, Michael G; Vaccaro, Alexander R; Schroeder, Gregory D; Sadiqi, Said; Harrop, James

2017-09-01

Although less common than other musculoskeletal injuries, spinal trauma may lead to significantly more disability and costs. During the last 2 decades there was substantial improvement in our understanding of the basic patterns of spinal fractures leading to more reliable classification and injury severity assessment systems but also rapid developments in surgical techniques. Despite these advancements, there remain unresolved issues concerning the management of these injuries. At this moment there is persistent controversy within the spinal trauma community, which can be grouped under 6 headings. First of all there is still no unanimity on the role and timing of medical and surgical interventions for patients with associated neurologic injury. The same is also true for type and timing of surgical intervention in multiply injured patients. In some common injury types like odontoid fractures and burst type (A3-A4) fractures in thoracolumbar spine, there is wide variation in practice between operative versus nonoperative management without clear reasons. Also, the role of different surgical approaches and techniques in certain injury types are not clarified yet. Methods of nonoperative management and care of elderly patients with concurrent complex disorders are also areas where there is no consensus. In this overview article the main reasons for these controversies are reviewed and the possible ways for resolutions are discussed.

Testing common stream sampling methods for broad-scale, long-term monitoring

Treesearch

Eric K. Archer; Brett B. Roper; Richard C. Henderson; Nick Bouwes; S. Chad Mellison; Jeffrey L. Kershner

2004-01-01

We evaluated sampling variability of stream habitat sampling methods used by the USDA Forest Service and the USDI Bureau of Land Management monitoring program for the upper Columbia River Basin. Three separate studies were conducted to describe the variability of individual measurement techniques, variability between crews, and temporal variation throughout the summer...

Using rainwater harvesting techniques for firefighting in forest plantations

Treesearch

P. Garcia-Chevesich; R. Valdes-Pineda; D. Neary; R. Pizarro

2015-01-01

Fire is a natural component of forest ecosystems in parts of North America, South America, Europe, Australia, Africa and the Mediterranean region. These fires are usually uncontrolled wildfires in areas of ignitable vegetation but can also be prescribed fires set for vegetation management purposes. Wildfires are commonly characterised based on cause of ignition,...

Poultry Disease Risk Management: Biosecurity Instructional CD-ROM

ERIC Educational Resources Information Center

Vaillancourt, Jean-Pierre; Lambert, Gene; Popovich, Laura W.

2007-01-01

Delivery and formatting techniques for technical materials have traditionally been determined by common sense, not cognitive theory. In fact, for hundreds of years, verbal messages in the form of lecture and print have been the primary method of disseminating information to the learner. To move beyond verbal messages and toward the assimilation of…

The Budget Process in Parks and Recreation. A Case Study Manual.

ERIC Educational Resources Information Center

Kelsey, Craig; Gray, Howard

This case study manual, designed for undergraduate or graduate students studying the area of parks and recreation fiscal management, considers the practical, critical skills of budgeting techniques. The manual deals with the most common budgeting styles in a step-by-step approach with case study exercises. Each chapter includes an introduction to…

Toward exploratory analysis of diversity unified across fields of study: an information visualization approach

Treesearch

Tuan Pham; Julia Jones; Ronald Metoyer; Frederick Colwell

2014-01-01

The study of the diversity of multivariate objects shares common characteristics and goals across disciplines, including ecology and organizational management. Nevertheless, subject-matter experts have adopted somewhat separate diversity concepts and analysis techniques, limiting the potential for sharing and comparing across disciplines. Moreover, while large and...

Creating and managing wetland impoundments to provide habitat for aquatic birds

USGS Publications Warehouse

Perry, M.C.; Kangas, P.; Obrecht, H.H.; Comin, Francisco A.; Herrera-Silveira, Jorge A.; Ramirez-Ramirez, Javier

2000-01-01

Patuxent Research Refuge, located in Central Maryland (USA), has approximately 140 ha of impoundments that were constructed for recreational and wildlife conservation purposes. Impoundments are of three major designs: dammed ravines, excavated basins, and diked ponds. Over 50 species of wetland plants were transplanted to impoundments of Patuxent from many parts of the United States between 1945 and 1963 to determine the species best suited for establishment in tannin-stained infertile waters. The wood duck was the only waterfowl species commonly observed on the Refuge when the area was established, but Canada geese, mallards, and black ducks, were introduced and numerous techniques developed to improve nesting and brood habitat. Twenty-six waterfowl species and 80 species of other water birds have used the impoundments for resting, feeding, or nesting. Management is now conducted to optimize avian biodiversity. Management techniques include drawdowns of water every 3-5 years in most impoundments to provide maximum plant and invertebrate food resources for wildlife. Research on the impounded wetlands at Patuxent has included evaluation of vegetation in regard to water level management, improving nest box design to reduce use of boxes by starlings, imprinting of waterfowl to elevated nesting structures to reduce predation on nests, and drawdown techniques to increase macroinvertebrates. Data on waterfowl abundance are evaluated relative to management activities and a preliminary computer model for management of the impoundments has been developed. Past, present, and future management and research projects are reviewed in this paper.

Pediatric foreign bodies and their management.

PubMed

Kay, Marsha; Wyllie, Robert

2005-06-01

Ingestion of foreign bodies is a common pediatric problem, with more than 100,000 cases occurring each year. The vast majority of pediatric ingestions are accidental; increasing incidence of intentional ingestions starts in the adolescent age group. In the United States, the most common pediatric foreign bodies ingested are coins, followed by a variety of other objects, including toys, toy parts, sharp objects, batteries, bones, and food. In adolescents and adults, meat or food impactions are the most common accidental foreign body ingestion. Esophageal pathology underlies most cases of food impaction. Management of foreign body ingestions varies based on the object ingested, its location, and the patient's age and size. Esophageal foreign bodies as a group require early intervention because of their potential to cause respiratory symptoms and complications, esophageal erosions, or even an aortoesophageal fistula. Ingested batteries that lodge in the esophagus require urgent endoscopic removal even in the asymptomatic patient due to the high risk of complications. Sharp foreign bodies increase the foreign body complication rate from less than 1% to 15% to 35%, except for straight pins, which usually follow a relatively benign course unless multiple pins are ingested. Magnets are increasingly ingested, due to their ubiquitous nature and the perception that they do not pose a risk. Ingestion of multiple magnets creates a significant risk of obstruction, perforation, and fistula development. Methods to deal with foreign bodies include the suture technique, the double snare technique, and the combined forceps/snare technique for long, large, and sharp foreign bodies, along with newer equipment, such as retrieval nets and a variety of specialized forceps.

Airway Problems in Neonates—A Review of the Current Investigation and Management Strategies

PubMed Central

Mok, Quen

2017-01-01

Airway problems in the neonatal population are often life threatening and raise challenging issues in diagnosis and management. The airway problems can result from congenital or acquired lesions and can be broadly classified into those causing obstruction or those due to an abnormal “communication” in the airway. Many different investigations are now available to identify the diagnosis and quantify the severity of the problem, and these tests can be simple or invasive. Bronchography and bronchoscopy are essential to determine the extent and severity of the airway problem and to plan treatment strategy. Further imaging techniques help to delineate other commonly associated abnormalities. Echocardiography is also important to confirm any associated cardiac abnormality. In this review, the merits and disadvantages of the various investigations now available to the clinician will be discussed. The current therapeutic strategies are discussed, and the review will focus on the most challenging conditions that cause the biggest management conundrums, specifically laryngotracheal cleft, congenital tracheal stenosis, and tracheobronchomalacia. Management of acquired stenosis secondary to airway injury from endotracheal intubation will also be discussed as this is a common problem. Slide tracheoplasty is the preferred surgical option for long-segment tracheal stenosis, and results have improved significantly. Stents are occasionally required for residual or recurrent stenosis following surgical repair. There is sufficient evidence that a multidisciplinary team approach for managing complex airway issues provides the best results for the patient. There is ongoing progress in the field with newer diagnostic tools as well as development of innovative management techniques, such as biodegradable stents and stem cell-based tracheal transplants, leading to a much better prognosis for these children in the future. PMID:28424763

Treatment of inherently unstable open or infected fractures by open wound management and external skeletal fixation.

PubMed

Ness, M G

2006-02-01

To assess the use of external skeletal fixation with open wound management for the treatment of inherently unstable open or infected fractures in dogs. A retrospective review of 10 cases. Fracture stabilisation and wound management required only a single anaesthetic, and despite the challenging nature of these injuries, the final outcome was acceptable or good in every case. However, minor complications associated with the fixator pins were quite common, and two dogs developed complications which required additional surgery. Open management of wounds, even when bone was exposed, proved to be an effective technique, and external skeletal fixators were usually effective at maintaining stability throughout an inevitably extended fracture healing period.

Management of chest drainage tubes after lung surgery.

PubMed

Satoh, Yukitoshi

2016-06-01

Since chest tubes have been routinely used to drain the pleural space, particularly after lung surgery, the management of chest tubes is considered to be essential for the thoracic surgeon. The pleural drainage system requires effective drainage, suction, and water-sealing. Another key point of chest tube management is that a water seal is considered to be superior to suction for most air leaks. Nowadays, the most common pleural drainage device attached to the chest tube is the three-bottle system. An electronic chest drainage system has been developed that is effective in standardizing the postoperative management of chest tubes. More liberal use of digital drainage devices in the postoperative management of the pleural space is warranted. The removal of chest tubes is a common procedure occurring almost daily in hospitals throughout the world. Extraction of the tube is usually done at the end of full inspiration or at the end of full expiration. The tube removal technique is not as important as how it is done and the preparation for the procedure. The management of chest tubes must be based on careful observation, the patient's characteristics, and the operative procedures that had been performed.

Survey of common practices among oculofacial surgeons in the Asia-Pacific region: Graves' orbitopathy.

PubMed

Sundar, Gangadhara; Chiam, Nathalie; Lun, Katherine; Koh, Victor

2014-10-01

A web-based anonymous survey was performed to evaluate practice preferences in the management of Graves' orbitopathy amongst oculofacial surgeons in the Asia-Pacific region. A questionnaire with contentious topics in Graves' orbitopathy was sent out via email to oculofacial surgeons in 14 countries within Asia-Pacific between May to December 2012. A response rate of 25.2% to 34.6% was achieved (32-44 of 127 participants). 61.0% of respondents encountered Graves' orbitopathy commonly in their practice. The more common causes of vision loss in Graves' orbitopathy included dysthyroid optic neuropathy (67.5%) and exposure keratopathy (15.0%). The clinical activity score was the most popular grading system for assessing Graves' orbitopathy. The preferred non-surgical therapeutic approaches included intravenous pulsed methylprednisolone (79.5%), oral steroids (56.4%), orbital radiation (12.8%), steroid-sparing immunosuppressants (10.3%) and watchful observation (7.7%). Thyroid orbital decompression was uncommonly or rarely performed by respondents. Orbital surgical decompression was most commonly performed via the two-wall technique (73.5%) and most respondents performed fat decompression (69.4%). Post-operatively, the most common complications include under correction (45.5%) and diplopia (42.4%). We report the results of the first survey on the management of Graves' orbitopathy amongst oculofacial surgeons in Asia-Pacific. Our respondents practice preferences reflected the Graves' orbitopathy management consensus statement by the European group on Graves' orbitopathy in 2008.

Unfavourable results with distraction in craniofacial skeleton

PubMed Central

Agarwal, Rajiv

2013-01-01

Distraction osteogenesis has revolutionised the management of craniofacial abnormalities. The technique however requires precise planning, patient selection, execution and follow-up to achieve consistent and positive results and to avoid unfavourable results. The unfavourable results with craniofacial distraction stem from many factors ranging from improper patient selection, planning and use of inappropriate distraction device and vector. The present study analyses the current standards and techniques of distraction and details in depth the various errors and complications that may occur due to this technique. The commonly observed complications of distraction have been detailed along with measures and suggestions to avoid them in clinical practice. PMID:24501455

DOE Office of Scientific and Technical Information (OSTI.GOV)

Boucher, Laurel A.

Successful collaboration requires effective communication and collective problem solving. Regardless of the subject area --- environmental remediation, waste management, program planning and budgeting --- those involved must focus their efforts in an orderly and cooperative manner. A thinking tool is a technique used to get individuals to focus on specific components of the task at the same time and to eliminate the 'noise' that accompanies communications among individuals with different objectives and different styles of communicating. For example, one of these thinking tools is a technique which enables a working group to delineate its roles, responsibilities and communication protocols somore » that it can deliver the right information to the right people at the right time. Another enables a group to objectively and collectively evaluate and improve a policy, plan, or program. A third technique enables a group to clarify its purpose and direction while generating interest and buy-in. A fourth technique makes it possible for a group with polarized opinions to acknowledge their differences as well as what they have in common. A fifth technique enables a group to consider a subject of importance from all perspectives so as to produce a more comprehensive and sustainable solution. These thinking tools make effective communication and collective problem solving possible in radioactive waste management and remediation. They can be used by a wide spectrum of professionals including policy specialists, program administrators, program and project managers, and technical specialists. (author)« less

Congenital penile curvature: update and management.

PubMed

Makovey, Iryna; Higuchi, Ty T; Montague, Drogo K; Angermeier, Kenneth W; Wood, Hadley M

2012-08-01

Congenital penile curvature results from disproportionate development of the tunica albuginea of the corporal bodies and is not associated with urethral malformation. Patients usually present after reaching puberty as the curvature becomes more apparent with erections, and severe curvature can make intercourse difficult or impossible, at which point surgical repair is recommended. Excellent outcomes can be expected with surgical intervention. The three most commonly used repair techniques are the original Nesbit procedure, modified Nesbit procedure, and plication. Nesbit and modified Nesbit techniques require that an incision is made in the tunica albuginea while plication techniques utilize plicating sutures without an incision. While Nesbit and modified Nesbit techniques are more complex operations, these generally result in less recurrences and more satisfactory outcomes as opposed to the quicker and simpler plication technique.

Practical aspects of inhaler use in the management of chronic obstructive pulmonary disease in the primary care setting.

PubMed

Yawn, Barbara P; Colice, Gene L; Hodder, Rick

2012-01-01

Sustained bronchodilation using inhaled medications in moderate to severe chronic obstructive pulmonary disease (COPD) grades 2 and 3 (Global Initiative for Chronic Obstructive Lung Disease guidelines) has been shown to have clinical benefits on long-term symptom control and quality of life, with possible additional benefits on disease progression and longevity. Aggressive diagnosis and treatment of symptomatic COPD is an integral and pivotal part of COPD management, which usually begins with primary care physicians. The current standard of care involves the use of one or more inhaled bronchodilators, and depending on COPD severity and phenotype, inhaled corticosteroids. There is a wide range of inhaler devices available for delivery of inhaled medications, but suboptimal inhaler use is a common problem that can limit the clinical effectiveness of inhaled therapies in the real-world setting. Patients' comorbidities, other physical or mental limitations, and the level of inhaler technique instruction may limit proper inhaler use. This paper presents information that can overcome barriers to proper inhaler use, including issues in device selection, steps in correct technique for various inhaler devices, and suggestions for assessing and monitoring inhaler techniques. Ensuring proper inhaler technique can maximize drug effectiveness and aid clinical management at all grades of COPD.

Practical aspects of inhaler use in the management of chronic obstructive pulmonary disease in the primary care setting

PubMed Central

Yawn, Barbara P; Colice, Gene L; Hodder, Rick

2012-01-01

Sustained bronchodilation using inhaled medications in moderate to severe chronic obstructive pulmonary disease (COPD) grades 2 and 3 (Global Initiative for Chronic Obstructive Lung Disease guidelines) has been shown to have clinical benefits on long-term symptom control and quality of life, with possible additional benefits on disease progression and longevity. Aggressive diagnosis and treatment of symptomatic COPD is an integral and pivotal part of COPD management, which usually begins with primary care physicians. The current standard of care involves the use of one or more inhaled bronchodilators, and depending on COPD severity and phenotype, inhaled corticosteroids. There is a wide range of inhaler devices available for delivery of inhaled medications, but suboptimal inhaler use is a common problem that can limit the clinical effectiveness of inhaled therapies in the real-world setting. Patients’ comorbidities, other physical or mental limitations, and the level of inhaler technique instruction may limit proper inhaler use. This paper presents information that can overcome barriers to proper inhaler use, including issues in device selection, steps in correct technique for various inhaler devices, and suggestions for assessing and monitoring inhaler techniques. Ensuring proper inhaler technique can maximize drug effectiveness and aid clinical management at all grades of COPD. PMID:22888221

Success of Intubation Rescue Techniques after Failed Direct Laryngoscopy in Adults: A Retrospective Comparative Analysis from the Multicenter Perioperative Outcomes Group.

PubMed

Aziz, Michael F; Brambrink, Ansgar M; Healy, David W; Willett, Amy Wen; Shanks, Amy; Tremper, Tyler; Jameson, Leslie; Ragheb, Jacqueline; Biggs, Daniel A; Paganelli, William C; Rao, Janavi; Epps, Jerry L; Colquhoun, Douglas A; Bakke, Patrick; Kheterpal, Sachin

2016-10-01

Multiple attempts at tracheal intubation are associated with mortality, and successful rescue requires a structured plan. However, there remains a paucity of data to guide the choice of intubation rescue technique after failed initial direct laryngoscopy. The authors studied a large perioperative database to determine success rates for commonly used intubation rescue techniques. Using a retrospective, observational, comparative design, the authors analyzed records from seven academic centers within the Multicenter Perioperative Outcomes Group between 2004 and 2013. The primary outcome was the comparative success rate for five commonly used techniques to achieve successful tracheal intubation after failed direct laryngoscopy: (1) video laryngoscopy, (2) flexible fiberoptic intubation, (3) supraglottic airway as part of an exchange technique, (4) optical stylet, and (5) lighted stylet. A total of 346,861 cases were identified that involved attempted tracheal intubation. A total of 1,009 anesthesia providers managed 1,427 cases of failed direct laryngoscopy followed by subsequent intubation attempts (n = 1,619) that employed one of the five studied intubation rescue techniques. The use of video laryngoscopy resulted in a significantly higher success rate (92%; 95% CI, 90 to 93) than other techniques: supraglottic airway conduit (78%; 95% CI, 68 to 86), flexible bronchoscopic intubation (78%; 95% CI, 71 to 83), lighted stylet (77%; 95% CI, 69 to 83), and optical stylet (67%; 95% CI, 35 to 88). Providers most frequently choose video laryngoscopy (predominantly GlideScope [Verathon, USA]) to rescue failed direct laryngoscopy (1,122/1,619; 69%), and its use has increased during the study period. Video laryngoscopy is associated with a high rescue intubation success rate and is more commonly used than other rescue techniques.

NATIONAL CONFERENCE ON MANPOWER TRAINING AND THE OLDER WORKER (WASHINGTON, D.C., JANUARY 17-19, 1966).

ERIC Educational Resources Information Center

Department of Health, Education, and Welfare, Washington, DC.

APPROXIMATELY 225 REPRESENTATIVES OF PUBLIC AND PRIVATE EDUCATION, MANAGEMENT, LABOR, AND FEDERAL, STATE, AND LOCAL AGENCIES PARTICIPATED IN THE CONFERENCE WHICH AIMED TO PROVIDE A COMMON PLATFORM FOR THE MOST INFORMED PEOPLE FROM MANY DISCIPLINES TO FOCUS ON THIS LARGELY UNEXPLORED AREA, IDENTIFY SUCCESSFUL PROGRAMS AND TECHNIQUES, AND IDENTIFY…

Analysis of Docudrama Techniques and Negotiating One's Identity in David Edgar's "Pentecost"

ERIC Educational Resources Information Center

Al Sharadgeh, Samer Ziyad

2018-01-01

Edgar manages to invert the subordinate function of generally accepted objective indicators of membership of a particular national group--language, religion, common history, and territory--into the essential mode of imperative distinction shaping the unique national identity. In other words, it is the fresco and the value assigned to it that…

Space shuttle program information control and retrieval system feasibility study report

NASA Technical Reports Server (NTRS)

Lingle, C. P.

1973-01-01

The feasibility of having a common information management network for space shuttle data, is studied. Identified are the information types required, sources and users of the information, and existing techniques for acquiring, storing and retrieving the data. The study concluded that a decentralized system is feasible, and described a recommended development plan for it.

Defense Acquisition Transformation Report to Congress

DTIC Science & Technology

2007-02-01

current initiatives and for the purposes of this report are put into a framework of workforce, acquisition, requirements, budget, industry and organization...requirements. The Capability Portfolio Management Initiative provides a common framework to recognize federated ownership and senior-level teams have been...Performance Trade Off Constraints Risk Based Source Selection techniques are also being piloted to provide an improved framework for

How do paramedics manage the airway during out of hospital cardiac arrest?

PubMed Central

Voss, Sarah; Rhys, Megan; Coates, David; Greenwood, Rosemary; Nolan, Jerry P.; Thomas, Matthew; Benger, Jonathan

2014-01-01

Aim The best method of initial airway management during resuscitation for out of hospital cardiac arrest (OHCA) is unknown. The airway management techniques used currently by UK paramedics during resuscitation for OHCA are not well documented. This study describes the airway management techniques used in the usual practice arm of the REVIVE-Airways feasibility study, and documents the pathway of interventions to secure and sustain ventilation during OHCA. Method Data were collected from OHCAs attended by paramedics participating in the REVIVE-Airways trial between March 2012 and February 2013. Patients were included if they were enrolled in the usual practice arm of the study, fulfilled the main study eligibility criteria and did not receive either of the intervention supraglottic airway devices during the resuscitation attempt. Results Data from 196 attempted resuscitations were included in the analysis. The initial approach to airway management was bag-mask for 108 (55%), a supraglottic airway device (SAD) for 39 (20%) and tracheal intubation for 49 (25%). Paramedics made further airway interventions in 64% of resuscitations. When intubation was the initial approach, there was no further intervention in 76% of cases; this compares to 16% and 44% with bag-mask and SAD respectively. The most common reason cited by paramedics for changing from bag-mask was to carry out advanced life support, followed by regurgitation and inadequate ventilation. Inadequate ventilation was the commonest reason cited for removing a SAD. Conclusion Paramedics use a range of techniques to manage the airway during OHCA, and as the resuscitation evolves. It is therefore desirable to ensure that a range of techniques and equipment, supported by effective training, are available to paramedics who attend OHCA. PMID:25260723

The Potential of Sequential Extraction in the Characterisation and Management of Wastes from Steel Processing: A Prospective Review

PubMed Central

Rodgers, Kiri J.; Hursthouse, Andrew; Cuthbert, Simon

2015-01-01

As waste management regulations become more stringent, yet demand for resources continues to increase, there is a pressing need for innovative management techniques and more sophisticated supporting analysis techniques. Sequential extraction (SE) analysis, a technique previously applied to soils and sediments, offers the potential to gain a better understanding of the composition of solid wastes. SE attempts to classify potentially toxic elements (PTEs) by their associations with phases or fractions in waste, with the aim of improving resource use and reducing negative environmental impacts. In this review we explain how SE can be applied to steel wastes. These present challenges due to differences in sample characteristics compared with materials to which SE has been traditionally applied, specifically chemical composition, particle size and pH buffering capacity, which are critical when identifying a suitable SE method. We highlight the importance of delineating iron-rich phases, and find that the commonly applied BCR (The community Bureau of reference) extraction method is problematic due to difficulties with zinc speciation (a critical steel waste constituent), hence a substantially modified SEP is necessary to deal with particular characteristics of steel wastes. Successful development of SE for steel wastes could have wider implications, e.g., for the sustainable management of fly ash and mining wastes. PMID:26393631

The Potential of Sequential Extraction in the Characterisation and Management of Wastes from Steel Processing: A Prospective Review.

PubMed

Rodgers, Kiri J; Hursthouse, Andrew; Cuthbert, Simon

2015-09-18

As waste management regulations become more stringent, yet demand for resources continues to increase, there is a pressing need for innovative management techniques and more sophisticated supporting analysis techniques. Sequential extraction (SE) analysis, a technique previously applied to soils and sediments, offers the potential to gain a better understanding of the composition of solid wastes. SE attempts to classify potentially toxic elements (PTEs) by their associations with phases or fractions in waste, with the aim of improving resource use and reducing negative environmental impacts. In this review we explain how SE can be applied to steel wastes. These present challenges due to differences in sample characteristics compared with materials to which SE has been traditionally applied, specifically chemical composition, particle size and pH buffering capacity, which are critical when identifying a suitable SE method. We highlight the importance of delineating iron-rich phases, and find that the commonly applied BCR (The community Bureau of reference) extraction method is problematic due to difficulties with zinc speciation (a critical steel waste constituent), hence a substantially modified SEP is necessary to deal with particular characteristics of steel wastes. Successful development of SE for steel wastes could have wider implications, e.g., for the sustainable management of fly ash and mining wastes.

Ideal, nonideal, and no-marker variables: The confirmatory factor analysis (CFA) marker technique works when it matters.

PubMed

Williams, Larry J; O'Boyle, Ernest H

2015-09-01

A persistent concern in the management and applied psychology literature is the effect of common method variance on observed relations among variables. Recent work (i.e., Richardson, Simmering, & Sturman, 2009) evaluated 3 analytical approaches to controlling for common method variance, including the confirmatory factor analysis (CFA) marker technique. Their findings indicated significant problems with this technique, especially with nonideal marker variables (those with theoretical relations with substantive variables). Based on their simulation results, Richardson et al. concluded that not correcting for method variance provides more accurate estimates than using the CFA marker technique. We reexamined the effects of using marker variables in a simulation study and found the degree of error in estimates of a substantive factor correlation was relatively small in most cases, and much smaller than error associated with making no correction. Further, in instances in which the error was large, the correlations between the marker and substantive scales were higher than that found in organizational research with marker variables. We conclude that in most practical settings, the CFA marker technique yields parameter estimates close to their true values, and the criticisms made by Richardson et al. are overstated. (c) 2015 APA, all rights reserved).

Clinical Recommendation: Vulvovaginitis.

PubMed

Zuckerman, Andrea; Romano, Mary

2016-12-01

Vulvovaginitis is a commonly encountered condition among prepubertal and adolescent females. The objective of this report is to provide the latest evidence regarding the diagnosis and management of vulvovaginitis in prepubertal and adolescent females. In this systematic review we used the Grading of Recommendations Assessment, Development and Evaluation evidence system. Vulvovaginal complaints are common in the pediatric and adolescent age group. The patient's age in conjunction with history and associated complaints will guide evaluation, diagnosis, and treatment. Treatment should include counseling on hygiene and voiding techniques as well as therapy for any specific pathogens identified. Copyright © 2016.

Management of Recurrent Subdural Hematomas.

PubMed

Desai, Virendra R; Scranton, Robert A; Britz, Gavin W

2017-04-01

Subdural hematomas commonly recur after surgical evacuation, at a rate of 2% to 37%. Risk factors for recurrence can be patient related, radiologic, or surgical. Patient-related risk factors include alcoholism, seizure disorders, coagulopathy, and history of ventriculoperitoneal shunt. Radiologic factors include poor brain reexpansion postoperatively, significant subdural air, greater midline shift, heterogeneous hematomas (layered or multi-loculated), and higher-density hematomas. Surgical factors include lack of or poor postoperative drainage. Most recurrent hematomas are managed successfully with burr hole craniostomies with postoperative closed-system drainage. Refractory hematomas may be managed with a variety of techniques, including craniotomy or subdural-peritoneal shunt placement. Copyright © 2016 Elsevier Inc. All rights reserved.

Autonomously managed electrical power systems

NASA Technical Reports Server (NTRS)

Callis, Charles P.

1986-01-01

The electric power systems for future spacecraft such as the Space Station will necessarily be more sophisticated and will exhibit more nearly autonomous operation than earlier spacecraft. These new power systems will be more reliable and flexible than their predecessors offering greater utility to the users. Automation approaches implemented on various power system breadboards are investigated. These breadboards include the Hubble Space Telescope power system test bed, the Common Module Power Management and Distribution system breadboard, the Autonomusly Managed Power System (AMPS) breadboard, and the 20 kilohertz power system breadboard. Particular attention is given to the AMPS breadboard. Future plans for these breadboards including the employment of artificial intelligence techniques are addressed.

Evaluation and nonsurgical management of rotator cuff calcific tendinopathy.

PubMed

Greis, Ari C; Derrington, Stephen M; McAuliffe, Matthew

2015-04-01

Rotator cuff calcific tendinopathy is a common finding that accounts for about 7% of patients with shoulder pain. There are numerous theories on the pathogenesis of rotator cuff calcific tendinopathy. The diagnosis is confirmed with radiography, MRI or ultrasound. There are numerous conservative treatment options available and most patients can be managed successfully without surgical intervention. Nonsteroidal anti-inflammatory drugs and multiple modalities are often used to manage pain and inflammation; physical therapy can help improve scapular mechanics and decrease dynamic impingement; ultrasound-guided needle aspiration and lavage techniques can provide long-term improvement in pain and function in these patients. Copyright © 2015 Elsevier Inc. All rights reserved.

Stent-Assisted Endovascular Treatment of Anterior Communicating Artery Aneurysms - Literature Review.

PubMed

Kocur, Damian; Ślusarczyk, Wojciech; Przybyłko, Nikodem; Bażowski, Piotr; Właszczuk, Adam; Kwiek, Stanisław

2016-01-01

The anterior cerebral artery is a common location of intracranial aneurysms. The standard coil embolization technique is limited by its inability to occlude wide-neck aneurysms. Stent deployment across the aneurysm neck supports the coil mass inside the aneurysmal sac, and furthermore, has an effect on local hemodynamic and biologic changes. In this article, various management strategies and techniques as well as angiographic outcomes and complications related to stent-assisted endovascular treatment of anterior communicating artery aneurysms are presented. This treatment method is safe and associated with low morbidity and mortality rates.

Endovascular repair of an iliac arteriovenous fistula secondary to perforation from a common iliac aneurysm in a patient with Ehler-Danlos syndrome.

PubMed

Sala Almonacil, Vicente Andrés; Zaragozá García, José Miguel; Gómez Palonés, Francisco Julián; Plaza Martínez, Ángel; Ortíz Monzón, Eduardo

2012-08-01

Type IV Ehler-Danlos syndrome (EDS) patients are prone to life-threatening vascular complications. Surgical management of those complications is challenging owing to vessel wall fragility, which may result in hemorrhagic events and high mortality rates. Here we report a case of left common iliac aneurysm perforation of the ipsilateral iliac vein repaired using endovascular technique in a patient with EDS. A 54-year-old patient presented with heart failure symptoms that evolved over 1 week in association with left leg edema and steal syndrome due to a perforation of the left iliac vein caused by a left common iliac aneurysm. A thrombosed right common iliac aneurysm and several other visceral and peripheral aneurysms were discovered on computed tomographic scan at admission. An aortouniiliac stent graft was used to seal the fistula. After 18 months of follow-up, the patient remained asymptomatic. We suggest that endovascular therapy is useful to manage vascular complications in patients with EDS. Copyright © 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved.

Blood Groups in the Species Survival Plan®, European Endangered Species Program, and Managed in situ Populations of Bonobo (Pan paniscus), Common Chimpanzee (Pan troglodytes), Gorilla (Gorilla ssp.), and Orangutan (Pongo pygmaeus ssp.)

PubMed Central

Gamble, Kathryn C.; Moyse, Jill A.; Lovstad, Jessica N.; Ober, Carole B.; Thompson, Emma E.

2014-01-01

Blood groups of humans and great apes long have been considered similar although are not interchangeable between species. In this study, human monoclonal antibody technology was used to assign human ABO blood groups to whole blood samples from great apes housed in North American and European zoos and in situ managed populations, as a practical means to assist blood transfusion situations for these species. From a subset of each of the species (bonobo, common chimpanzee, gorilla, and orangutans), DNA sequence analysis was performed to determine blood group genotype. Bonobo and common chimpanzee populations were predominantly group A which concurred with historic literature and was confirmed by genotyping. In agreement with historic literature, a smaller number of the common chimpanzees sampled were group O although this O blood group was more often present in wild-origin animals as compared to zoo-born animals. Gorilla blood groups were inconclusive by monoclonal antibody techniques and by genetic studies were inconsistent with any known human blood group. As the genus and specifically the Bornean species, orangutans were identified with all human blood groups, including O, which had not been reported previously. Following this study, it was concluded that blood groups of bonobo, common chimpanzees, and some orangutans can be reliably assessed by human monoclonal antibody technology. However, this technique was not reliable for gorilla or orangutans other than those with blood group A. Even in those species with reliable blood group detection, blood transfusion preparation must include cross-matching to minimize adverse reactions for the patient. PMID:20853409

Diagnosis and management of acute complications in patients with colon cancer: bleeding, obstruction, and perforation

PubMed Central

Yang, Xue-Fei

2014-01-01

Among the colorectal cancers, the incidence of colon cancer has obviously increased. As a result, the actual incidence of colon cancer has exceeded that of rectal cancer, which dramatically changed the long-existing epidemiological profile. The acute complications of colon cancer include bleeding, obstruction, and perforation, which were among the common acute abdominal surgical conditions. The rapid and accurate diagnosis of these acute complications was very important, and laparoscopic techniques can be applied in abdominal surgery for management of the complications. PMID:25035661

Evaluation and management of perianal abscess and anal fistula: a consensus statement developed by the Italian Society of Colorectal Surgery (SICCR).

PubMed

Amato, A; Bottini, C; De Nardi, P; Giamundo, P; Lauretta, A; Realis Luc, A; Tegon, G; Nicholls, R J

2015-10-01

Perianal sepsis is a common condition ranging from acute abscess to chronic fistula formation. In most cases, the source is considered to be a non-specific cryptoglandular infection starting from the intersphincteric space. The key to successful treatment is the eradication of the primary track. As surgery may lead to a disturbance of continence, several sphincter-preserving techniques have been developed. This consensus statement examines the pertinent literature and provides evidence-based recommendations to improve individualized management of patients.

A review of behaviour change theories and techniques used in group based self-management programmes for chronic low back pain and arthritis.

PubMed

Keogh, Alison; Tully, Mark A; Matthews, James; Hurley, Deirdre A

2015-12-01

Medical Research Council (MRC) guidelines recommend applying theory within complex interventions to explain how behaviour change occurs. Guidelines endorse self-management of chronic low back pain (CLBP) and osteoarthritis (OA), but evidence for its effectiveness is weak. This literature review aimed to determine the use of behaviour change theory and techniques within randomised controlled trials of group-based self-management programmes for chronic musculoskeletal pain, specifically CLBP and OA. A two-phase search strategy of electronic databases was used to identify systematic reviews and studies relevant to this area. Articles were coded for their use of behaviour change theory, and the number of behaviour change techniques (BCTs) was identified using a 93-item taxonomy, Taxonomy (v1). 25 articles of 22 studies met the inclusion criteria, of which only three reported having based their intervention on theory, and all used Social Cognitive Theory. A total of 33 BCTs were coded across all articles with the most commonly identified techniques being 'instruction on how to perform the behaviour', 'demonstration of the behaviour', 'behavioural practice', 'credible source', 'graded tasks' and 'body changes'. Results demonstrate that theoretically driven research within group based self-management programmes for chronic musculoskeletal pain is lacking, or is poorly reported. Future research that follows recommended guidelines regarding the use of theory in study design and reporting is warranted. Copyright © 2015 Elsevier Ltd. All rights reserved.

Integration of E-education and Knowledge Management

NASA Astrophysics Data System (ADS)

Wan, Liyong; Zhao, Chengling; Guo, Wei

With the realization that knowledge is a core resource, organizations are now attempting to manage knowledge in a more systematic and more effective way. However, managing knowledge is not always an easy task. In particular contexts, such as online e-education, knowledge is distributed across both time and space and may be constrained by social, cultural and language differences. This paper demonstrated the common characters of knowledge management and e-education, and proposed the current potential problems in e-education. The authors tried to develop a set of guidelines to help overcome problems using tools and techniques from KM, they proposed three strategies: corporate explicit knowledge and tacit knowledge; use the theory of KM to guide e-education resource management; use the theory of KM to guide e-education resource management. These strategies will help us to develop a better e-education framework.

The Evaluation and Office Management of Hemorrhoids for the Gastroenterologist.

PubMed

Guttenplan, Mitchel

2017-07-01

Hemorrhoid disease is extremely common, and seldom requires surgical intervention. The vast majority of patients can be cared for in the office setting and by the gastroenterologist. This piece aims to summarize the epidemiology and pathophysiology of hemorrhoid disease, along with the proper evaluation and office-based treatment of these patients. Most GI fellowship training programs spend little time on these topics, and the recommendation has been made to include anorectal care in the GI's "core curriculum." The use of the anoscope and a proper anorectal examination are keys to evaluating these patients, and the techniques available to treat these patients are described. Often overlooked in these patients are other anorectal issues that occur alongside hemorrhoidal issues very commonly-the most common being anal fissure. Comprehensive management of all of these issues will allow all but the most severely affected patients to avoid the expense and morbidity of surgical intervention. The anatomy, etiology, pathophysiology, diagnosis, and non-surgical treatment of hemorrhoid disease are presented with the gastroenterologist in mind.

Ectopic pregnancy.

PubMed

Carr, R J; Evans, P

2000-03-01

Ectopic pregnancy occurs in approximately 2% of all pregnancies in the United States, and is the nation's leading cause of first trimester maternal death. Its incidence has increased sixfold in the past 25 years, despite significant improvements in techniques for early diagnosis and management. This article reviews the epidemiology, risk factors, and common clinical presentations of ectopic pregnancy. Both traditional and newly developed strategies for diagnosis and management are described. The primary care physician is in an excellent position to screen for and diagnose ectopic pregnancy, and to counsel patients regarding treatment options and future risks. With the increasing trend toward outpatient nonsurgical management of ectopics, it is expected that the roll of the primary care physician in managing patients with ectopic pregnancy will continue to increase.

[The socio-hygienic monitoring as an integral system for health risk assessment and risk management at the regional level].

PubMed

Kuzmin, S V; Gurvich, V B; Dikonskaya, O V; Malykh, O L; Yarushin, S V; Romanov, S V; Kornilkov, A S

2013-01-01

The information and analytical framework for the introduction of health risk assessment and risk management methodologies in the Sverdlovsk Region is the system of socio-hygienic monitoring. Techniques of risk management that take into account the choice of most cost-effective and efficient actions for improvement of the sanitary and epidemiologic situation at the level of the region, municipality, or a business entity of the Russian Federation, have been developed and proposed. To assess the efficiency of planning and activities for health risk management common method approaches and economic methods of "cost-effectiveness" and "cost-benefit" analyses provided in method recommendations and introduced in the Russian Federation are applied.

Practical anesthetic considerations in patients undergoing tracheobronchial surgeries: a clinical review of current literature

PubMed Central

Ahuja, Sanchit; Cohen, Barak; Hinkelbein, Jochen; Diemunsch, Pierre

2016-01-01

Tracheobronchial surgeries require close cooperation and extensive communication between the anesthesia providers and the surgeons. Anesthetic management of tracheal and bronchial pathologies differ basically from regular upper airways management, due access to the patients airway is limited, mostly even practically impossible for the anesthesia providers. As a consequence, the surgeon overtakes responsibility for the airway access from the anesthesia provider in the variety of the cases. Preoperative recognition of a difficult airway, detailed planning and being aware of plan B and plan C are the elementary keys to success. Providers have to be aware, that preoperative airway assessment does not always correlate with the ease of oxygenation and ventilation. Therefore, various methods have been described in the literature and several authors have adopted unique ways to manage the airways in a successful manner. With the advancement of surgical techniques over the years, anesthetic management has also evolved tremendously to match the needs. The commonly encountered conditions requiring surgical interventions include post-intubation stenosis and foreign body aspiration. In this review we will discuss the most common pathologies of tracheobronchial lesions and specific anesthetic management considerations related to them. PMID:28066624

[Peripheral nerves phenolisation in spasticity management - forgotten art or interesting perspective?

PubMed

Kiwerski, Jerzy; Turżańska, Karolina; Pluta, Ryszard; Drelich, Małgorzata; Zarębska, Aneta; Jabłoński, Mirosław

Spasticity is one of the most common obstacles in the process of rehabilitation after permanent central nervous system injury. Statistics show that the problem affects more than 12 billion people all over the world. Treatment of spasticity is necessary for proper rehabilitation, prevention of secondary disability, pain management and also strongly influences quality of life. Nowadays the most common formula used for the treatment of local spasticity is injection of botulinum toxin. Years ago and also nowadays physicians all over the world successfully used phenol as the chemodenervating factor. This technique today almost forgot in Poland but still used in other countries. Peripheral nerves phenolisation had been used in STOCER (Konstancin) since 1965. The procedure was performed once in 59 patients, twice in 13 patients and three times in 7 patients. Evaluation was based on clinical presentation completed with patient self evaluation form. Good - 36 cases (45%), moderate - 34 cases (43%), bad - 9 cases (12%). Peripheral nerve phenolisation seems to be an interesting alternative to botulinum toxin in the management of spasticity.

Current surgical practices in cleft care: cleft palate repair techniques and postoperative care.

PubMed

Katzel, Evan B; Basile, Patrick; Koltz, Peter F; Marcus, Jeffrey R; Girotto, John A

2009-09-01

The purpose of this study was to objectively report practices commonly used in cleft palate repair in the United States. This study investigates current surgical techniques, postoperative care, and complication rates for cleft palate repair surgery. All 803 surgeon members of the American Cleft Palate-Craniofacial Association were sent online and/or paper surveys inquiring about their management of cleft palate patients. Three-hundred six surveys were received, a 38 percent response rate. This represented responses of surgeons from 100 percent of American Cleft Palate-Craniofacial Association registered cleft teams. Ninety-six percent of respondents perform a one-stage repair. Eighty-five percent of surgeons perform palate surgery when the patient is between 6 and 12 months of age. The most common one-stage repair techniques are the Bardach style (two flaps) with intravelar veloplasty and the Furlow palatoplasty. After surgery, 39 percent of surgeons discharge patients within 24 hours. Another 43 percent discharge patients within 48 hours. During postoperative management, 92 percent of respondents implement feeding restrictions. Eighty-five percent of physicians use arm restraints. Surgeons' self-reported complications rates are minimal: 54 percent report a fistula in less than 5 percent of cases. The reported need for secondary speech surgery varies widely. The majority of respondents repair clefts in one stage. The most frequently used repair techniques are the Furlow palatoplasty and the Bardach style with intravelar veloplasty. After surgery, the majority of surgeons discharge patients in 1 or 2 days, and nearly all surgeons implement feeding restrictions and the use of arm restraints. The varying feeding protocols are reviewed in this article.

Crew interface specification development study for in-flight maintenance and stowage functions

NASA Technical Reports Server (NTRS)

Carl, J. G.

1971-01-01

The need and potential solutions for an orderly systems engineering approach to the definition, management and documentation requirements for in-flight maintenance, assembly, servicing, and stowage process activities of the flight crews of future spacecraft were investigated. These processes were analyzed and described using a new technique (mass/function flow diagramming), developed during the study, to give visibility to crew functions and supporting requirements, including data products. This technique is usable by NASA for specification baselines and can assist the designer in identifying both upper and lower level requirements associated with these processes. These diagrams provide increased visibility into the relationships between functions and related equipments being utilized and managed and can serve as a common communicating vehicle between the designer, program management, and the operational planner. The information and data product requirements to support the above processes were identified along with optimum formats and contents of these products. The resulting data product concepts are presented to support these in-flight maintenance and stowage processes.

[Brachial plexus. Anesthesia and analgesia].

PubMed

Schulz-Stübner, S

2003-07-01

This review explains the different approaches to the brachial plexus (posterior cervical, interscalene, supra- and infraclavicular, and axillary) and their advantages and disadvantages (indications, contraindications, and complications) for surgery and postoperative or chronic pain management. One of the focussed areas of this review is the use of continuous catheter techniques. Information about the most commonly used local anesthetics as well as adjuncts suggested in the literature is summarized. As essential components for the success of those techniques, organizational and documentation requirements are described. In summary, regional techniques for single shot or continuous block of the brachial plexus are an efficient and safe way of providing anesthesia and analgesia for surgery or pain in the region of the shoulder, arm, or hand.

Evaluating forest product potential as part of planning ecological restoration treatments on forested landscapes

Treesearch

R. James Barbour; Ryan Singleton; Douglas A. Maguire

2007-01-01

As landscape-scale assessments and modeling become a more common method for evaluating alternatives in integrated resource management, new techniques are needed to display and evaluate outcomes for large numbers of stands over long periods. In this proof of concept, we evaluate the potential to provide financial support for silvicultural treatments by selling timber...

Carcass addition does not enhance juvenile salmonid biomass, growth, or retention in six Northwestern California streams.

Treesearch

Bret Harvey; Margaret A. Wilzbach

2010-01-01

Fisheries managers commonly consider the addition of salmon carcasses when seeking to enhance salmonid populations. However, the range of environmental conditions under which the technique is effective remains poorly defined. We addressed this issue by measuring the effects of wintertime addition of salmon carcasses on the biomass, growth, and retention of juvenile...

Repurposing environmental DNA samples: Detecting the western pearlshell (Margaritifera falcata) as a proof of concept

Treesearch

Joseph C. Dysthe; Torrey Rodgers; Thomas W. Franklin; Kellie J. Carim; Michael K. Young; Kevin S. McKelvey; Karen E. Mock; Michael K. Schwartz

2018-01-01

Information on the distribution of multiple species in a common landscape is fundamental to effective conservation and management. However, distribution data are expensive to obtain and often limited to high-profile species in a system. A recently developed technique, environmental DNA (eDNA) sampling, has been shown to be more sensitive than traditional detection...

Deep Venous Thrombosis: An Interventionalist's Approach

PubMed Central

Jenkins, J. Stephen; Michael, Paul

2014-01-01

Background Deep venous thrombosis (DVT) of the lower extremity has traditionally been anatomically categorized into proximal DVT (thrombosis involving the popliteal vein and above) and distal DVT (isolated calf vein thrombosis). Proximal DVT involving the common femoral and/or iliac veins, referred to as iliofemoral DVT (IFDVT), represents a disease process with a worse prognosis and higher risk for poor clinical outcomes compared to proximal DVT not involving the common femoral or iliac draining veins. Methods This review discusses therapeutic options for treatment of lower extremity IFDVT, including adjuvant anticoagulation and catheter-based invasive therapies; literature supporting current acute interventional techniques; and the recommendations from the recently published American Heart Association guidelines. Results Patients with IFDVT represent an opportune subset of patients for acute interventional management with currently available techniques. This subset of patients with proximal DVT has a worse prognosis, is less well studied, and benefits more from acute intervention compared to patients with proximal DVT or distal DVT. Conclusion Invasive catheter-based therapies that remove thrombus and correct venous outflow obstructions improve outcomes and morbidity in patients with IFDVT. Future trials that address IFDVT specifically will improve our understanding and the proper management of this higher-risk subset of patients with DVT. PMID:25598728

Lower-extremity peripheral nerve blocks in the perioperative pain management of orthopaedic patients: AAOS exhibit selection.

PubMed

Stein, Benjamin E; Srikumaran, Umasuthan; Tan, Eric W; Freehill, Michael T; Wilckens, John H

2012-11-21

The utilization of peripheral nerve blocks in orthopaedic surgery has paralleled the rise in the number of ambulatory surgical procedures performed. Optimization of pain control in the perioperative orthopaedic patient contributes to improved patient satisfaction, early mobilization, decreased length of hospitalization, and decreased associated hospital and patient costs. Our purpose was to provide a concise, pertinent review of the use of peripheral nerve blocks in various orthopaedic procedures of the lower extremity, with specific focus on procedural anatomy, indications, patient outcome measures, and complications. We reviewed the literature and reference textbooks on commonly performed lower-extremity peripheral nerve block procedures in orthopaedic surgery, focusing on those most commonly used. The use of lower-extremity peripheral nerve blocks is a safe and effective approach to perioperative pain management. Different techniques and timing can have an important impact on patient satisfaction, and each technique has specific indications and complications. For major hip surgery, one of the most commonly used is the lumbar plexus block, which can result in early mobilization, reduced postoperative pain, and decreased opioid-associated adverse events. Associated complications include epidural spread of anesthesia, retroperitoneal hematoma formation, and postoperative falls. For arthroscopic and open knee procedures, the femoral nerve block is frequently used adjunctively. It provides improved early postoperative pain control, early mobilization with therapy, and increased patient satisfaction compared with intra-articular or intravenous opioids alone; it also provides cost savings. However, some studies have shown no significant difference in outcome measures compared with intra-articular opioids alone for arthroscopic anterior cruciate ligament reconstruction. Associated complications include nerve injury, intravascular injection, and postoperative falls. The use of peripheral nerve blocks in lower-extremity surgery is becoming a mainstay of perioperative pain management strategy.

Evidence-Based Medicine: Liposuction.

PubMed

Chia, Christopher T; Neinstein, Ryan M; Theodorou, Spero J

2017-01-01

After studying this article, the participant should be able to: 1. Review the appropriate indications and techniques for suction-assisted lipectomy body contouring surgery. 2. Accurately calculate the patient limits of lidocaine for safe dosing during the tumescent infiltration phase of liposuction. 3. Determine preoperatively possible "red flags" or symptoms and signs in the patient history and physical examination that may indicate a heightened risk profile for a liposuction procedure. 4. Provide an introduction to adjunctive techniques to liposuction such as energy-assisted liposuction and to determine whether or not the reader may decide to add them to his or her practice. With increased focus on one's aesthetic appearance, liposuction has become the most popular cosmetic procedure in the world since its introduction in the 1980s. As it has become more refined with experience, safety, patient selection, preoperative assessment, fluid management, proper technique, and overall care of the patient have been emphasized and improved. For the present article, a systematic review of the relevant literature regarding patient workup, tumescent fluid techniques, medication overview, and operative technique was conducted with a practical approach that the reader will possibly find clinically applicable. Recent trends regarding energy-assisted liposuction and body contouring local anesthesia use are addressed. Deep venous thromboembolism prophylaxis is mentioned, as are other common and less common possible complications. The article provides a literature-supported overview on liposuction techniques with an emphasis on preoperative assessment, medicines used, operative technique, and outcomes.

Proximal Humerus Fractures: Evaluation and Management in the Elderly Patient

PubMed Central

Grawe, Brian

2018-01-01

Introduction: Proximal humerus fractures are common in the elderly. The evaluation and management of these injuries is often controversial. The purpose of this study is to review recent evidence and provide updated recommendations for treating proximal humerus fractures in the elderly. Methods: A literature review of peer-reviewed publications related to the evaluation and management of proximal humerus fractures in the elderly was performed. There was a focus on randomized controlled trials and systematic reviews published within the last 5 years. Results: The incidence of proximal humerus fractures is increasing. It is a common osteoporotic fracture. Bone density is a predictor of reduction quality and can be readily assessed with anteroposterior views of the shoulder. Social independence is a predictor of outcome, whereas age is not. Many fractures are minimally displaced and respond acceptably to nonoperative management. Displaced and severe fractures are most frequently treated operatively with intramedullary nails, locking plates, percutaneous techniques, or arthroplasty. Discussion: Evidence from randomized controlled trials and systematic reviews is insufficient to recommend a treatment; however, most techniques have acceptable or good outcomes. Evaluation should include an assessment of the patient’s bone quality, social independence, and surgical risk factors. With internal fixation, special attention should be paid to medial comminution, varus angulation, and restoration of the calcar. With arthroplasty, attention should be paid to anatomic restoration of the tuberosities and proper placement of the prosthesis. Conclusion: A majority of minimally displaced fractures can be treated conservatively with early physical therapy. Treatment for displaced fractures should consider the patient’s level of independence, bone quality, and surgical risk factors. Fixation with percutaneous techniques, intramedullary nails, locking plates, and arthroplasty are all acceptable treatment options. There is no clear evidence-based treatment of choice, and the surgeon should consider their comfort level with various procedures during the decision-making process. PMID:29399372

Using web technique in the managing regulatory requirements of medical equipment for the nursing department.

PubMed

Chien, Chia-Hung; Hwang, Bao-Hwa; Lin, Thuey-Ru; Wang, Cheng-Yi; Chong, Fok-Ching

2006-01-01

The centralized and information management are in common use technique of modern management. The management of the medical equipment emphasized in the purchase and the maintenance management in early days,and cost down now is import factor for medical equipment management because the health insurance system causes the hospital budget reduced, so in the cost down strategy is to reduce the amount of money and promoting the efficient of use . Another important subject in medical equipment management is patient safety, so how to ensuring the quality of medical equipment is also having to notice. In the paper, we will provide an architecture for assistant the nursing department to develop a information system on the centralized and information management of valuable medical equipment. Through the system operation we hope can promote the effect and the quality of the medical equipment usage. This system implement up to now has more than half a year, and could acquired some concrete result: the utilization rate promotes doubly, the rate of breaking downs, the borrowed time cuts 75%, the cost downs for equipment purchase and satisfaction increases for user. In this paper, in addition to explaining the above-mentioned result,also discusses the design principle and structure on the whole system. We hope the protocol could be used as for clinical unit to control their valuable equipments and match the authority expectation.

Methodological Challenges in Physical Activity Research with Older Adults

PubMed Central

Chase, Jo-Ana D.

2015-01-01

The aging adult population is growing, as well as the incidence of chronic illness among older adults. Physical activity has been demonstrated in the literature to be a beneficial component of self-management for chronic illnesses commonly found in the older adult population. Health sciences research seeks to develop new knowledge, practices, and policies that may benefit older adults’ management of chronic illness and quality of life. However, research with the older adult population, though beneficial, includes potential methodological challenges specific to this age group. This article discusses common methodological issues in research among older adults, with a focus on physical activity intervention studies. Awareness and understanding of these issues may facilitate future development of research studies devoted to the aging adult population, through appropriate modification and tailoring of sampling techniques, intervention development, and data measures and collection. PMID:21821726

The management of abdominal wall hernias – in search of consensus

PubMed Central

Bury, Kamil; Śmietański, Maciej

2015-01-01

Introduction Laparoscopic repair is becoming an increasingly popular alternative in the treatment of abdominal wall hernias. In spite of numerous studies evaluating this technique, indications for laparoscopic surgery have not been established. Similarly, implant selection and fixation techniques have not been unified and are the subject of scientific discussion. Aim To assess whether there is a consensus on the management of the most common ventral abdominal wall hernias among recognised experts. Material and methods Fourteen specialists representing the boards of European surgical societies were surveyed to determine their choice of surgical technique for nine typical primary ventral and incisional hernias. The access method, type of operation, mesh prosthesis and fixation method were evaluated. In addition to the laparoscopic procedures, the number of tackers and their arrangement were assessed. Results In none of the cases presented was a consensus of experts obtained. Laparoscopic and open techniques were used equally often. Especially in the group of large hernias, decisions on repair methods were characterised by high variability. The technique of laparoscopic mesh fixation was a subject of great variability in terms of both method selection and the numbers of tackers and sutures used. Conclusions Recognised experts have not reached a consensus on the management of abdominal wall hernias. Our survey results indicate the need for further research and the inclusion of large cohorts of patients in the dedicated registries to evaluate the results of different surgical methods, which would help in the development of treatment algorithms for surgical education in the future. PMID:25960793

Research Gaps in Practice Guidelines for Acute Postoperative Pain Management in Adults: Findings From a Review of the Evidence for an American Pain Society Clinical Practice Guideline.

PubMed

Gordon, Debra B; de Leon-Casasola, Oscar A; Wu, Christopher L; Sluka, Kathleen A; Brennan, Timothy J; Chou, Roger

2016-02-01

Acute postoperative pain is a common clinical condition that, when poorly controlled, can result in a number of significant negative consequences. The American Pain Society commissioned an evidence-based guideline on the management of postoperative pain to promote evidence-based, safe, and effective perioperative pain management. An interdisciplinary panel developed 31 key questions and inclusion criteria to guide the evidence review. Investigators reviewed 6556 abstracts from multiple electronic databases up to November 2012, an updated evidence review to October 2014, and key references suggested by expert reviewers. More than 800 primary studies not included in a systematic review and 107 systematic reviews were included. Despite a large body of evidence, a number of critical research gaps were identified where only low-quality or insufficient evidence was found to help guide clinical practice recommendations. This report identifies evidence gaps including optimal methods and timing of perioperative patient education, nonpharmacological modalities, combinations of analgesic techniques, monitoring of patient response to treatment, techniques for neuraxial and regional analgesia, and organizational care delivery models. Recommendations to help guide the design of future perioperative studies are offered. Acute postoperative pain is a common clinical condition requiring an evidence-based, planned, and multimodal approach. Despite the plethora of published evidence, much of it is weak and key questions remain unanswered. Researchers are encouraged to work together to produce strong evidence to help guide clinical decisions in perioperative pain management. Copyright © 2016 American Pain Society. Published by Elsevier Inc. All rights reserved.

Aspect-Oriented Model-Driven Software Product Line Engineering

NASA Astrophysics Data System (ADS)

Groher, Iris; Voelter, Markus

Software product line engineering aims to reduce development time, effort, cost, and complexity by taking advantage of the commonality within a portfolio of similar products. The effectiveness of a software product line approach directly depends on how well feature variability within the portfolio is implemented and managed throughout the development lifecycle, from early analysis through maintenance and evolution. This article presents an approach that facilitates variability implementation, management, and tracing by integrating model-driven and aspect-oriented software development. Features are separated in models and composed of aspect-oriented composition techniques on model level. Model transformations support the transition from problem to solution space models. Aspect-oriented techniques enable the explicit expression and modularization of variability on model, template, and code level. The presented concepts are illustrated with a case study of a home automation system.

SPECT/CT in imaging foot and ankle pathology-the demise of other coregistration techniques.

PubMed

Mohan, Hosahalli K; Gnanasegaran, Gopinath; Vijayanathan, Sanjay; Fogelman, Ignac

2010-01-01

Disorders of the ankle and foot are common and given the complex anatomy and function of the foot, they present a significant clinical challenge. Imaging plays a crucial role in the management of these patients, with multiple imaging options available to the clinician. The American College of radiology has set the appropriateness criteria for the use of the available investigating modalities in the management of foot and ankle pathologies. These are broadly classified into anatomical and functional imaging modalities. Recently, single-photon emission computed tomography and/or computed tomography scanners, which can elegantly combine functional and anatomical images have been introduced, promising an exciting and important development. This review describes our clinical experience with single-photon emission computed tomography and/or computed tomography and discusses potential applications of these techniques.

Surgical timing of treating injured extremities: an evolving concept of urgency.

PubMed

Crist, Brett D; Ferguson, Tania; Murtha, Yvonne M; Lee, Mark A

2013-01-01

The management of some orthopaedic extremity injuries has changed over the past decade because of changing resource availability and the risks of complications. It is helpful to review the current literature regarding orthopaedic extremity emergencies and urgencies. The effects of the techniques of damage control orthopaedic techniques and the concept of the orthopaedic trauma room have also affected the management of these injuries. The available literature indicates that the remaining true orthopaedic extremity emergencies include compartment syndrome and vascular injuries associated with fractures and dislocations. Orthopaedic urgencies include open fracture management, femoral neck fractures in young patients treated with open reduction and internal fixation, and talus fractures that are open or those with impending skin compromise. Deciding when the definitive management of orthopaedic extremity injuries will occur has evolved as the concept of damage control orthopaedics has become more commonly accepted. Patient survival rates have improved with current resuscitative protocols. Definitive fixation of extremity injuries should be delayed until the patient's physiologic and extremity soft-tissue status allows for appropriate definitive management while minimizing the risks of complications. In patients with semiurgent orthopaedic injuries, the use of an orthopaedic trauma room has led to more efficient care of patients, fewer complications, and better time management for surgeons who perform on-call service for patients with traumatic orthopaedic injuries.

Latest recanalization techniques for complex superficial femoral artery occlusions.

PubMed

Gonzalez, L; Chen, A; Lin, P H; Pisimisis, G; Barshes, N R; Bechara, C F; Kougias, P

2012-08-01

Complex, long segment lesions of the superficial femoral artery (SFA) are common, occurring in 40% of patients with peripheral vascular disease. In particular, chronic total occlusions (CTOs) continue to pose a challenge in the endovascular management of SFA disease. Several conventional wire and catheter based techniques have been described including subintimal recanalization and retrograde techniques. In addition, advances in endovascular technology have led to the development of a series of new devices aimed specifically at facilitating the crossing of long segment SFA occlusions or establishing re-entry of the true lumen. Here we present an overview of the minimally invasive techniques used to recanalize CTOs of the SFA and the latest specialized devices available for both recanalization and re-entry, as well as a summary of the literature supporting their application.

Development of an antimycin-impregnated bait for controlling common carp

USGS Publications Warehouse

Rach, J.J.; Luoma, J.A.; Marking, L.L.

1994-01-01

The common carp Cyprinus carpio is a major problem for fisheries and wildlife managers because its feeding behavior causes degradation of valuable fish and waterfowl habitat. This study was designed to evaluate the effectiveness of an antimycin-impregnated bait for control of common carp. The toxic bait contained fish meal, a binder, antimycin, and water. The ingredients were mixed together and made into pellets. This bait was force-fed to common carp or administered in a pond environment, where fish voluntarily fed on the bait. The lowest lethal dose in the forcefeeding study was 0.346 mg antimycin/kg of fish and doses that exceeded 0.811 mg antimycin/kg were toxic to all fish. On three occasions, adult common carp held in 0.004-ha concrete ponds were offered 10 g of toxic bait containing 5.0, 7.5, and 10 mg antimycin/g of bait and the mean mortalities 96 h later were 21, 35, and 51%, respectively. Three tests were conducted in 0.04-ha earthen ponds each containing 100 adult common carp; these fish were offered 50 g of the toxic bait that contained 10 mg antimycin/g, and the mean mortalities (96 h) were 19, 32, and 74%. Toxic baits should be used in conjunction with other management techniques, and only when common carp are congregated and actively feeding, and when few nontarget bottom- feeding species are present.

Contemporary management of isolated iliac aneurysms.

PubMed

Krupski, W C; Selzman, C H; Floridia, R; Strecker, P K; Nehler, M R; Whitehill, T A

1998-07-01

Because isolated common iliac artery aneurysms are infrequent, are difficult to detect and treat, and have traditionally been associated with high operative mortality rates in reported series, we analyzed the outcomes of operative repair of 31 isolated common iliac artery aneurysms in 21 patients to ascertain morbidity and mortality rates with contemporary techniques of repair. A retrospective review study was conducted in a university teaching hospital and a Department of Veterans Affairs Medical Center. Perioperative mortality and operative morbidity rates were examined in 17 men and four women with isolated common iliac artery aneurysms between 1984 and 1997. Ages ranged from 38 to 87 years (mean 69 +/- 8 years). Slightly more than half of the cases were symptomatic, with abdominal pain, neurologic, claudicative, genitourinary, or hemodynamic symptoms. One aneurysm had ruptured and one was infected. There was one iliac artery-iliac vein fistula. All aneurysms involved the common iliac artery. Coexistent unilateral or bilateral external iliac aneurysms were present in four patients; there were three accompanying internal iliac aneurysms. Overall, 52% of patients had unilateral aneurysms and 48% had bilateral aneurysms. Aneurysms ranged in maximal diameter from 2.5 to 12 cm (mean 5.6 +/- 2 cm). No patients were unavailable for follow-up, which averaged 5.5 years. Nineteen patients underwent direct operative repair of isolated iliac aneurysms. One patient had placement of an endoluminal covered stent graft; another patient at high risk had percutaneous placement of coils within the aneurysm to occlude it in conjunction with a femorofemoral bypass graft. Patients with bilateral aneurysms underwent aortoiliac or aortofemoral interposition grafts, whereas unilateral aneurysms were managed with local interposition grafts. There were no deaths in the perioperative period. Only one elective operation (5%) resulted in a significant complication, compartment syndrome requiring fasciotomy. The patient treated with the covered stent required femorofemoral bypass when the stent occluded 1 week after the operation. The patient treated with coil occlusion of a large common iliac aneurysm died 2 years later when the aneurysm ruptured. Isolated iliac artery aneurysms can be managed with much lower mortality and morbidity rates than aneurysm previously been reported by using a systematic operative approach. Percutaneous techniques may be less durable and effective than direct surgical repair.

Desires and management preferences of stakeholders regarding feral cats in the Hawaiian islands.

PubMed

Lohr, Cheryl A; Lepczyk, Christopher A

2014-04-01

Feral cats are abundant in many parts of the world and a source of conservation conflict. Our goal was to clarify the beliefs and desires held by stakeholders regarding feral cat abundance and management. We measured people's desired abundance of feral cats in the Hawaiian Islands and identified an order of preference for 7 feral cat management techniques. In 2011 we disseminated a survey to 5407 Hawaii residents. Approximately 46% of preidentified stakeholders and 20% of random residents responded to the survey (1510 surveys returned). Results from the potential for conflict index revealed a high level of consensus (86.9% of respondents) that feral cat abundance should be decreased. The 3 most common explanatory variables for respondents' stated desires were enjoyment from seeing feral cats (84%), intrinsic value of feral cats (12%), and threat to native fauna (73%). The frequency with which respondents saw cats and change in the perceived abundance of cats also affected respondent's desired abundance of cats; 41.3% of respondents stated that they saw feral cats daily and 44.7% stated that the cat population had increased in recent years. Other potential environmental impacts of feral cats had little affect on desired abundance. The majority of respondents (78%) supported removing feral cats from the natural environment permanently. Consensus convergence models with data from 1388 respondents who completed the relevant questions showed live capture and lethal injection was the most preferred technique and trap-neuter-release was the least preferred technique for managing feral cats. However, the acceptability of each technique varied among stakeholders. Our results suggest that the majority of Hawaii's residents would like to see effective management that reduces the abundance of feral or free-roaming cats. © 2013 Society for Conservation Biology.

Minimal access surgery of pediatric inguinal hernias: a review.

PubMed

Saranga Bharathi, Ramanathan; Arora, Manu; Baskaran, Vasudevan

2008-08-01

Inguinal hernia is a common problem among children, and herniotomy has been its standard of care. Laparoscopy, which gained a toehold initially in the management of pediatric inguinal hernia (PIH), has managed to steer world opinion against routine contralateral groin exploration by precise detection of contralateral patencies. Besides detection, its ability to repair simultaneously all forms of inguinal hernias (indirect, direct, combined, recurrent, and incarcerated) together with contralateral patencies has cemented its role as a viable alternative to conventional repair. Numerous minimally invasive techniques for addressing PIH have mushroomed in the past two decades. These techniques vary considerably in their approaches to the internal ring (intraperitoneal, extraperitoneal), use of ports (three, two, one), endoscopic instruments (two, one, or none), sutures (absorbable, nonabsorbable), and techniques of knotting (intracorporeal, extracorporeal). In addition to the surgeons' experience and the merits/limitations of individual techniques, it is the nature of the defect that should govern the choice of technique. The emerging techniques show a trend toward increasing use of extracorporeal knotting and diminishing use of working ports and endoscopic instruments. These favor wider adoption of minimal access surgery in addressing PIH by surgeons, irrespective of their laparoscopic skills and experience. Growing experience, wider adoption, decreasing complications, and increasing advantages favor emergence of minimal access surgery as the gold standard for the treatment of PIH in the future. This article comprehensively reviews the laparoscopic techniques of addressing PIH.

[Managing focal incidental renal lesions].

PubMed

Nicolau, C; Paño, B; Sebastià, C

2016-01-01

Incidental renal lesions are relatively common in daily radiological practice. It is important to know the different diagnostic possibilities for incidentally detected lesions, depending on whether they are cystic or solid. The management of cystic lesions is guided by the Bosniak classification. In solid lesions, the goal is to differentiate between renal cancer and benign tumors such as fat-poor angiomyolipoma and oncocytoma. Radiologists need to know the recommendations for the management of these lesions and the usefulness of the different imaging techniques and interventional procedures in function of the characteristics of the incidental lesion and the patient's life expectancy. Copyright © 2015 SERAM. Published by Elsevier España, S.L.U. All rights reserved.

Stabilization and treatment of dental avulsions and fractures by emergency physicians using just-in-time training.

PubMed

McIntosh, Mark S; Konzelmann, Jason; Smith, Jeffrey; Kalynych, Colleen J; Wears, Robert L; Schneider, Howard; Wylie, Todd; Kaminski, Anne; Matar-Joseph, Madeline

2009-10-01

The objective of this investigation is to use a dental simulation model to compare splinting and bandaging methods for managing tooth avulsions and fractures, as measured by dentist evaluators for quality and time to complete each stabilization procedure. This was a randomized crossover study comparing 3 splinting techniques for managing a traumatically avulsed tooth (periodontal pack, wire, and bondable reinforcement ribbon) and 2 bandage techniques for managing a fractured tooth (calcium hydroxide paste and light-cured composite). After viewing a Just-in-Time training video, a convenience sample of emergency physicians performed the 5 stabilization techniques on dental models containing extracted teeth embedded in clay to simulate a segment of the human dentition. Data collected included time to complete each procedure, the evaluation of dentists about whether the procedure was performed satisfactorily or unsatisfactorily, and the ranking of dentists' and participants' preferred technique. Twenty-five emergency physicians participated in the study: 17 residents, 2 pediatric emergency medicine fellows, and 6 attending physicians. Reported median time, as well as minimum and maximum times to complete each splinting technique for an avulsed tooth, was as follows: periodontal pack 4.4 minutes (2.5 to 6.5 minutes), wire 8.6 minutes (5.8 to 12.9 minutes), and bondable reinforcement ribbon 8.9 minutes (5.6 to 15 minutes). Median time (and minimum and maximum times) to complete each protective bandaging technique for a fractured tooth was calcium hydroxide paste 4.6 minutes (3 to 9.6 minutes) and light-cured composite 7.1 minutes (5.5 to 14.1 minutes). When asked to choose a preferred splinting and bandaging technique according to the performance of the physicians, the dentists chose the bondable reinforcement ribbon 96% (24/25) and the light-cured composite 100% (25/25) of the time. Study participants had no measurable or agreeable preference for a particular splinting or bandaging technique. The results of this study suggest that of the stabilization procedures completed by emergency physicians, dentists preferred the bondable reinforcement ribbon for managing an avulsed tooth and the light-cured composite technique for managing a fractured tooth over the commonly taught and more frequently used procedures in emergency medicine.

Why do I need to know this? Optics/photonics problem-based learning in the math classroom

NASA Astrophysics Data System (ADS)

Donnelly, Matthew J.; Donnelly, Judith F.; Donnelly, Stephanie

2017-08-01

A common complaint of engineering managers is that new employees at all levels, technician through engineer, tend to have rote calculation ability but are unable to think critically and use structured problem solving techniques to apply mathematical concepts. Further, they often have poor written and oral communication skills and difficulty working in teams. Ironically, a common question of high school mathematics students is "Why do I need to know this?" In this paper we describe a project using optics/photonics and Problem Based Learning (PBL) to address these issues in a high school calculus classroom.

Space station common module power system network topology and hardware development

NASA Technical Reports Server (NTRS)

Landis, D. M.

1985-01-01

Candidate power system newtork topologies for the space station common module are defined and developed and the necessary hardware for test and evaluation is provided. Martin Marietta's approach to performing the proposed program is presented. Performance of the tasks described will assure systematic development and evaluation of program results, and will provide the necessary management tools, visibility, and control techniques for performance assessment. The plan is submitted in accordance with the data requirements given and includes a comprehensive task logic flow diagram, time phased manpower requirements, a program milestone schedule, and detailed descriptions of each program task.

Strength of cerclage fixation systems: a biomechanical study.

PubMed

Incavo, S J; Difazio, F; Wilder, D

1990-11-01

This study examined the load to failure ratio and stiffness of eight different cerclage techniques commonly used in the clinical management of fractures. For a single-loop cerclage, titanium cable was the strongest, while stainless steel wire secured with a commercial tightener was the weakest (P < 0.05). When a single-loop configuration is necessary (i.e. trochanteric attachment) a cable system is superior to cerclage wiring. A double-wrap of either cable or wire was considerably stronger than any single-wrap cerclage technique and stronger than two cerclage wires (P < 0.05). Copyright © 1990. Published by Elsevier Ltd.

Stent-Assisted Endovascular Treatment of Anterior Communicating Artery Aneurysms – Literature Review

PubMed Central

Kocur, Damian; Ślusarczyk, Wojciech; Przybyłko, Nikodem; Bażowski, Piotr; Właszczuk, Adam; Kwiek, Stanisław

2016-01-01

Summary The anterior cerebral artery is a common location of intracranial aneurysms. The standard coil embolization technique is limited by its inability to occlude wide-neck aneurysms. Stent deployment across the aneurysm neck supports the coil mass inside the aneurysmal sac, and furthermore, has an effect on local hemodynamic and biologic changes. In this article, various management strategies and techniques as well as angiographic outcomes and complications related to stent-assisted endovascular treatment of anterior communicating artery aneurysms are presented. This treatment method is safe and associated with low morbidity and mortality rates. PMID:27559426

Identification and Management of Chronic Pain in Primary Care: a Review.

PubMed

Mills, Sarah; Torrance, Nicola; Smith, Blair H

2016-02-01

Chronic pain is a common, complex, and challenging condition, where understanding the biological, social, physical and psychological contexts is vital to successful outcomes in primary care. In managing chronic pain the focus is often on promoting rehabilitation and maximizing quality of life rather than achieving cure. Recent screening tools and brief intervention techniques can be effective in helping clinicians identify, stratify and manage both patients already living with chronic pain and those who are at risk of developing chronic pain from acute pain. Frequent assessment and re-assessment are key to ensuring treatment is appropriate and safe, as well as minimizing and addressing side effects. Primary care management should be holistic and evidence-based (where possible) and incorporates both pharmacological and non-pharmacological approaches, including psychology, self-management, physiotherapy, peripheral nervous system stimulation, complementary therapies and comprehensive pain-management programmes. These may either be based wholly in primary care or supported by appropriate specialist referral.

A Review of Techniques Used in the Management of Growing Skull Fractures.

PubMed

Vezina, Noemie; Al-Halabi, Becher; Shash, Hani; Dudley, Roy R; Gilardino, Mirko S

2017-05-01

Growing skull fractures (GSFs) are rare complications of pediatric head trauma that comprise skull fractures associated with an underlying dural tear and an intact arachnoid membrane. They are often misdiagnosed, and delay in management can lead to progression of the disease along with its neurological sequelae. Multiple clinical reports and qualitative reviews on this entity exist. To our knowledge, this represents the largest clinical review reporting on established techniques in the management of these fractures. A literature search was performed on the databases Embase, Medline, Cochrane, and PubMed from their inception until February 2015 using the terms "Growing," "Skull," "Fracture," and their equivalent terms. Studies included were case series with 5 or more patients describing GSFs and their management. Twenty-two articles reporting 440 patients were included in the analysis. The mean age at trauma was 8.8 months, with the mean at presentation of 21.9 months and 57.8% of the patients being males. Most commonly, a combined dura-cranioplasty was done in 61.6% of the patients. A range of autoplastic and alloplastic materials were used in both of these techniques. Improvement from preoperative clinical status in seizures and neurological deficits was noted in 18 (12.7%) and 11 (7.05%) of the patients, respectively, following operative repair and medical management. Early recognition is crucial in the management and treatment of GSF. Children at risk for developing GSF should be monitored clinically for up to 3 months following the initial insult. The surgical treatment depends on the size of the fracture and the age of the patient. A summary of the presentation, management, associated outcomes, complications, and recommendations discussed in the literature are reported within.

Laparoscopic access overview: Is there a safest entry method?

PubMed

Bianchi, G; Martorana, E; Ghaith, A; Pirola, G M; Rani, M; Bove, P; Porpiglia, F; Manferrari, F; Micali, S

2016-01-01

Laparoscopy is a minimally invasive technique to access the abdominal cavity, for diagnostic or therapeutic applications. Optimizing the access technique is an important step for laparoscopic procedures. The aim of this study is to assess the outcomes of different laparoscopic access techniques and to identify the safest one. Laparoscopic access questionnaire was forwarded via e-mail to the 60 centers who are partners in working group for laparoscopic and robotic surgery of the Italian Urological Society (SIU) and their American and European reference centers. The response rate was 68.33%. The total number of procedures considered was 65.636. 61.5% of surgeons use Veress needle to create pneumoperitoneum. Blind trocar technique is the most commonly used, but has the greatest number of complications. Optical trocar technique seems to be the safest, but it's the less commonly used. The 28,2% of surgeons adopt open Hasson's technique. Total intra-operative complications rate was 3.3%. Open conversion rate was 0.33%, transfusion rate was 1.13%, and total post-operative complication rate was 2.53%. Laparoscopic access is a safe technique with low complication rate. Most of complications can be managed conservatively or laparoscopically. The choice of access technique can affect the rate and type of complications and should be planned according to surgeon experience, safety of each technique and patient characteristics. All access types have perioperative complications. According with our study, optical trocar technique seems to be the safest. Copyright © 2016 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

Symptom management strategies for men with early-stage prostate cancer: results from the Prostate Cancer Patient Education Program (PC PEP).

PubMed

Vij, Alok; Kowalkowski, Marc A; Hart, Tae; Goltz, Heather Honoré; Hoffman, David J; Knight, Sara J; Caroll, Peter R; Latini, David M

2013-12-01

While the literature on prostate cancer health-related quality of life has grown extensively, little is known about symptom management strategies used by men to manage treatment-related side effects and the effectiveness of those strategies. We collected 628 symptom management reports from 98 men treated for localized prostate cancer. Participants were recruited from email lists and a prostate cancer clinic in Northern California. Data were collected using the Critical Incident Technique. Symptom management reports were assigned to categories of urinary, sexual, bowel, mental health, systemic, or "other." We calculated descriptive statistics by symptom type and management strategy effectiveness. The most common symptoms were urinary (26 %) and sexual (23 %). Participants' symptom management strategies varied widely, from medical and surgical interventions (20 %) to behavioral strategies (11 %) to diet and lifestyle interventions (12 %). The effectiveness of symptom management strategies varied, with sexual symptoms being managed effectively only 47 % of the time to mental health symptom management strategies considered effective 89 % of the time. Doing nothing was a commonly reported (15 %) response to symptoms and was effective only 14 % of the time. Men report the least effectiveness in symptom management for sexual dysfunction after prostate cancer treatment. Including men's experience with managing treatment side effects may be an important way to improve survivorship programs and make them more acceptable to men. More work is needed to find out why men frequently do nothing in response to symptoms when effective solutions exist and how providers can successfully engage such men.

Symptom Management Strategies for Men with Early-Stage Prostate Cancer: Results from the Prostate Cancer Patient Education Program (PCPEP)

PubMed Central

Vij, Alok; Kowalkowski, Marc A.; Hart, Tae; Goltz, Heather Honoré; Hoffman, David J.; Knight, Sara J.; Caroll, Peter R.

2013-01-01

While the literature on prostate cancer health-related quality of life has grown extensively, little is known about symptom management strategies used by men to manage treatment-related side effects and the effectiveness of those strategies. We collected 628 symptom management reports from 98 men treated for localized prostate cancer. Participants were recruited from email lists and a prostate cancer clinic in Northern California. Data were collected using the Critical Incident Technique. Symptom management reports were assigned to categories of urinary, sexual, bowel, mental health, systemic, or “other.” We calculated descriptive statistics by symptom type and management strategy effectiveness. The most common symptoms were urinary (26 %) and sexual (23 %). Participants’ symptom management strategies varied widely, from medical and surgical interventions (20 %) to behavioral strategies (11 %) to diet and lifestyle interventions (12 %). The effectiveness of symptom management strategies varied, with sexual symptoms being managed effectively only 47 % of the time to mental health symptom management strategies considered effective 89 % of the time. Doing nothing was a commonly reported (15 %) response to symptoms and was effective only 14 % of the time. Men report the least effectiveness in symptom management for sexual dysfunction after prostate cancer treatment. Including men’s experience with managing treatment side effects may be an important way to improve survivorship programs and make them more acceptable to men. More work is needed to find out why men frequently do nothing in response to symptoms when effective solutions exist and how providers can successfully engage such men. PMID:23996206

Obstetrical emergencies.

PubMed

Biddle, D; Macintire, D K

2000-05-01

This article discusses different techniques that can be used in the diagnosis and treatment of obstetrical emergencies. Female reproductive emergencies commonly encountered by small animal practitioners include pyometra, dystocia, cesarean section, mastitis, eclampsia, uterine torsion, and uterine prolapse. A thorough knowledge of normal and abnormal reproductive behavior will aid the emergency veterinarian in successfully managing such cases. Timely diagnosis and treatment of these emergencies will often give a good outcome.

Applied Computational Electromagnetics Society Journal and Newletter, Volume 14 No. 1

DTIC Science & Technology

1999-03-01

code validation, performance analysis, and input/output standardization; code or technique optimization and error minimization; innovations in...SOUTH AFRICA Alamo, CA, 94507-0516 USA Washington, DC 20330 USA MANAGING EDITOR Kueichien C. Hill Krishna Naishadham Richard W. Adler Wright Laboratory...INSTITUTIONAL MEMBERS ALLGON DERA Nasvagen 17 Common Road, Funtington INNOVATIVE DYNAMICS Akersberga, SWEDEN S-18425 Chichester, P018 9PD UK 2560 N. Triphammer

The common cold: potential for future prevention or cure.

PubMed

Passioti, Maria; Maggina, Paraskevi; Megremis, Spyridon; Papadopoulos, Nikolaos G

2014-02-01

The common cold is the most frequent, although generally mild, human disease. Human Rhinoviruses are the prevalent causative agents, but other viruses are also implicated. Being so common, viral colds, have significant implications on public health and quality of life, but may also be life-threatening for vulnerable groups of patients. Specific diagnosis and treatment of the common cold still remain unmet needs. Molecular diagnostic techniques allow specific detection of known pathogens as well as the identification of newly emerging viruses. Although a number of medications or natural treatments have been shown to have some effect, either on the number or on the severity of common colds, no single agent is considerably effective. Virus-specific management remains in most cases a challenging potential as many factors have to be taken into account, including the diversity of the viral genomes, the heterogeneity of affected individuals, as well as the complexity of this long standing host-virus relationship.

An Update to Hepatobiliary Stents

PubMed Central

Moy, Brian T.; Birk, John W.

2015-01-01

Endoscopic stent placement is a common primary management therapy for benign and malignant biliary strictures. However, continuous use of stents is limited by occlusion and migration. Stent technology has evolved significantly over the past two decades to reduce these problems. The purpose of this article is to review current guidelines in managing malignant and benign biliary obstructions, current endoscopic techniques for stent placement, and emerging stent technology. What began as a simple plastic stent technology has evolved significantly to include uncovered, partially covered, and fully covered self-expanding metal stents (SEMS) as well as magnetic, bioabsorbable, drug-eluting, and antireflux stents.1 PMID:26357636

Prevention and Management of Nerve Injuries in Thoracic Surgery.

PubMed

Auchincloss, Hugh G; Donahue, Dean M

2015-11-01

Nerve injuries can cause substantial morbidity after thoracic surgical procedures. These injuries are preventable, provided that the surgeon has a thorough understanding of the anatomy and follows important surgical principles. When nerve injuries occur, it is important to recognize the options available in the immediate and postoperative settings, including expectant management, immediate nerve reconstruction, or auxiliary procedures. This article covers the basic anatomy and physiology of nerves and nerve injuries, an overview of techniques in nerve reconstruction, and a guide to the nerves most commonly involved in thoracic operative procedures. Copyright © 2015 Elsevier Inc. All rights reserved.

Endourologic management of malignant ureteral obstruction: indications, results, and quality-of-life issues.

PubMed

Sountoulides, Petros; Pardalidis, Nikolaos; Sofikitis, Nikolaos

2010-01-01

Obstruction of the upper urinary tract is a problem commonly faced by practicing urologists. The constant evolution in endourology has effectively facilitated minimally invasive management of upper-tract obstruction. In a case in which malignancy is the cause of obstruction, however, the situation significantly changes. Questions arise regarding the need for relieving the obstruction, the means to accomplish this, and the benefits and drawbacks of each technique regarding both their efficacy and their impact on the patients well-being and the crucial issue of quality of life in the face of malignancy.

Assessment and Management of Hypertension in Patients on Dialysis

PubMed Central

Flynn, Joseph; Pogue, Velvie; Rahman, Mahboob; Reisin, Efrain; Weir, Matthew R.

2014-01-01

Hypertension is common, difficult to diagnose, and poorly controlled among patients with ESRD. However, controversy surrounds the diagnosis and treatment of hypertension. Here, we describe the diagnosis, epidemiology, and management of hypertension in dialysis patients, and examine the data sparking debate over appropriate methods for diagnosing and treating hypertension. Furthermore, we consider the issues uniquely related to hypertension in pediatric dialysis patients. Future clinical trials designed to clarify the controversial results discussed here should lead to the implementation of diagnostic and therapeutic techniques that improve long-term cardiovascular outcomes in patients with ESRD. PMID:24700870

Management of Cleft Maxillary Hypoplasia with Anterior Maxillary Distraction: Our Experience.

PubMed

Chacko, Tojan; Vinod, Sankar; Mani, Varghese; George, Arun; Sivaprasad, K K

2014-12-01

Maxillary hypoplasia is a common developmental problem in cleft lip and palate deformities. Since 1970s these deformities have traditionally been corrected by means of orthognathic surgery. Management of skeletal deformities in the maxillofacial region has been an important challenge for maxillofacial surgeons and orthodontists. Distraction osteogenesis is a surgical technique that uses body's own repairing mechanisms for optimal reconstruction of the tissues. We present four cases of anterior maxillary distraction osteogenesis with tooth borne distraction device-Hyrax, which were analyzed retrospectively for the efficacy of the tooth borne device-Hyrax and skeletal stability of distracted anterior maxillary segment.

Combined Angio-Seal™ and stenting rescue treatment in a case of iatrogenic common carotid artery dissection during direct puncture for ruptured intracranial aneurysm embolization: a technical note.

PubMed

Iosif, Christina; Clarençon, Frédéric; Di Maria, Federico; Law-Ye, Bruno; Le Jean, Lise; Capelle, Laurent; Chiras, Jacques; Sourour, Nader

2013-05-01

Direct puncture may offer an alternative access for embolization of intracranial aneurysms in patients presenting with tortuous vessels. Nevertheless, major complications such as compressive hematoma and arterial dissection can occur with this technique. A tight common carotid artery (CCA) dissection was seen secondary to direct puncture in a 72-year-old patient who presented with a ruptured anterior communicating artery (ACom) aneurysm. After regular coiling of the aneurysm and using a femoral approach, an Angio-Seal™ device (St Jude Medical, Saint Paul, MN, USA) was placed and a carotid wallstent (Stryker Neurovascular, Fremont, CA, USA) successfully deployed at the dissected CCA, which was followed by good clinical and angiographic outcomes. A combined rescue technique combining Angio-Seal insertion and stent deployment was safe and effective for managing iatrogenic carotid artery dissection. Copyright © 2013. Published by Elsevier Masson SAS.

Wrist Pain in Gymnasts: A Review of Common Overuse Wrist Pathology in the Gymnastics Athlete.

PubMed

Benjamin, Holly J; Engel, Sean C; Chudzik, Debra

Injury rates among gymnasts are among the highest of any sport at the high school and collegiate level per athletic exposure. The wrist has increased injury risk due to repetitive physical stresses predisposing it to acute injury, overuse, and degenerative damage. This article will review the most common overuse wrist injuries seen in gymnasts. Prompt evaluation and management is necessary to avoid the negative sequelae that can often accompany these injuries. Little is known about effective sport-specific injury prevention strategies, but general guidelines for overuse injury prevention including limiting excessive loading of the wrist, maintaining wrist joint flexibility, an emphasis on proper technique, and incorporating wrist and general core strengthening seem beneficial. General return to play principles are similar for all gymnast-related wrist injuries, including resolution of pain, restoration of normal wrist joint function, completion of a progressive rehabilitation program, and use of proper technique.

Intraoperative fluoroscopic evaluation of screw placement during pelvic and acetabular surgery.

PubMed

Yi, Chengla; Burns, Sean; Hak, David J

2014-01-01

The surgical treatment of pelvic and acetabular fractures can be technically challenging. Various techniques are available for the reconstruction of pelvic and acetabular fractures. Less invasive percutaneous fracture stabilization techniques, with closed reduction or limited open reduction, have been developed and are gaining popularity in the management of pelvic and acetabular fractures. These techniques require knowledge and interpretation of various fluoroscopic images to ensure appropriate and safe screw placement. Given the anatomic complexity of the intrapelvic structures and the 2-dimensional nature of standard fluoroscopy, multiple images oriented in different planes are needed to assess the accuracy of guide wire and screw placement. This article reviews the fluoroscopic imaging of common screw orientations during pelvic and acetabular surgery.

An international survey on noninvasive ventilation use for acute respiratory failure in general non-monitored wards.

PubMed

Cabrini, Luca; Esquinas, Antonio; Pasin, Laura; Nardelli, Pasquale; Frati, Elena; Pintaudi, Margherita; Matos, Paulo; Landoni, Giovanni; Zangrillo, Alberto

2015-04-01

Use of noninvasive ventilation (NIV) for the treatment of patients with acute respiratory failure (ARF) has greatly increased in the last decades. In contrast, the increasing knowledge of its effectiveness and physician confidence in managing this technique have been accompanied by a declining number of available ICU beds. As a consequence, the application of NIV outside the ICU has been reported as a growing phenomenon. Previously published surveys highlighted a great heterogeneity in NIV use, clinical indications, settings, and efficacy. Moreover, they revealed a marked heterogeneity with regard to staff training and technical and organizational aspects. We performed the first worldwide web-based survey focused on NIV use in general wards for ARF. A questionnaire to obtain data regarding hospital and ICU characteristics, settings and modalities of NIV application and monitoring, estimated outcomes, technical and organizational aspects, and observed complications was developed. The multiple-choice anonymous questionnaire to be filled out online was distributed worldwide by mail, LinkedIn, and Facebook professional groups. One-hundred fifty-seven questionnaires were filled out and analyzed. Respondents were from 51 countries from all 5 continents. NIV application in general wards was reported by 66% of respondents. Treatments were reported as increasing in 57% of cases. Limited training and human resources were the most common reasons for not using NIV in general wards. Overall, most respondents perceived that NIV avoids tracheal intubation in most cases; worsening of ARF, intolerance, and inability to manage secretions were the most commonly reported causes of NIV failure. Use of NIV in general wards was reported as effective, common, and gradually increasing. Improvement in staff training and introduction of protocols could help to make this technique safer and more common when applied in general wards setting. Copyright © 2015 by Daedalus Enterprises.

Neuroimaging of epilepsy

PubMed Central

Cendes, Fernando; Theodore, William H.; Brinkmann, Benjamin H.; Sulc, Vlastimil; Cascino, Gregory D.

2017-01-01

Imaging is pivotal in the evaluation and management of patients with seizure disorders. Elegant structural neuroimaging with magnetic resonance imaging (MRI) may assist in determining the etiology of focal epilepsy and demonstrating the anatomical changes associated with seizure activity. The high diagnostic yield of MRI to identify the common pathological findings in individuals with focal seizures including mesial temporal sclerosis, vascular anomalies, low-grade glial neoplasms and malformations of cortical development has been demonstrated. Positron emission tomography (PET) is the most commonly performed interictal functional neuroimaging technique that may reveal a focal hypometabolic region concordant with seizure onset. Single photon emission computed tomography (SPECT) studies may assist performance of ictal neuroimaging in patients with pharmacoresistant focal epilepsy being considered for neurosurgical treatment. This chapter highlights neuroimaging developments and innovations, and provides a comprehensive overview of the imaging strategies used to improve the care and management of people with epilepsy. PMID:27430454

Complicated bile duct stones

PubMed Central

Roy, Ashwin; Martin, Derrick

2013-01-01

Common bile duct stones (CBDSs) are solid deposits that can either form within the gallbladder or migrate to the common bile duct (CBD), or form de novo in the biliary tree. In the USA around 15% of the population have gallstones and of these, 3% present with symptoms annually. Because of this, there have been major advancements in the management of gallstones and related conditions. Management is based on the patient's risk profile; young and healthy patients are likely to be recommended for surgery and elderly patients with comorbidities are usually recommended for endoscopic procedures. Imaging of gallstones has advanced in the last 30 years with endoscopic retrograde cholangiopancreatography evolving from a diagnostic to a therapeutic procedure in removing CBDSs. We present a complicated case of a patient with a CBDS and periampullary diverticulum and discuss the techniques used to diagnose and remove the stone from the biliary system. PMID:23946532

An automated technique for potential differentiation of ovarian mature teratomas from other benign tumours using neural networks classification of 2D ultrasound static images: a pilot study

NASA Astrophysics Data System (ADS)

Al-karawi, Dhurgham; Sayasneh, A.; Al-Assam, Hisham; Jassim, Sabah; Page, N.; Timmerman, D.; Bourne, T.; Du, Hongbo

2017-05-01

Ovarian cysts are a common pathology in women of all age groups. It is estimated that 5-10% of women have a surgical intervention to remove an ovarian cyst in their lifetime. Given this frequency rate, characterization of ovarian masses is essential for optimal management of patients. Patients with benign ovarian masses can be managed conservatively if they are asymptomatic. Mature teratomas are common benign ovarian cysts that occur, in most cases, in premenopausal women. These ovarian cysts can contain different types of human tissue including bone, cartilage, fat, hair, or other tissue. If they are causing no symptoms, they can be harmless and may not require surgery. Subjective assessment by ultrasound examiners has a high diagnostic accuracy when characterising mature teratomas from other types of tumours. The aim of this study is to develop a computerised technique with the potential to characterise mature teratomas and distinguish them from other types of benign ovarian tumours. Local Binary Pattern (LBP) was applied to extract texture features that are specific in distinguishing teratomas. Neural Networks (NN) was then used as a classifier for recognising mature teratomas. A pilot sample set of 130 B-mode static ovarian ultrasound images (41 mature teratomas tumours and 89 other types of benign tumours) was used to test the effectiveness of the proposed technique. Test results show an average accuracy rate of 99.4% with a sensitivity of 100%, specificity of 98.8% and positive predictive value of 98.9%. This study demonstrates that the NN and LBP techniques can accurately classify static 2D B-mode ultrasound images of benign ovarian masses into mature teratomas and other types of benign tumours.

Use of tissue adhesive as a field expedient barrier dressing for hand wounds in disaster responders.

PubMed

Levy, Matthew J; Tang, Nelson

2014-02-01

Injuries sustained by disaster responders can impede the affected individuals' ability to perform critical functions and often require the redirection of already scarce resources. Soft-tissue injuries to the hand are commonly experienced by disaster workers and even seemingly mild lacerations can pose the potential for significant complications in such hazard-filled environments. In this report, the authors describe their experience utilizing tissue adhesive to create a functional and effective barrier dressing for a hand injury sustained by a responder at the West, Texas USA fertilizer plant explosion. This technique of wound management allowed the patient to continue performing essential onsite functions for a sustained period following the explosion and the subsequent investigative processes. At the 30-day follow-up, the wound was well healed and without complications. This technique proved to be a valuable method of field expedient wound management and is worthy of consideration in similar future circumstances.

Imaging and interventions in hilar cholangiocarcinoma: A review

PubMed Central

Madhusudhan, Kumble Seetharama; Gamanagatti, Shivanand; Gupta, Arun Kumar

2015-01-01

Hilar cholangiocarcinoma is a common malignant tumor of the biliary tree. It has poor prognosis with very low 5-year survival rates. Various imaging modalities are available for detection and staging of the hilar cholangiocarcinoma. Although ultrasonography is the initial investigation of choice, imaging with contrast enhanced computed tomography scan or magnetic resonance imaging is needed prior to management. Surgery is curative wherever possible. Radiological interventions play a role in operable patients in the form of biliary drainage and/or portal vein embolization. In inoperable cases, palliative interventions include biliary drainage, biliary stenting and intra-biliary palliative treatment techniques. Complete knowledge of application of various imaging modalities available and about the possible radiological interventions is important for a radiologist to play a critical role in appropriate management of such patients.We review the various imaging techniques and appearances of hilar cholangiocarcinoma and the possible radiological interventions. PMID:25729485

Managing nurses through disciplinary power: a Foucauldian analysis of workplace violence.

PubMed

St-Pierre, Isabelle; Holmes, Dave

2008-04-01

This paper describes discipline as a specific technique of power which constitutes, in our view, a form of institutional violence. The need to create and maintain safe and healthy work environments for healthcare professionals is well documented. Foucault's concept of disciplinary power was used to explore institutional violence from a critical perspective. Violence is identified as an important factor in the recruitment and retention of healthcare professionals. Given the shortage of such professionals, there is an urgent need to take a fresh look at their working environments and working conditions. Power, surveillance and disciplinary techniques are used at all levels of hospital management to control and contain both human resources and costs. By associating common workplace practices with institutional violence, employers who have a policy of zero tolerance toward workplace violence will need to re-examine their current ways of operating.

Role of Endoscopic Gastroplasty Techniques in the Management of Obesity.

PubMed

Jung, Yunho

2017-01-01

Health and wellness represent a major global concern. Trends such as a lack of exercise and excessive consumption of calories are major causes of the rapid increase in obesity worldwide. Obesity should be controlled because it can result in other illnesses, such as diabetes, high blood pressure, high cholesterol, coronary artery disease, stroke, breathing disorders, or cancer. However, many people have difficulty in managing obesity through exercise, dietary control, behavioral modifications, and drug therapy. Bariatric surgery is not commonly used due to a variety of complications, even though it has been demonstrated to produce reliable results with respect to adequate weight loss when performed using an open or a laparoscopic approach. Endoscopic bariatric procedures are emerging techniques that are less invasive and safer compared with current surgical approaches. However, the evaluation of endoluminal procedures is limited by the small number of studies and their short-term follow-up.

Endoscopic Therapy in Crohn's Disease: Principle, Preparation, and Technique.

PubMed

Chen, Min; Shen, Bo

2015-09-01

Stricture and fistula are common complications of Crohn's disease. Endoscopic balloon dilation and needle-knife stricturotomy has become a valid treatment option for Crohn's disease-associated strictures. Endoscopic therapy is also increasingly used in Crohn's disease-associated fistula. Preprocedural preparations, including routine laboratory testing, imaging examination, anticoagulant management, bowel cleansing and proper sedation, are essential to ensure a successful and safe endoscopic therapy. Adverse events, such as perforation and excessive bleeding, may occur during endoscopic intervention. The endoscopist should be well trained, always be cautious, anticipate for possible procedure-associated complications, be prepared for damage control during endoscopy, and have surgical backup ready. In this review, we discuss the principle, preparation, techniques of endoscopic therapy, as well as the prevention and management of endoscopic procedure-associated complications. We propose that inflammatory bowel disease endoscopy may be a part of training for "super" gastroenterology fellows, i.e., those seeking a career in advanced endoscopy or in inflammatory bowel disease.

Current Australian physiotherapy management of hip osteoarthritis.

PubMed

Cowan, Sallie M; Blackburn, Meagan S; McMahon, Kylie; Bennell, Kim L

2010-12-01

Symptomatic osteoarthritis can be a painful, costly and debilitating condition. Whilst there is a substantial body of literature surrounding osteoarthritis of the knee, there is less reported research on the hip joint, especially pertaining to physiotherapy intervention. This descriptive study aimed to describe current physiotherapy management of osteoarthritis of the hip by Australian physiotherapists in private practice and acute hospital settings. Cross-sectional survey. A questionnaire was administered to 364 public and private practitioners in the state of Victoria. A response rate of 66% was achieved. Physiotherapists working in the private and public sectors reported frequent use of manual therapy (78% and 87%, respectively), aquatic therapy (82% and 58%, respectively) and home exercise programmes (88% and 80%, respectively). Class-based physiotherapy is employed less frequently (44% and 28%, respectively). Strengthening exercises are the most common treatment technique. The widespread use of exercise and manual therapy in the management of osteoarthritis of the hip is highlighted. There was little difference in overall physiotherapy management between the public and private settings. The results identify interventions commonly used in clinical practice. The need for further research to evaluate the effectiveness of frequently used interventions is also highlighted. Copyright © 2010 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

VRLane: a desktop virtual safety management program for underground coal mine

NASA Astrophysics Data System (ADS)

Li, Mei; Chen, Jingzhu; Xiong, Wei; Zhang, Pengpeng; Wu, Daozheng

2008-10-01

VR technologies, which generate immersive, interactive, and three-dimensional (3D) environments, are seldom applied to coal mine safety work management. In this paper, a new method that combined the VR technologies with underground mine safety management system was explored. A desktop virtual safety management program for underground coal mine, called VRLane, was developed. The paper mainly concerned about the current research advance in VR, system design, key techniques and system application. Two important techniques were introduced in the paper. Firstly, an algorithm was designed and implemented, with which the 3D laneway models and equipment models can be built on the basis of the latest mine 2D drawings automatically, whereas common VR programs established 3D environment by using 3DS Max or the other 3D modeling software packages with which laneway models were built manually and laboriously. Secondly, VRLane realized system integration with underground industrial automation. VRLane not only described a realistic 3D laneway environment, but also described the status of the coal mining, with functions of displaying the run states and related parameters of equipment, per-alarming the abnormal mining events, and animating mine cars, mine workers, or long-wall shearers. The system, with advantages of cheap, dynamic, easy to maintenance, provided a useful tool for safety production management in coal mine.

Imaging in Diabetic Retinopathy: A Review of Current and Future Techniques.

PubMed

Gajree, Sonul; Borooah, Shyamanga; Dhillon, Baljean

2017-01-01

Diabetic eye disease is the most common cause of blindness worldwide in the population under 65 years of age. The prevalence of sight-threatening diabetic eye disease continues to rise rapidly, resulting in an increasing burden on health systems worldwide. This highlights the need to develop new tools to help in the screening, diagnosis and management of diabetic eye disease. This review aims to provide a brief overview of the current standard in care for diabetic eye disease, before providing an up to date overview of newer imaging modalities, with potential application in the management of diabetic eye care. A literature search for the terms "enhanced depth imaging OCT", "swept source OCT", "retinal oximetry", "OCT angiography", "fundus autofluorescence" with the term "diabetes" was performed using the pubmed and google scholar databases. Only articles published within the last two years were selected for use in this article. There has been a rapid increase in the available imaging techniques used to manage diabetic eye disease. To date there has been variable use of these next generation imaging techniques. A greater understanding of how phenotypic findings link to the risk of sight loss is required before there is more widespread adoption by mainstream diabetic eye services. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

Current Practice of Therapeutic Mammaplasty: A Survey of Oncoplastic Breast Surgeons in England

PubMed Central

Aggarwal, Shweta; Marla, Sekhar; Nyanhongo, Donald; Kotecha, Sita; Basu, Narendra Nath

2016-01-01

Introduction. Therapeutic mammaplasty (TM) is a useful technique in the armamentarium of the oncoplastic breast surgeon (OBS). There is limited guidance on patient selection, technique, coding, and management of involved margins. The practices of OBS in England remain unknown. Methods. Questionnaires were sent to all OBS involved with the Training Interface Group. We assessed the number of TM cases performed per surgeon, criteria for patient selection, pedicle preference, contralateral symmetrisation, use of routine preoperative MRI, management of involved margins, and clinical coding. Results. We had an overall response rate of 43%. The most common skin resection technique utilised was wise pattern followed by vertical scar. Superior-medial pedicle was preferred by the majority of surgeons (62%) followed by inferior pedicle (34%). Twenty percent of surgeons would always proceed to a mastectomy following an involved margin, whereas the majority would offer reexcision based on several parameters. The main absolute contraindication to TM was tumour to breast ratio >50%. One in five surgeons would not perform TM in smokers and patients with multifocal disease. Discussion. There is a wide variation in the practice of TM amongst OBS. Further research and guidance would be useful to standardise practice, particularly management of involved margins and coding for optimal reimbursement. PMID:27110398

Information flow in the DAMA project beyond database managers: information flow managers

NASA Astrophysics Data System (ADS)

Russell, Lucian; Wolfson, Ouri; Yu, Clement

1996-12-01

To meet the demands of commercial data traffic on the information highway, a new look at managing data is necessary. One projected activity, sharing of point of sale information, is being considered in the Demand Activated Manufacturing Project (DAMA) of the American Textile Partnership (AMTEX) project. A scenario is examined in which 100 000 retail outlets communicate over a period of days. They provide the latest estimate of demand for sewn products across a chain of 26 000 suppliers through the use of bill of materials explosions at four levels of detail. Enabling this communication requires an approach that shares common features with both workflows and database management. A new paradigm, the information flow manager, is developed to handle this situation, including the case where members of the supply chain fail to communicate and go out of business. Techniques for approximation are introduced so as to keep estimates of demand as current as possible.

Building Common Ground for Environmental Flows using Traditional Techniques and Novel Engagement Approaches.

PubMed

Mott Lacroix, Kelly E; Xiu, Brittany C; Megdal, Sharon B

2016-04-01

Despite increased understanding of the science of environmental flows, identification and implementation of effective environmental flow policies remains elusive. Perhaps the greatest barrier to implementing flow policies is the framework for water management. An alternative management approach is needed when legal rights for environmental flows do not exist, or are ineffective at protecting ecosystems. The research presented here, conducted in the U.S. state of Arizona, provides an empirical example of engagement to promote social learning as an approach to finding ways to provide water for the environment where legal rights for environmental flows are inadequate. Based on our engagement process we propose that identifying and then building common ground require attention to the process of analyzing qualitative data and the methods for displaying complex information, two aspects not frequently discussed in the social learning or stakeholder engagement literature. The results and methods from this study can help communities develop an engagement process that will find and build common ground, increase stakeholder involvement, and identify innovative solutions to provide water for the environment that reflect the concerns of current water users.

Marketing and design of residential energy conservation programs for the elderly

DOE Office of Scientific and Technical Information (OSTI.GOV)

Berry, L.; Schweitzer, M.; Freeman, E.

1988-02-01

This report describes barriers to energy conservation by the elderly. Because of these barriers, they have a greater need for programs that assist with the installation of energy-efficiency improvements. In response to this need, a number of specialized programs are operated for the elderly. This report contains descriptions of 39 energy conservation programs for the elderly. Telephone interviews were conducted with the managers of these programs to identify marketing techniques and organizational structures. Interagency networking, presentations and referrals are the most common methods of recruiting clients. Other marketing techniques in order of the frequency of use are: direct mail, billmore » inserts, television, radio, printed materials, and telemarketing. Many managers consider word-of-mouth advertising from satisfied clients the most effective form of marketing. Interagency networking and support (financial, structural and in-kind) can offer real advantages in the operation of conservation programs for the elderly. The use of specific marketing techniques is probably less important to success in recruiting clients than the degree of trust potential clients have in the sponsoring organization(s). 4 figs., 10 tabs.« less

Content and quality of websites supporting self-management of chronic breathlessness in advanced illness: a systematic review

PubMed Central

Luckett, Tim; Disler, Rebecca; Hosie, Annmarie; Johnson, Miriam; Davidson, Patricia; Currow, David; Sumah, Anthony; Phillips, Jane

2016-01-01

Chronic breathlessness is a common, burdensome and distressing symptom in many advanced chronic illnesses. Self-management strategies are essential to optimise treatment, daily functioning and emotional coping. People with chronic illness commonly search the internet for advice on self-management. A review was undertaken in June 2015 to describe the content and quality of online advice on breathlessness self-management, to highlight under-served areas and to identify any unsafe content. Google was searched from Sydney, Australia, using the five most common search terms for breathlessness identified by Google Trends. We also hand-searched the websites of national associations. Websites were included if they were freely available in English and provided practical advice on self-management. Website quality was assessed using the American Medical Association Benchmarks. Readability was assessed using the Flesch–Kincaid grades, with grade 8 considered the maximum acceptable for enabling access. Ninety-one web pages from 44 websites met the inclusion criteria, including 14 national association websites not returned by Google searches. Most websites were generated in the USA (n=28, 64%) and focused on breathing techniques (n=38, 86%) and chronic obstructive pulmonary disease (n=27, 61%). No websites were found to offer unsafe advice. Adherence to quality benchmarks ranged from 9% for disclosure to 77% for currency. Fifteen (54%) of 28 written websites required grade ⩾9 reading level. Future development should focus on advice and tools to support goal setting, problem solving and monitoring of breathlessness. National associations are encouraged to improve website visibility and comply with standards for quality and readability. PMID:27225898

Role of community pharmacists in asthma - Australian research highlighting pathways for future primary care models.

PubMed

Saini, B; Krass, I; Smith, L; Bosnic-Anticevich, S; Armour, C

2011-01-01

Asthma is one of the most common chronic conditions affecting the Australian population. Amongst primary healthcare professionals, pharmacists are the most accessible and this places pharmacists in an excellent position to play a role in the management of asthma. Globally, trials of many community pharmacy-based asthma care models have provided evidence that pharmacist delivered interventions can improve clinical, humanistic and economic outcomes for asthma patients. In Australia, a decade of coordinated research efforts, in various aspects of asthma care, has culminated in the implementation trial of the Pharmacy Asthma Management Service (PAMS), a comprehensive disease management model.There has been research investigating asthma medication adherence through data mining, ways in which usual asthma care can be improved. Our research has focused on self-management education, inhaler technique interventions, spirometry trials, interprofessional models of care, and regional trials addressing the particular needs of rural communities. We have determined that inhaler technique education is a necessity and should be repeated if correct technique is to be maintained. We have identified this effectiveness of health promotion and health education, conducted within and outside the confines of the pharmacy, in public for a and settings such as schools, and established that this outreach role is particularly well received and increases the opportunity for people with asthma to engage in their asthma management.Our research has identified that asthma patients have needs which pharmacists delivering specialized models of care, can address. There is a lot of evidence for the effectiveness of asthma care by pharmacists, the future must involve integration of this role into primary care.

A Compilation of Common Algal Control and Management Techniques.

DTIC Science & Technology

1980-01-01

sources within their exten- sive watersheds. Excessive algal production and the subsequent decay of algal biomass often result in oxygen depletion...organisms in the food chain. c. Harmless to man and animals. 8 d. No incorporation into mineral or biological cycles. e. No adverse effect on water...phytoplankton decreased by ca 30 percent and, due to better light conditions, the productive layer increased. The number of zooplankton, especially

Arthroscopic Synovectomy of Wrist in Rheumatoid Arthritis.

PubMed

Shim, Jae Woo; Park, Min Jong

2017-11-01

Rheumatoid arthritis (RA) is a systemic inflammatory disorder affecting multiple joints. Wrist involvement is common. Patients with persistent symptoms despite medical management are candidates for surgery. Synovectomy can provide pain relief and functional improvement for rheumatoid wrist. Arthroscopic synovectomy is a safe and reliable method, with minimal postoperative morbidity. This article reviews the role, technique, and results of arthroscopic synovectomy in the rheumatoid wrist. Copyright © 2017 Elsevier Inc. All rights reserved.

Peyronie's Disease: Still a Surgical Disease.

PubMed

Martinez, Daniel; Ercole, Cesar E; Hakky, Tariq S; Kramer, Andrew; Carrion, Rafael

2012-01-01

Peyronie's Disease (PD) remains a challenging and clinically significant morbid condition. Since its first description by François Gigot de la Peyronie, much of the treatment for PD remains nonstandardized. PD is characterized by the formation of fibrous plaques at the level of the tunica albuginea. Clinical manifestations include morphologic changes, such as curvatures and hourglass deformities. Here, we review the common surgical techniques for the management of patients with PD.

How to identify and manage oak wilt in Texas

Treesearch

D. N. Appel; R. S. Cameron; A. D. Wilson; J. D. Johnson.

2008-01-01

Measures can be taken to break root connections between live oaks or dense groups of red oaks to reduce or stop root transmission of the oak wilt fungus. The most common technique is to sever roots by trenching at least 4 ft deep with trenching machines, rock saws, or ripper bars. Trenches more than 4 ft deep may be needed to assure control in deeper soils. Although...

Effective Network Management via System-Wide Coordination and Optimization

DTIC Science & Technology

2010-08-01

Srinath Sridhar, Matthew Streeter, Jimeng Sun, Michael Tschantz, Rangarajan Vasudevan, Vijay Vasude- van, Gaurav Veda, Shobha Venkataraman, Justin... Sharma and Byers [150] suggest the use of Bloom filters. While minimizing redundant measurements is a common high-level theme between cSamp and their...NSDI, 2004. [150] M. R. Sharma and J. W. Byers. Scalable Coordination Techniques for Distributed Network Monitoring. In Proc. of PAM, 2005. [151] S

Managing Variation in Services in a Software Product Line Context

DTIC Science & Technology

2010-05-01

Oriented Domain Analysis ( FODA ) Feasibility Study (CMU/SEI-90-TR-021, ADA235785). Software Engineering Institute, Carnegie Mellon University, 1990...the systems in the product line, and a plan for building the systems. Product line scope and product line analysis define the boundaries and...systems, as well as expected ways in which they may vary. Product line analysis applies established modeling techniques to engineer the common and

Soil Conservation Techniques for Hillside Farms. A Guide for Peace Corps Volunteers. Appropriate Technologies for Development. Peace Corps Information Collection & Exchange Reprint Series No. R-62.

ERIC Educational Resources Information Center

Crozier, Carl

This guide provides agricultural extensionists with basic information that will help them design plans for the conservation of soils and the management of water runoff in specific agricultural plots. It is based on experiences with small hillside farms in Honduras and takes into account the resources and constraints commonly encountered there.…

Designing a pain management protocol for craniotomy: A narrative review and consideration of promising practices

PubMed Central

Vacas, Susana; Van de Wiele, Barbara

2017-01-01

Background: Craniotomy is a relatively common surgical procedure with a high incidence of postoperative pain. Development of standardized pain management and enhanced recovery after surgery (ERAS) protocols are necessary and crucial to optimize outcomes and patient satisfaction and reduce health care costs. Methods: This work is based upon a literature search of published manuscripts (between 1996 and 2017) from Pubmed, Cochrane Central Register, and Google Scholar. It seeks to both synthesize and review our current scientific understanding of postcraniotomy pain and its part in neurosurgical ERAS protocols. Results: Strategies to ameliorate craniotomy pain demand interventions during all phases of patient care: preoperative, intraoperative, and postoperative interventions. Pain management should begin in the perioperative period with risk assessment, patient education, and premedication. In the intraoperative period, modifications in anesthesia technique, choice of opioids, acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs), regional techniques, dexmedetomidine, ketamine, lidocaine, corticosteroids, and interdisciplinary communication are all strategies to consider and possibly deploy. Opioids remain the mainstay for pain relief, but patient-controlled analgesia, NSAIDs, standardization of pain management, bio/behavioral interventions, modification of head dressings as well as patient-centric management are useful opportunities that potentially improve patient care. Conclusions: Future research on mechanisms, predictors, treatments, and pain management pathways will help define the combinations of interventions that optimize pain outcomes. PMID:29285407

Adaptation of Soil Physical Measurement Techniques for the Delineation of Mud and Lakebed Sediments at Neusiedler See

PubMed Central

Kogelbauer, Ilse; Heine, Erwin; D'Amboise, Christopher; Müllebner, Christoph; Sokol, Wolfgang; Loiskandl, Willibald

2013-01-01

For many water management issues of shallow lakes with non-consolidated sediments hydrographic surveys of the open water area and reed belt areas are required. In the frame of water management strategy for the steppe lake Neusiedler See, located between Austria and Hungary, a hydrographic survey was conducted. In the open water area (water depth ≥1 m) a sediment echosounder was used. To validate these measurements and to distinguish between water, mud, and sediment layers in the shallow lake and reed belt area additional measurements were needed. As no common standard methods are available yet, we developed a measurement system based on two commonly applied soil physical measurement techniques providing reproducible physical values: a capacitive sensor and a cone penetrometer combined with GNSS-positioning enable dynamic measurements of georeferenced vertical water-mud-bedsediments profiles. The system bases on site-specific calibrated sensors and allows instantaneous, in situ measurements. The measurements manifest a sharp water-mud interface by a sudden decline to smaller water content which is a function of the dielectric permittivity. A second decline indicates the transition to compacted mud. That is concurrently the density where the penetrometer starts registering significant penetration resistance. The penetrometer detects shallow lakebed-sediment layers. Within the lake survey this measurement system was successfully tested. PMID:24351626

Towards predictive diagnosis and management of rotator cuff disease: using curvelet transform for edge detection and segmentation of tissue

NASA Astrophysics Data System (ADS)

Pai Raikar, Vipul; Kwartowitz, David M.

2016-04-01

Degradation and injury of the rotator cuff is one of the most common diseases of the shoulder among the general population. In orthopedic injuries, rotator cuff disease is only second to back pain in terms of overall reduced quality of life for patients. Clinically, this disease is managed via pain and activity assessment and diagnostic imaging using ultrasound and MRI. Ultrasound has been shown to have good accuracy for identification and measurement of rotator cuff tears. In our previous work, we have developed novel, real-time techniques to biomechanically assess the condition of the rotator cuff based on Musculoskeletal Ultrasound. Of the rotator cuff tissues, supraspinatus is the first that sees degradation and is the most commonly affected. In our work, one of the challenges lies in effectively segmenting and characterizing the supraspinatus. We are exploring the possibility of using curvelet transform for improving techniques to segment tissue in ultrasound. Curvelets have been shown to give optimal multi-scale representation of edges in images. They are designed to represent edges and singularities along curves in images which makes them an attractive proposition for use in ultrasound segmentation. In this work, we present a novel approach to the possibility of using curvelet transforms for automatic edge and feature extraction for the supraspinatus.

New arrows in the quiver for targeting care management: high-risk versus high-opportunity case identification.

PubMed

Bernstein, Richard H

2007-01-01

"Care management" purposefully obscures the distinctions between disease and case management and stresses their common features: action in the present to prevent adverse future outcomes and costs. It includes identifying a high-need population by referrals, screening, or data analysis, assessing those likely to benefit from interventions, intervening, evaluating the intervention, and adjusting interventions when needed. High-risk individuals can be identified using at least 9 techniques, from referrals and questionnaires to retrospective claims analysis and predictive models. Other than referrals, software based on the risk-adjustment methodology that we have adapted can incorporate all these methodologies. Because the risk adjustment employs extensive case mix and severity adjustment, it provides care managers with 3 innovative ways to identify not only high-risk individuals but also high-opportunity cases.

Acute perioperative pain in neonates: An evidence-based review of neurophysiology and management.

PubMed

Maitra, Souvik; Baidya, Dalim Kumar; Khanna, Puneet; Ray, Bikash Ranjan; Panda, Shasanka Shekhar; Bajpai, Minu

2014-03-01

Current literature lacks systematic data on acute perioperative pain management in neonates and mainly focuses only on procedural pain management. In the current review, the neurophysiological basis of neonatal pain perception and the role of different analgesic drugs and techniques in perioperative pain management in neonates are systematically reviewed. Intravenous opioids such as morphine or fentanyl as either intermittent bolus or continuous infusion remain the most common modality for the treatment of perioperative pain. Paracetamol has a promising role in decreasing opioid requirement. However, routine use of ketorolac or other nonsteroidal anti-inflammatory drugs is not usually recommended. Epidural analgesia is safe in experienced hands and provides several benefits over systemic opioids such as early extubation and early return of bowel function. Copyright © 2014. Published by Elsevier B.V.

Our experience with the so-called pull-through technique combined with liposuction for management of gynecomastia.

PubMed

Bracaglia, Roberto; Fortunato, Regina; Gentileschi, Stefano; Seccia, Antonio; Farallo, Eugenio

2004-07-01

Gynecomastia is a benign enlargement of male breast, common in adolescents and adults. To treat this deformity, we have been carrying out liposuction through small cutaneous incisions placed in the axilla and on the sternum. If necessary, we performed a surgical excision of glandular tissue through a periareolar incision. From 1995, we started to perform surgical excision of glandular tissue, if necessary, through the small incisions made for liposuction, thus avoiding the periareolar scars. We describe our experience with this technique, which we believe excellent for the correction of glandular and fatty glandular gynecomastia, obtaining excellent esthetic results and minimal local scarring.

Foot and ankle tendoscopies: current concepts review

PubMed Central

Monteagudo, Manuel; Maceira, Ernesto; Martinez de Albornoz, Pilar

2016-01-01

Tendoscopy is an apparently safe and reliable procedure to manage some foot and ankle disorders. The most common foot and ankle tendoscopies are: Achilles; peroneal; and posterior tibial tendon. Tendoscopy may be used as an adjacent procedure to other techniques. Caution is recommended to avoid neurovascular injuries. Predominantly level IV and V studies are found in the literature, with no level I studies still available. There are many promising and evolving endoscopic techniques for tendinopathies around the foot and ankle, but studies of higher levels of evidence are needed to strongly recommend these procedures. Cite this article: EFORT Open Rev 2016;1:440-447. DOI: 10.1302/2058-5241.160028 PMID:28461923

New echocardiographic techniques for evaluation of left atrial mechanics.

PubMed

Todaro, Maria Chiara; Choudhuri, Indrajit; Belohlavek, Marek; Jahangir, Arshad; Carerj, Scipione; Oreto, Lilia; Khandheria, Bijoy K

2012-12-01

Until recently the left atrium had been subordinate to the left ventricle, but cardiologists now recognize that left atrial (LA) function is indispensable to normal circulatory performance. Transthoracic two-dimensional (2D) and Doppler echocardiography can elucidate parameters of LA function non-invasively. Yet, with the advent of 2D speckle-tracking echocardiography, we are able to detect early LA dysfunction even before structural changes occur. This is pivotal in some common disease states, such as atrial fibrillation, hypertension, and heart failure, in which LA deformation parameters can influence clinical management. However, a unique standardized technique to investigate LA deformation needs to be validated.

Therapeutic enhancement: nursing intervention category for patients diagnosed with Readiness for Therapeutic Regimen Management.

PubMed

Kelly, Cynthia W

2008-04-01

To present a new nursing intervention category called therapeutic enhancement. Fewer than half of North Americans follow their physician's recommendations for diet and exercise, even when such are crucial to their health or recovery. It is imperative that nurses consider new ways to promote healthy behaviours. Therapeutic enhancement is intended to provide such a fresh approach. Traditional intervention techniques focusing on education, contracts, social support and more frequent interaction with physicians appear not to be effective when used alone. Successful strategies have been multidisciplinary; and have included interventions by professional nurses who assist patients to understand their disease and the disease process and that helps them to develop disease-management and self-management skills. Therapeutic enhancement incorporates The Stages of Change Theory, Commitment to Health Theory, Motivational Interviewing techniques and instrumentation specifically designed for process evaluation of health-promoting interventions. This is a critical review of approaches that, heretofore, have not been synthesised in a single published article. Based on the commonly used Stages of Change model, therapeutic enhancement is useful for patients who are at the action stage of change. Using therapeutic enhancement as well as therapeutic strategies identified in Stages of Change Theory, such as contingency management, helping relationships, counterconditioning, stimulus control and Motivational Interviewing techniques, nursing professionals can significantly increase the chances of patients moving from action to the maintenance stage of change for a specific health behaviour. Using the nursing intervention category, therapeutic enhancement can increase caregivers' success in helping patients maintain healthy behaviours.

Post hoc evaluation of a common-sense intervention for asthma management in community pharmacy.

PubMed

Watkins, Kim; Seubert, Liza; Schneider, Carl R; Clifford, Rhonda

2016-11-18

The aim was to evaluate a common-sense, behavioural change intervention to implement clinical guidelines for asthma management in the community pharmacy setting. The components of the common-sense intervention were described in terms of categories and dimensions using the Intervention Taxonomy (ITAX) and Behaviour Change Techniques (BCTs) using the Behaviour Change Wheel (BCW), Capability, Opportunity and Motivation-Behaviour (COM-B) System and Behaviour Change Techniques Taxonomy (BCTTv1). The retrospective application of these existing tools facilitated evaluation of the mechanism, fidelity, logistics and rationale of the common-sense intervention. The initial intervention study was conducted in 336 community pharmacies in the metropolitan area of Perth, Western Australia. Small-group workshops were conducted in 25 pharmacies; 162 received academic detailing and 149 acted as controls. The intervention was designed to improve pharmacy compliance with guidelines for a non-prescription supply of asthma reliever medications. Retrospective application of ITAX identified mechanisms for the short-acting β agonists intervention including improving knowledge, behavioural skills, problem-solving skills, motivation and self-efficacy. All the logistical elements were considered in the intervention design but the duration and intensity of the intervention was minimal. The intervention was delivered as intended (as a workshop) to 13.4% of participants indicating compromised fidelity and significant adaptation. Retrospective application of the BCW, COM-B system and BCTTv1 identified 9 different behaviour change techniques as the rationale for promoting guideline-based practice change. There was a sound rationale and clear mechanism for all the components of the intervention but issues related to logistics, adaptability and fidelity might have affected outcomes. Small group workshops could be a useful implementation strategy in community pharmacy, if logistical issues can be overcome and less adaptation occurs. Duration, intensity and reinforcement need consideration for successful wider implementation. Further qualitative evaluations, triangulation of research and evaluations across interventions should be used to provide a greater understanding of unresolved issues. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Conquest of darkness by management of the stars

NASA Astrophysics Data System (ADS)

Wiseman, Robert S.

This text was presented as the Thomas B. Dowd Memorial Lecture for 1991 national Infrared Information Symposium (IRIS). The history of Army Night Vision from World War II to 1972 proves how the right organization with talented people and proper support can succeed. This presentation not only illustrates the growth of image intensifier technology and families of equipment, but the key events and stars that made it all happen. Described are the management techniques used and how to organize for effective research, development, engineering, and production programs; the evolution of the Far Infrared Common Module program is described; and how the Night Vision Laboratory was unique.

Psychosocial interventions in attention-deficit/hyperactivity disorder: update.

PubMed

Antshel, Kevin M

2015-01-01

Attention-deficit/hyperactivity disorder (ADHD) is the most common reason for referral to child and adolescent psychiatry clinics. Although stimulant medications represent an evidence-based approach to managing ADHD, psychosocial interventions for child/adolescent ADHD target functional impairments as the intervention goal, and rely heavily on behavioral therapy techniques and operant conditioning principles. Evidence-based psychosocial interventions for managing pediatric ADHD include behavioral parent training, school-based interventions relying on behavioral modification, teaching skills, and operant conditioning principles, and intensive summer treatment programs. The use of conjoint psychosocial treatments with ADHD medications may enable lower doses of each form of treatment. Copyright © 2015 Elsevier Inc. All rights reserved.

Radiation dose reduction in computed tomography: techniques and future perspective

PubMed Central

Yu, Lifeng; Liu, Xin; Leng, Shuai; Kofler, James M; Ramirez-Giraldo, Juan C; Qu, Mingliang; Christner, Jodie; Fletcher, Joel G; McCollough, Cynthia H

2011-01-01

Despite universal consensus that computed tomography (CT) overwhelmingly benefits patients when used for appropriate indications, concerns have been raised regarding the potential risk of cancer induction from CT due to the exponentially increased use of CT in medicine. Keeping radiation dose as low as reasonably achievable, consistent with the diagnostic task, remains the most important strategy for decreasing this potential risk. This article summarizes the general technical strategies that are commonly used for radiation dose management in CT. Dose-management strategies for pediatric CT, cardiac CT, dual-energy CT, CT perfusion and interventional CT are specifically discussed, and future perspectives on CT dose reduction are presented. PMID:22308169

Overcoming Barriers to Integrating Behavioral Health and Primary Care Services

PubMed Central

Grazier, Kyle L.; Smiley, Mary L.; Bondalapati, Kirsten S.

2016-01-01

Objective: Despite barriers, organizations with varying characteristics have achieved full integration of primary care services with providers and services that identify, treat, and manage those with mental health and substance use disorders. What are the key factors and common themes in stories of this success? Methods: A systematic literature review and snowball sampling technique was used to identify organizations. Site visits and key informant interviews were conducted with 6 organizations that had over time integrated behavioral health and primary care services. Case studies of each organization were independently coded to identify traits common to multiple organizations. Results: Common characteristics include prioritized vulnerable populations, extensive community collaboration, team approaches that included the patient and family, diversified funding streams, and data-driven approaches and practices. Conclusions: While significant barriers to integrating behavioral health and primary care services exist, case studies of organizations that have successfully overcome these barriers share certain common factors. PMID:27380923

Surgical Treatment for Failure of Repair of Patellar and Quadriceps Tendon Rupture With Ipsilateral Hamstring Tendon Graft.

PubMed

Maffulli, Nicola; Papalia, Rocco; Torre, Guglielmo; Denaro, Vincenzo

2017-03-01

Tears of the patellar and quadriceps tendon are common in the active population, especially in athletes. At present, several techniques for surgical repair and reconstruction are available. When reruptures occur, a reconstruction is mandatory. In the present paper, we describe a surgical technique for patellar and quadriceps tendon reconstruction using ipsilateral hamstring autograft. After routine hamstring tendon harvesting, the tendon ends are prepared using a whip stitch. A transverse tunnel is drilled in the midportion of the patella, the hamstring graft is passed through the patella, and firmly secured to the patellar tunnel openings with sutures. The details of the technique are fully described. Autologous ipsilateral hamstring tendon grafts provide a secure sound means to manage these challenging injuries.

Does Angling Technique Selectively Target Fishes Based on Their Behavioural Type?

PubMed Central

Wilson, Alexander D. M.; Brownscombe, Jacob W.; Sullivan, Brittany; Jain-Schlaepfer, Sofia; Cooke, Steven J.

2015-01-01

Recently, there has been growing recognition that fish harvesting practices can have important impacts on the phenotypic distributions and diversity of natural populations through a phenomenon known as fisheries-induced evolution. Here we experimentally show that two common recreational angling techniques (active crank baits versus passive soft plastics) differentially target wild largemouth bass (Micropterus salmoides) and rock bass (Ambloplites rupestris) based on variation in their behavioural tendencies. Fish were first angled in the wild using both techniques and then brought back to the laboratory and tested for individual-level differences in common estimates of personality (refuge emergence, flight-initiation-distance, latency-to-recapture and with a net, and general activity) in an in-lake experimental arena. We found that different angling techniques appear to selectively target these species based on their boldness (as characterized by refuge emergence, a standard measure of boldness in fishes) but not other assays of personality. We also observed that body size was independently a significant predictor of personality in both species, though this varied between traits and species. Our results suggest a context-dependency for vulnerability to capture relative to behaviour in these fish species. Ascertaining the selective pressures angling practices exert on natural populations is an important area of fisheries research with significant implications for ecology, evolution, and resource management. PMID:26284779

Straight-line drift fences and pitfall traps

USGS Publications Warehouse

Corn, Paul Stephen

1994-01-01

Straight-line drift fences typically are short barriers (5-15 m) that direct animals traveling on the substrate surface into traps places at the ends of or beside the barriers. Traps (described below) can be pitfalls, funnel traps, or a combination of the two. Drift fences with pitfall or funnel traps and pitfall traps without fences are used commonly to inventory and monitor populations of amphibians and reptiles. For example, 9 of 17 field studies reported for management of terrestrial vertebrates (Sarzo et al. 1988) used these techniques to sample amphibians. Drift fences with pitfall traps can be used to determine species richness at a site and to detect the presence of rare species. They also can yield data on relative abundances and habitat use of selected species. Pitfall traps arrayed in a grid without fences can also be used to study the population ecology and habitat use of selected species. Population density can be estimated with this latter technique if used in conjunction with mark-recapture techniques (see Chapter 8). Drift fence arrays or pitfall grids can be left in place for long-term monitoring. In this section, I discuss the use of this technique to obtain data on amphibians away from breeding ponds. Use of drift fences and traps to monitory amphibian activity at breeding ponds is discussed in the section "Drift Fences Encircling Breeding Sits", below (technique 9). Some materials and procedures are common to both techniques. Investigators contemplating the use of drift fences and traps in any context should read both accounts.

Anesthetic and Obstetric Management of Syringomyelia During Labor and Delivery: A Case Series and Systematic Review.

PubMed

Garvey, Gráinne Patricia; Wasade, Vibhangini S; Murphy, Kellie E; Balki, Mrinalini

2017-09-01

Syringomyelia is a rare, slowly progressive neurological condition characterized by the presence of a syrinx within the spinal cord. Consensus regarding the safest mode of delivery and anesthetic management in patients with syringomyelia remains controversial and presents management dilemmas. This study reviews the cases of syringomyelia at our institution and provides a systematic review of the literature to guide decisions regarding labor and delivery management. A retrospective review of cases at our hospital from 2002 to 2014 and a systematic review of the literature from 1946 to 2014 were undertaken. Hospital records and electronic databases were interrogated using International Classification of Diseases, 10th Revision codes and the keywords "syringomyelia," "syringobulbia," and "pregnancy." Data regarding demographics, diagnosis, radiology reports, neurological symptoms, mode of delivery, anesthetic management, and maternal-fetal outcomes were collected. We collected and analyzed data on a total of 43 pregnancies in 39 patients. The most common location for syrinx was in the cervicothoracic region (41.9%). The large majority of patients (n = 34; 87%) demonstrated signs and symptoms associated with syringomyelia before delivery. Syringomyelia associated with Arnold Chiari malformation was documented in 49% (n = 21) cases. General anesthesia was the most commonly used (n = 21/30, 70%) anesthetic technique for cesarean delivery. The majority (n = 9/13, 69%) of patients had an epidural sited for labor analgesia. There were no maternal or neonatal complications associated with neuraxial anesthesia; however, 3 cases (14%) raised concerns regarding general anesthesia including difficult intubation, transient worsening of neurological symptoms postpartum, and prolonged muscle paralysis after atracurium. Despite concerns regarding aggravation of the syrinx with vaginal delivery, this mode of delivery has never caused any documented long-term worsening of neurological condition. All techniques of anesthesia have been performed successfully without major lasting complications. All cases necessitate patient counseling and individualized multidisciplinary involvement to ensure maternal safety.

Arthroscopic management of the contact athlete with instability.

PubMed

Harris, Joshua D; Romeo, Anthony A

2013-10-01

The shoulder is the most commonly dislocated joint in the body, with a greater incidence of instability in contact and collision athletes. In contact and collision athletes that have failed nonoperative treatment, the most important factors to consider when planning surgery are amount of bone loss (glenoid, humeral head); patient age; and shoulder hyperlaxity. Clinical outcomes, instability recurrence rate, and return to sport rate are not significantly different between arthroscopic suture anchor and open techniques. Lateral decubitus positioning with distraction and four portal (including seven-degree and 5-o’clock positions) techniques allow for 360-degree access to the glenoid rim, with placement of at least three sutures anchors below 3 o’clock for optimal results. In patients with significant glenoid bone loss (>20%-25%, inverted pear glenoid), open bone augmentation techniques are indicated and arthroscopic techniques are contraindicated. Copyright © 2013 Elsevier Inc. All rights reserved.

Stage-directed individualized therapy in esophageal cancer.

PubMed

Goense, Lucas; van Rossum, Peter S N; Kandioler, Daniela; Ruurda, Jelle P; Goh, Khean-Lee; Luyer, Misha D; Krasna, Mark J; van Hillegersberg, Richard

2016-10-01

Esophageal cancer is the eighth most common cancer worldwide, and the incidence of esophageal carcinoma is rapidly increasing. With the advent of new staging and treatment techniques, esophageal cancer can now be managed through various strategies. A good understanding of the advances and limitations of new staging techniques and how these can guide in individualizing treatment is important to improve outcomes for esophageal cancer patients. This paper outlines the recent progress in staging and treatment of esophageal cancer, with particularly attention to endoscopic techniques for early-stage esophageal cancer, multimodality treatment for locally advanced esophageal cancer, assessment of response to neoadjuvant treatment, and the role of cervical lymph node dissection. Furthermore, advances in robot-assisted surgical techniques and postoperative recovery protocols that may further improve outcomes after esophagectomy are discussed. © 2016 The Authors. Annals of the New York Academy of Sciences published by Wiley Periodicals Inc. on behalf of The New York Academy of Sciences.

Fixation of comminuted midshaft clavicle fractures with bone fragments separated by soft tissue using a novel double ligature technique: A case report.

PubMed

Ju, Wei-Na; Wang, Cheng-Xue; Wang, Tie-Jun; Qi, Bao-Chang

2017-11-01

Clavicle fractures are common, and mostly occur in the midshaft. Methods for operative treatment of midshaft clavicle fractures are evolving, as they improve clinical outcomes compared with traditional conservative management. However, fixation of comminuted midshaft clavicle fractures with bone fragments separated by soft tissue remains a challenge. Here, we present a case of comminuted midshaft clavicle fracture with a bone fragment separated from the main fracture by soft tissue. Left comminuted midshaft clavicle fracture. We treated this patient with a novel double ligature technique using absorbable suturing. In the past 7 years, we have treated >50 patients with this technique. We have achieved good clinical outcomes with no complications. We recommend widespread use of our novel double ligature technique for treating comminuted midshaft clavicle fractures with bone fragments separated by soft tissue.

Fixation of comminuted midshaft clavicle fractures with bone fragments separated by soft tissue using a novel double ligature technique

PubMed Central

Ju, Wei-Na; Wang, Cheng-Xue; Wang, Tie-Jun; Qi, Bao-Chang

2017-01-01

Abstract Rationale: Clavicle fractures are common, and mostly occur in the midshaft. Methods for operative treatment of midshaft clavicle fractures are evolving, as they improve clinical outcomes compared with traditional conservative management. However, fixation of comminuted midshaft clavicle fractures with bone fragments separated by soft tissue remains a challenge. Patient concerns: Here, we present a case of comminuted midshaft clavicle fracture with a bone fragment separated from the main fracture by soft tissue. Diagnosis: Left comminuted midshaft clavicle fracture. Interventions: We treated this patient with a novel double ligature technique using absorbable suturing. Outcomes: In the past 7 years, we have treated >50 patients with this technique. We have achieved good clinical outcomes with no complications. Lessons: We recommend widespread use of our novel double ligature technique for treating comminuted midshaft clavicle fractures with bone fragments separated by soft tissue. PMID:29137088

Risk management in the competitive electric power industry

NASA Astrophysics Data System (ADS)

Dahlgren, Robert William

From 1990 until present day, the electric power industry has experienced dramatic changes worldwide. This recent evolution of the power industry has included creation and multiple iterations of competitive wholesale markets in many different forms. The creation of these competitive markets has resulted in increased short-term volatility of power prices. Vertically integrated utilities emerged from years of regulatory controls to now experience the need to perform risk assessment. The goal of this dissertation is to provide background and details of the evolution of market structures combined with examples of how to apply price risk assessment techniques such as Value-at-Risk (VaR). In Chapter 1, the history and evolution of three selected regional markets, PJM, California, and England and Wales is presented. A summary of the commonalities and differences is presented to provide an overview of the rate of transformation of the industry in recent years. The broad area of risk management in the power industry is also explored through a State-of-the-Art Literature Survey. In Chapter 2, an illustration of risk assessment to power trading is presented. The techniques of Value-at-Risk and Conditional Value-at-Risk are introduced and applied to a common scenario. The advantages and limitations of the techniques are compared through observation of their results against the common example. Volatility in the California Power Markets is presented in Chapter 3. This analysis explores the California markets in the summer of 2000 including the application of VaR analysis to the extreme volatility observed during this period. In Chapter 4, CVaR is applied to the same California historical data used in Chapter 3. In addition, the unique application of minimizing the risk of a power portfolio by minimizing CVaR is presented. The application relies on recent research into CVaR whereby the portfolio optimization problem can be reduced to a Linear Programming problem.

Peyronie's Disease: Still a Surgical Disease

PubMed Central

Martinez, Daniel; Ercole, Cesar E.; Hakky, Tariq S.; Kramer, Andrew; Carrion, Rafael

2012-01-01

Peyronie's Disease (PD) remains a challenging and clinically significant morbid condition. Since its first description by François Gigot de la Peyronie, much of the treatment for PD remains nonstandardized. PD is characterized by the formation of fibrous plaques at the level of the tunica albuginea. Clinical manifestations include morphologic changes, such as curvatures and hourglass deformities. Here, we review the common surgical techniques for the management of patients with PD. PMID:22956943

Open and Arthroscopic Surgical Treatment of Femoroacetabular Impingement

PubMed Central

Kuhns, Benjamin D.; Frank, Rachel M.; Pulido, Luis

2015-01-01

Femoroacetabular impingement (FAI) is a common cause of hip pain, and when indicated, can be successfully managed through open surgery or hip arthroscopy. The goal of this review is to describe the different approaches to the surgical treatment of FAI. We present the indications, surgical technique, rehabilitation, and complications associated with (1) open hip dislocation, (2) reverse periacetabular osteotomy, (3) the direct anterior “mini-open” approach, and (4) arthroscopic surgery for FAI. PMID:26697431

Vaginal cuff dehiscence after intracavitary brachytherapy for endometrial cancer

PubMed Central

Shah, Karan; Potkul, Ronald

2012-01-01

We describe 2 unusual cases of vaginal dehiscence after intracavitary brachytherapy performed following robotic laparoscopic hysterectomy (RLH) along with their management. This unusual complication, which may be more common because of the robotic procedures, can be prevented by careful examination and possible delay of the onset of brachytherapy, if indicated. Our report reviews techniques of avoiding this complication and suggests that these complications should be discussed with the patients. PMID:23349653

Management of stomal varices with transvenous obliteration utilizing sodium tetradecyl sulfate foam sclerosis.

PubMed

Saad, Wael E A; Schwaner, Sandra; Lippert, Allison; Sabri, Saher S; Al-Osaimi, Abdullah; Matsumoto, Alan H; Angle, John F; Caldwell, Stephen

2014-12-01

The management of parastomal varices is not established. Transjugular intrahepatic portosystemic shunt (TIPS) creation is the most commonly described treatment; however, the rebleed rate after TIPS is 21-37%. The purpose of the study is to determine the effectiveness of transvenous obliteration using sodium tetradecyl sulfate (STS) and to describe a new simplified technique in obliterating these varices. Four patients are presented who underwent transvenous obliteration using STS. One was obliterated using balloon occlusion from the systemic veins, the second was obliterated without balloon from a transhepatic antegrade approach, and the last two patients were obliterated using the direct antegrade technique. This simplified technique requires only a micropuncture kit (not requiring balloons or coils) and ultrasound transducer compression of the systemic draining veins, relying on high portal pressure to keep the sclerosant confined to the varices. The sclerosant is essentially trapped between the portal pressure and the ultrasound-transducer compression (10-15 min). Technical success was achieved in all four patients without procedural or postprocedural complications and no rebleeding for a mean follow-up of 17 (range 2-33) months. Transvenous obliteration of parastomal varices utilizing STS as a sclerosant is safe and effective. The newly described technique is simple, feasible, and requires minimal equipment (no balloons or coils or catheters).

An introduction to Kundalini yoga meditation techniques that are specific for the treatment of psychiatric disorders.

PubMed

Shannahoff-Khalsa, David S

2004-02-01

The ancient system of Kundalini yoga includes a vast array of meditation techniques and many were discovered to be specific for treating the psychiatric disorders as we know them today. One such technique was found to be specific for treating obsessive-compulsive disorder (OCD), the fourth most common psychiatric disorder, and the tenth most disabling disorder worldwide. Two published clinical trials are described here for treating OCD using a specific Kundalini yoga protocol. This OCD protocol also includes techniques that are useful for a wide range of anxiety disorders, as well as a technique specific for learning to manage fear, one for tranquilizing an angry mind, one for meeting mental challenges, and one for turning negative thoughts into positive thoughts. Part of that protocol is included here and published in detail elsewhere. In addition, a number of other disorder-specific meditation techniques are included here to help bring these tools to the attention of the medical and scientific community. These techniques are specific for phobias, addictive and substance abuse disorders, major depressive disorders, dyslexia, grief, insomnia and other sleep disorders.

Researching Mental Health Disorders in the Era of Social Media: Systematic Review

PubMed Central

Vadillo, Miguel A; Curcin, Vasa

2017-01-01

Background Mental illness is quickly becoming one of the most prevalent public health problems worldwide. Social network platforms, where users can express their emotions, feelings, and thoughts, are a valuable source of data for researching mental health, and techniques based on machine learning are increasingly used for this purpose. Objective The objective of this review was to explore the scope and limits of cutting-edge techniques that researchers are using for predictive analytics in mental health and to review associated issues, such as ethical concerns, in this area of research. Methods We performed a systematic literature review in March 2017, using keywords to search articles on data mining of social network data in the context of common mental health disorders, published between 2010 and March 8, 2017 in medical and computer science journals. Results The initial search returned a total of 5386 articles. Following a careful analysis of the titles, abstracts, and main texts, we selected 48 articles for review. We coded the articles according to key characteristics, techniques used for data collection, data preprocessing, feature extraction, feature selection, model construction, and model verification. The most common analytical method was text analysis, with several studies using different flavors of image analysis and social interaction graph analysis. Conclusions Despite an increasing number of studies investigating mental health issues using social network data, some common problems persist. Assembling large, high-quality datasets of social media users with mental disorder is problematic, not only due to biases associated with the collection methods, but also with regard to managing consent and selecting appropriate analytics techniques. PMID:28663166

Abnormal uterine bleeding unrelated to structural uterine abnormalities: management in the perimenopausal period.

PubMed

Sabbioni, Lorenzo; Zanetti, Isabella; Orlandini, Cinzia; Petraglia, Felice; Luisi, Stefano

2017-02-01

Abnormal uterine bleeding (AUB) is one of the commonest health problems encountered by women and a frequent phenomenon during menopausal transition. The clinical management of AUB must follow a standardized classification system to obtain the better diagnostic pathway and the optimal therapy. The PALM-COEIN classification system has been approved by the International Federation of Gynecology and Obstetrics (FIGO); it recognizes structural causes of AUB, which can be measured visually with imaging techniques or histopathology, and non-structural entities such as coagulopathies, ovulatory dysfunctions, endometrial and iatrogenic causes and disorders not yet classified. In this review we aim to evaluate the management of nonstructural causes of AUB during the menopausal transition, when commonly women experience changes in menstrual bleeding patterns and unexpected bleedings which affect their quality of life.

Management of sinonasal complications after endoscopic orbital decompression for Graves' orbitopathy.

PubMed

Antisdel, Jastin L; Gumber, Divya; Holmes, Janalee; Sindwani, Raj

2013-09-01

Endoscopic orbital decompression (EnOD) has proven to be safe and effective for the treatment of Graves' orbitopathy; however, complications do occur. Although the literature focuses on orbital complications, sinonasal complications including postobstructive sinusitis, hemorrhage, and cerebrospinal fluid (CSF) leak can also be challenging to manage. This study examines the incidence and management of sinonasal complications in these patients. Retrospective review. Clinical data, surgical findings, and postoperative outcomes were reviewed of patients who underwent EnOD for Graves' disease between March 2004 and November 2010. The incidence and management of postoperative sinonasal complications requiring an intervention were examined. The study group consisted of 50 consecutive patients (86 decompression procedures): 11 males and 39 females with an average age of 48.6 years (SD = 12.9). Incidence of significant sinonasal complications was 3.5% (5/86): with one patient experiencing postoperative hemorrhage requiring operative management, three patients with postoperative obstructive sinusitis, and one patient with nasal obstruction secondary to nasal adhesions that required lysis. The maxillary sinus was the most commonly involved and was managed using the mega-antrostomy technique. In the case of frontal sinusitis, an endoscopic transaxillary approach was utilized to avoid injury to decompressed orbital contents. All complications were successfully managed without sequelae. Sinonasal complications following EnOD are uncommon. In the setting of a decompressed orbit, even routine types of postoperative issues can be challenging and require additional considerations. Successful management of postoperative sinusitis related to outflow obstruction may require more extensive approaches and novel techniques. Copyright © 2013 The American Laryngological, Rhinological and Otological Society, Inc.

Storage management in Ada. Three reports. Volume 1: Storage management in Ada as a risk to the development of reliable software. Volume 2: Relevant aspects of language. Volume 3: Requirements of the language versus manifestations of current implementations

NASA Technical Reports Server (NTRS)

Auty, David

1988-01-01

The risk to the development of program reliability is derived from the use of a new language and from the potential use of new storage management techniques. With Ada and associated support software, there is a lack of established guidelines and procedures, drawn from experience and common usage, which assume reliable behavior. The risk is identified and clarified. In order to provide a framework for future consideration of dynamic storage management on Ada, a description of the relevant aspects of the language is presented in two sections: Program data sources, and declaration and allocation in Ada. Storage-management characteristics of the Ada language and storage-management characteristics of Ada implementations are differentiated. Terms that are used are defined in a narrow and precise sense. The storage-management implications of the Ada language are described. The storage-management options available to the Ada implementor and the implications of the implementor's choice for the Ada programmer are also described.

Skin conditions: benign nodular skin lesions.

PubMed

Nguyen, Tam; Zuniga, Ramiro

2013-04-01

Benign subcutaneous lesions are a common reason that patients visit family physicians. Lipomas are the most common of these lesions; they most often occur on the trunk and proximal extremities. Recent data show that as many as half of the fat cells in lipomas are atypical. Ultrasound is used increasingly to confirm lipoma diagnosis, but deep lesions should be evaluated with magnetic resonance imaging study or computed tomography scan to exclude involvement of underlying structures and/or liposarcoma. Small lesions can sometimes be managed with serial injections of midpotency steroids. Larger lesions (larger than 5 cm), those compressing other structures, or those suspicious for malignancy should be excised using standard surgical excision or, when possible, the newer minimal-scar segmental extraction technique. Ganglion cysts are another common lesion, the presence of which often is confirmed with ultrasound if the diagnosis is not clinically apparent. Management includes splinting, aspiration, and/or injection of steroids, with or without hyaluronidase. Epidermal inclusion cysts, also called sebaceous cysts, typically are asymptomatic unless they become infected. Ultrasound can aid in diagnosis. The only definitive management is surgical excision with complete removal of the cyst wall or capsule, using minimal-scar segmental extraction or conventional surgical removal. Written permission from the American Academy of Family Physicians is required for reproduction of this material in whole or in part in any form or medium.

Performance measurement: A tool for program control

NASA Technical Reports Server (NTRS)

Abell, Nancy

1994-01-01

Performance measurement is a management tool for planning, monitoring, and controlling as aspects of program and project management--cost, schedule, and technical requirements. It is a means (concept and approach) to a desired end (effective program planning and control). To reach the desired end, however, performance measurement must be applied and used appropriately, with full knowledge and recognition of its power and of its limitations--what it can and cannot do for the project manager. What is the potential of this management tool? What does performance measurement do that a traditional plan vs. actual technique cannot do? Performance measurement provides an improvement over the customary comparison of how much money was spent (actual cost) vs. how much was planned to be spent based on a schedule of activities (work planned). This commonly used plan vs. actual comparison does not allow one to know from the numerical data if the actual cost incurred was for work intended to be done.

Evolutionary perspectives on wildlife disease: concepts and applications

PubMed Central

Vander Wal, Eric; Garant, Dany; Pelletier, Fanie

2014-01-01

Wildlife disease has the potential to cause significant ecological, socioeconomic, and health impacts. As a result, all tools available need to be employed when host–pathogen dynamics merit conservation or management interventions. Evolutionary principles, such as evolutionary history, phenotypic and genetic variation, and selection, have the potential to unravel many of the complex ecological realities of infectious disease in the wild. Despite this, their application to wildlife disease ecology and management remains in its infancy. In this article, we outline the impetus behind applying evolutionary principles to disease ecology and management issues in the wild. We then introduce articles from this special issue on Evolutionary Perspectives on Wildlife Disease: Concepts and Applications, outlining how each is exemplar of a practical wildlife disease challenge that can be enlightened by applied evolution. Ultimately, we aim to bring new insights to wildlife disease ecology and its management using tools and techniques commonly employed in evolutionary ecology. PMID:25469154

The Use of Brain Stimulation in Dysphagia Management.

PubMed

Simons, Andre; Hamdy, Shaheen

2017-04-01

Dysphagia is common sequela of brain injury with as many as 50% of patients suffering from dysphagia following stroke. Currently, the majority of guidelines for clinical practice in the management of dysphagia focus on the prevention of complications while any natural recovery takes place. Recently, however, non-invasive brain stimulation (NIBS) techniques like transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) have started to attract attention and are applied to investigate both the physiology of swallowing and influences on dysphagia. TMS allows for painless stimulation of the brain through an intact skull-an effect which would normally be impossible with electrical currents due to the high resistance of the skull. By comparison, tDCS involves passing a small electric current (usually under 2 mA) produced by a current generator over the scalp and cranium external to the brain. Initial studies used these techniques to better understand the physiological mechanisms of swallowing in healthy subjects. More recently, a number of studies have investigated the efficacy of these techniques in the management of neurogenic dysphagia with mixed results. Controversy still exists as to which site, strength and duration of stimulation yields the greatest improvement in dysphagia. And while multiple studies have suggested promising effects of NIBS, more randomised control trials with larger sample sizes are needed to investigate the short- and long-term effects of NIBS in neurogenic dysphagia.

Irreparable Rotator Cuff Tears: Restoring Joint Kinematics by Tendon Transfers

PubMed Central

Greenspoon, Joshua A.; Millett, Peter J.; Moulton, Samuel G.; Petri, Maximilian

2016-01-01

Background: Tendon transfers can be a surgical treatment option in managing younger, active patients with massive irreparable rotator cuff tears. The purpose of this article is to provide an overview of the use of tendon transfers to treat massive irreparable rotator cuff tears and to summarize clinical outcomes. Methods: A selective literature search was performed and personal surgical experiences are reported. Results: Latissimus dorsi transfers have been used for many years in the management of posterosuperior rotator cuff tears with good reported clinical outcomes. It can be transferred without or with the teres major (L’Episcopo technique). Many surgical techniques have been described for latissimus dorsi transfer including single incision, double incision, and arthroscopically assisted transfer. Transfer of the pectoralis major tendon is the most common tendon transfer procedure performed for anterosuperior rotator cuff deficiencies. Several surgical techniques have been described, however transfer of the pectoralis major beneath the coracoid process has been found to most closely replicate the force vector that is normally provided by the intact subscapularis. Conclusion: Tendon transfers can be used successfully in the management of younger patients with massive irreparable rotator cuff tears and minimal glenohumeral arthritis. Improvements in clinical outcomes scores and range of motion have been demonstrated. This can delay arthroplasty, which is of particular importance for younger patients with high functional demands. PMID:27708730

The impact of community pharmacy-led medicines management support for people with COPD.

PubMed

Alton, Sarah; Farndon, Lisa

2018-06-02

Chronic obstructive pulmonary disease (COPD) is a common long-term condition involving restricted airflow, which reduces quality of life. Treatments include lifestyle changes (smoking cessation), pulmonary rehabilitation and medication with inhaled therapies. However, medication adherence is often suboptimal, resulting in poor health outcomes. A pilot project assessed the impact of medicines management support from a community pharmacy team for people with COPD, delivered in their own homes. Individuals were given a medication review and an assessment of their inhaler technique and were followed up at 3 and 6 months. The COPD Assessment Test (CAT) score was administered before and after the intervention. A change in score of 2 or more suggests a significant difference; the average score was 19.2 at the first assessment and 16.7 at the six month follow-up. Seventeen patients had improved CAT scores, 10 patients had a reduced score and three remained unchanged. Most patients evaluated the project positively as it helped them to improve their inhaler technique. Medicines optimisation was also achieved as a person-centred approach was taken; suboptimal practice had not been picked up by health professionals previously. Community pharmacists working in integrated care teams provide invaluable support to patients with COPD. This project will be rolled out across the community team, and training on medicines management and inhaler technique provided to other health professionals involved in the care of these patients.

Plantar fasciitis.

PubMed

Cutts, S; Obi, N; Pasapula, C; Chan, W

2012-11-01

In this article we look at the aetiology of plantar fasciitis, the other common differentials for heel pain and the evidence available to support each of the major management options. We also review the literature and discuss the condition. A literature search was performed using PubMed and MEDLINE(®). The following keywords were used, singly or in combination: 'plantar fasciitis', 'plantar heel pain', 'heel spur'. To maximise the search, backward chaining of reference lists from retrieved papers was also undertaken. Plantar fasciitis is a common and often disabling condition. Because the natural history of plantar fasciitis is not understood, it is difficult to distinguish between those patients who recover spontaneously and those who respond to formal treatment. Surgical release of the plantar fascia is effective in the small proportion of patients who do not respond to conservative measures. New techniques such as endoscopic plantar release and extracorporeal shockwave therapy may have a role but the limited availability of equipment and skills means that most patients will continue to be treated by more traditional techniques.

A Review of the Surgical Management of Perineal Hernias in Dogs.

PubMed

Gill, Sukhjit Singh; Barstad, Robert D

2018-05-14

Perineal hernia refers to the failure of the muscular pelvic diaphragm to support the rectal wall, resulting in herniation of pelvic and, occasionally, abdominal viscera into the subcutaneous perineal region. The proposed causes of pelvic diaphragm weakness include tenesmus associated with chronic prostatic disease or constipation, myopathy, rectal abnormalities, and gonadal hormonal imbalances. The most common presentation of perineal hernia in dogs is a unilateral or bilateral nonpainful swelling of the perineum. Clinical signs do occur, but not always. Clinical signs may include constipation, obstipation, dyschezia, tenesmus, rectal prolapse, stranguria, or anuria. The definitive diagnosis of perineal hernia is based on clinical signs and findings of weak pelvic diaphragm musculature during a digital rectal examination. In dogs, perineal hernias are mostly treated by surgical intervention. Appositional herniorrhaphy is sometimes difficult to perform as the levator ani and coccygeus muscles are atrophied and unsuitable for use. Internal obturator muscle transposition is the most commonly used technique. Additional techniques include superficial gluteal and semitendinosus muscle transposition, in addition to the use of synthetic implants and biomaterials. Pexy techniques may be used to prevent rectal prolapse and bladder and prostate gland displacement. Postoperative care involves analgesics, antibiotics, a low-residue diet, and stool softeners.

Cycling injuries of the lower extremity.

PubMed

Wanich, Tony; Hodgkins, Christopher; Columbier, Jean-Allain; Muraski, Erika; Kennedy, John G

2007-12-01

Cycling is an increasingly popular recreational and competitive activity, and cycling-related injuries are becoming more common. Many common cycling injuries of the lower extremity are preventable. These include knee pain, patellar quadriceps tendinitis, iliotibial band syndrome, hip pain, medial tibial stress syndrome, stress fracture, compartment syndrome, numbness of the foot, and metatarsalgia. Injury is caused by a combination of inadequate preparation, inappropriate equipment, poor technique, and overuse. Nonsurgical management may include rest, nonsteroidal anti-inflammatory drugs, corticosteroid injection, ice, a reduction in training intensity, orthotics, night splints, and physical therapy. Injury prevention should be the focus, with particular attention to bicycle fit and alignment, appropriate equipment, proper rider position and pedaling mechanics, and appropriate training.

Magnetic Resonance Imaging of Developmental Anomalies of the Uterus and the Vagina in Pediatric Patients.

PubMed

Gould, Sharon W; Epelman, Monica

2015-08-01

Developmental anomalies of the uterus and the vagina are associated with infertility and miscarriage and are most commonly detected in the postpubertal age-group. These conditions may also present in younger patients as a mass or pain owing to obstruction of the uterus or the vagina. Associated urinary tract anomalies are common, as well. Accurate diagnosis and thorough description of these anomalies is essential for appropriate management; however, evaluation may be difficult in an immature reproductive tract. Magnetic resonance imaging technique pertinent to imaging of the pediatric female reproductive tract is presented and illustrated along with the findings associated with various anomalies. Copyright © 2015 Elsevier Inc. All rights reserved.

Conscious Sedation: Emerging Trends in Pediatric Dentistry

PubMed Central

Attri, Joginder Pal; Sharan, Radhe; Makkar, Vega; Gupta, Kewal Krishan; Khetarpal, Ranjana; Kataria, Amar Parkash

2017-01-01

Dental fear and anxiety is a common problem in pediatric patients. There is considerable variation in techniques used to manage them. Various sedation techniques using many different anesthetic agents have gained considerable popularity over the past few years. Children are not little adults; they differ physically, psychologically, and emotionally. The purpose of this review is to survey recent trends and concerning issues in the rapidly changing field of pediatric sedation. We will study the topic from the perspective of an anesthesiologist. It will also provide information to practitioners on the practice of conscious sedation in dentistry and will also outline the route of administration, pharmacokinetics, and pharmacodynamics of various drugs used. PMID:28663606

How to locate & hire clinical/biomedical engineers, supervisors, managers & biomedical equipment technicians.

PubMed

Pacela, A F; Brush, L C

1993-01-01

This article has described the process and the resources available for locating and hiring clinical/biomedical engineers, supervisors, managers, and biomedical equipment technicians. First, the employer must determine the qualifications for the position, including job titles, descriptions, pay scales, and certification requirements. Next, the employer must find qualified applicants. The most common way to do this is to use "outside" contacts, such as help-wanted advertising, specialized job placement agencies, schools and colleges, military resources, regional biomedical societies, and nationwide societies. An "inside" search involves limited internal advertising of the position and using personal referrals for candidates. Finally, the employer must screen the applicants. The position description is the obvious first step in this process, but there are other pre-screening techniques, such as employment testing. Interviewing is the most common way to hire for job positions, but the interviewer needs to know about the position and ask the right questions. Post-interview screening is a final step to help determine the best job-person match.

Surveillance and management of urologic complications after spinal cord injury.

PubMed

Kreydin, Evgeniy; Welk, Blayne; Chung, Doreen; Clemens, Quentin; Yang, Claire; Danforth, Teresa; Gousse, Angelo; Kielb, Stephanie; Kraus, Stephen; Mangera, Altaf; Reid, Sheilagh; Szell, Nicole; Cruz, Francisco; Chartier-Kastler, Emmanuel; Ginsberg, David A

2018-05-29

Neurogenic bladder due to spinal cord injury has significant consequences for patients' health and quality of life. Regular surveillance is required to assess the status of the upper and lower urinary lower urinary tracts and prevent their deterioration. In this review, we examine surveillance techniques in neurogenic bladder, describe common complications of this disease, and address strategies for their management. This work represents the efforts of SIU-ICUD joint consultation on Urologic Management of the Spinal Cord injury. For this specific topic, a workgroup was formed and comprehensive literature search of English language manuscripts regarding neurogenic bladder management was performed using key words of neurogenic bladder. Articles were compiled, and recommendations in the chapter are based on group discussion and follow the Oxford Centre for Evidence-based Medicine system for Levels of Evidence (LOEs) and Grades of Recommendation (GORs). At a minimum, patients should undergo an annual history and physical examination, renal functional testing (e.g., serum creatinine), and upper tract imaging (e.g., renal ultrasonography). The existing evidence does not support the use of other modalities, such as cystoscopy or urodynamics, for routine surveillance. Urologic complications in neurogenic bladder patients are common and often more complex than in the general population. There is a shortage of high-quality evidence to support any particular neurogenic bladder surveillance protocol. However, there is consensus regarding certain aspects of regular genitourinary system evaluation in these patients. Proper surveillance allows the clinician to avoid or address common urological complications, and to guide, alter, or maintain appropriate therapeutic regimens for individual patients.

Portal hypertension: Imaging of portosystemic collateral pathways and associated image-guided therapy.

PubMed

Bandali, Murad Feroz; Mirakhur, Anirudh; Lee, Edward Wolfgang; Ferris, Mollie Clarke; Sadler, David James; Gray, Robin Ritchie; Wong, Jason Kam

2017-03-14

Portal hypertension is a common clinical syndrome, defined by a pathologic increase in the portal venous pressure. Increased resistance to portal blood flow, the primary factor in the pathophysiology of portal hypertension, is in part due to morphological changes occurring in chronic liver diseases. This results in rerouting of blood flow away from the liver through collateral pathways to low-pressure systemic veins. Through a variety of computed tomographic, sonographic, magnetic resonance imaging and angiographic examples, this article discusses the appearances and prevalence of both common and less common portosystemic collateral channels in the thorax and abdomen. A brief overview of established interventional radiologic techniques for treatment of portal hypertension will also be provided. Awareness of the various imaging manifestations of portal hypertension can be helpful for assessing overall prognosis and planning proper management.

Portal hypertension: Imaging of portosystemic collateral pathways and associated image-guided therapy

PubMed Central

Bandali, Murad Feroz; Mirakhur, Anirudh; Lee, Edward Wolfgang; Ferris, Mollie Clarke; Sadler, David James; Gray, Robin Ritchie; Wong, Jason Kam

2017-01-01

Portal hypertension is a common clinical syndrome, defined by a pathologic increase in the portal venous pressure. Increased resistance to portal blood flow, the primary factor in the pathophysiology of portal hypertension, is in part due to morphological changes occurring in chronic liver diseases. This results in rerouting of blood flow away from the liver through collateral pathways to low-pressure systemic veins. Through a variety of computed tomographic, sonographic, magnetic resonance imaging and angiographic examples, this article discusses the appearances and prevalence of both common and less common portosystemic collateral channels in the thorax and abdomen. A brief overview of established interventional radiologic techniques for treatment of portal hypertension will also be provided. Awareness of the various imaging manifestations of portal hypertension can be helpful for assessing overall prognosis and planning proper management. PMID:28348478

Environmental Concerns

NASA Astrophysics Data System (ADS)

Alma, Peter

1995-04-01

This series of A-level social biology topic books responds to the changing demands of social biology syllabuses, with each text dealing with a particular area of interest. Although the series is primarily intended for students of A-level social biology, the books will appeal to students studying a wide range of biological subjects at A-level. Environmental Concerns covers topics common to several A-level human and social biology syllabuses. It is particularly relevant to the human ecology and conservation options. The text focuses on the social and economic implications of current ecological issues as well as the basic biological concepts involved. It deals with the causes, effects and prevention of atmospheric and water pollution as well as with the disruption of ecosystems by changes in land use. The conflict of interests between conservation and exploitation is discussed, along with management techniques including the controversial method of culling to maintain diversity. The moral and aesthetic aspects of conservation and management are emphasised throughout, in addition to the scientific background of these techniques.

[Comparison of robotic surgery documentary in gynecological cancer].

PubMed

Vargas-Hernández, Víctor Manuel

2012-01-01

Robotic surgery is a surgical technique recently introduced, with major expansion and acceptance among the medical community is currently performed in over 1,000 hospitals around the world and in the management of gynecological cancer are being developed comprehensive programs for implementation. The objectives of this paper are to review the scientific literature on robotic surgery and its application in gynecological cancer to verify its safety, feasibility and efficacy when compared with laparoscopic surgery or surgery classical major surgical complications, infections are more common in traditional radical surgery compared with laparoscopic or robotic surgery and with these new techniques surgical and staying hospital are lesser than the former however, the disadvantages are the limited number of robot systems, their high cost and applies only in specialized centers that have with equipment and skilled surgeons. In conclusion robotic surgery represents a major scientific breakthrough and surgical management of gynecological cancer with better results to other types of conventional surgery and is likely in the coming years is become its worldwide.

Radiological interventions in malignant biliary obstruction

PubMed Central

Madhusudhan, Kumble Seetharama; Gamanagatti, Shivanand; Srivastava, Deep Narayan; Gupta, Arun Kumar

2016-01-01

Malignant biliary obstruction is commonly caused by gall bladder carcinoma, cholangiocarcinoma and metastatic nodes. Percutaneous interventions play an important role in managing these patients. Biliary drainage, which forms the major bulk of radiological interventions, can be palliative in inoperable patients or pre-operative to improve liver function prior to surgery. Other interventions include cholecystostomy and radiofrequency ablation. We present here the indications, contraindications, technique and complications of the radiological interventions performed in patients with malignant biliary obstruction. PMID:27247718

MRI brain imaging.

PubMed

Skinner, Sarah

2013-11-01

General practitioners (GPs) are expected to be allowed to request MRI scans for adults for selected clinically appropriate indications from November 2013 as part of the expansion of Medicare-funded MRI services announced by the Federal Government in 2011. This article aims to give a brief overview of MRI brain imaging relevant to GPs, which will facilitate explanation of scan findings and management planning with their patients. Basic imaging techniques, common findings and terminology are presented using some illustrative case examples.

Design Issues for Traffic Management for the ATM UBR + Service for TCP Over Satellite Networks

NASA Technical Reports Server (NTRS)

Jain, Raj

1999-01-01

This project was a comprehensive research program for developing techniques for improving the performance of Internet protocols over Asynchronous Transfer Mode (ATM) based satellite networks. Among the service categories provided by ATM networks, the most commonly used category for data traffic is the unspecified bit rate (UBR) service. UBR allows sources to send data into the network without any feedback control. The project resulted in the numerous ATM Forum contributions and papers.

Vascular anomalies: classification, imaging characteristics and implications for interventional radiology treatment approaches

PubMed Central

Prajapati, H J S; Martin, L G; Patel, T H

2014-01-01

The term vascular anomaly represents a broad spectrum of vascular pathology, including proliferating vascular tumours and vascular malformations. While the treatment of most vascular anomalies is multifactorial, interventional radiology procedures, including embolic therapy, sclerotherapy and laser coagulation among others, are playing an increasingly important role in vascular anomaly management. This review discusses the diagnosis and treatment of common vascular malformations, with emphasis on the technique, efficacy and complications of different interventional radiology procedures. PMID:24588666

Ecological Engineering Practices for the Reduction of Excess Nitrogen in Human-Influenced Landscapes: A Guide for Watershed Managers

NASA Astrophysics Data System (ADS)

Passeport, Elodie; Vidon, Philippe; Forshay, Kenneth J.; Harris, Lora; Kaushal, Sujay S.; Kellogg, Dorothy Q.; Lazar, Julia; Mayer, Paul; Stander, Emilie K.

2013-02-01

Excess nitrogen (N) in freshwater systems, estuaries, and coastal areas has well-documented deleterious effects on ecosystems. Ecological engineering practices (EEPs) may be effective at decreasing nonpoint source N leaching to surface and groundwater. However, few studies have synthesized current knowledge about the functioning principles, performance, and cost of common EEPs used to mitigate N pollution at the watershed scale. Our review describes seven EEPs known to decrease N to help watershed managers select the most effective techniques from among the following approaches: advanced-treatment septic systems, low-impact development (LID) structures, permeable reactive barriers, treatment wetlands, riparian buffers, artificial lakes and reservoirs, and stream restoration. Our results show a broad range of N-removal effectiveness but suggest that all techniques could be optimized for N removal by promoting and sustaining conditions conducive to biological transformations (e.g., denitrification). Generally, N-removal efficiency is particularly affected by hydraulic residence time, organic carbon availability, and establishment of anaerobic conditions. There remains a critical need for systematic empirical studies documenting N-removal efficiency among EEPs and potential environmental and economic tradeoffs associated with the widespread use of these techniques. Under current trajectories of N inputs, land use, and climate change, ecological engineering alone may be insufficient to manage N in many watersheds, suggesting that N-pollution source prevention remains a critical need. Improved understanding of N-removal effectiveness and modeling efforts will be critical in building decision support tools to help guide the selection and application of best EEPs for N management.

Pyeloplasty techniques using minimally invasive surgery (MIS) in pediatric patients.

PubMed

Turrà, Francesco; Escolino, Maria; Farina, Alessandra; Settimi, Alessandro; Esposito, Ciro; Varlet, François

2016-10-01

Hydronephrosis is the most common presentation of ureteropelvic junction (UPJ) obstruction. We reviewed literature, collecting data from Medline, to evaluate the current status of minimally invasive surgery (MIS) approach to pyeloplasty. Since the first pyeloplasty was described in 1939, several techniques has been applied to correct UPJ obstruction, but Anderson-Hynes dismembered pyeloplasty is established as the gold standard, to date also in MIS technique. According to literature several studies underline the safety and effectiveness of this approach for both trans- and retro-peritoneal routes, with a success rate between 81-100% and an operative time between 90-228 min. These studies have demonstrated the safety and efficacy of this procedure in the management of UPJ obstruction in children. Whether better the transperitoneal, than the retroperitoneal approach is still debated. A long learning curve is needed especially in suturing and knotting.

Partial Thickness Rotator Cuff Tears: Current Concepts

PubMed Central

Matthewson, Graeme; Beach, Cara J.; Nelson, Atiba A.; Woodmass, Jarret M.; Ono, Yohei; Boorman, Richard S.; Lo, Ian K. Y.; Thornton, Gail M.

2015-01-01

Partial thickness rotator cuff tears are a common cause of pain in the adult shoulder. Despite their high prevalence, the diagnosis and treatment of partial thickness rotator cuff tears remains controversial. While recent studies have helped to elucidate the anatomy and natural history of disease progression, the optimal treatment, both nonoperative and operative, is unclear. Although the advent of arthroscopy has improved the accuracy of the diagnosis of partial thickness rotator cuff tears, the number of surgical techniques used to repair these tears has also increased. While multiple repair techniques have been described, there is currently no significant clinical evidence supporting more complex surgical techniques over standard rotator cuff repair. Further research is required to determine the clinical indications for surgical and nonsurgical management, when formal rotator cuff repair is specifically indicated and when biologic adjunctive therapy may be utilized. PMID:26171251

Micrometeorological Mass Balance Measurements of Greenhouse Gas Emissions from Composting Green-waste

NASA Astrophysics Data System (ADS)

Kent, E. R.; Bailey, S.; Stephens, J.; Horwath, W. R.; Paw U, K.

2013-12-01

Managed decomposition of organic materials is increasingly being used as an alternative waste management option and the resulting compost can be used as a fertilizer and soil amendment in home gardens and agriculture. An additional benefit is the avoidance of methane emissions associated with anaerobic decomposition in landfills. Greenhouse gases are still emitted during the composting process, but few studies have measured emissions from a full-scale windrow of composting green-waste. This study uses a micrometeorological mass balance technique (upwind and downwind vertical profile measurements of trace gas concentrations and wind velocity) to calculate emissions of carbon dioxide, methane, and nitrous oxide from a pile of composting green-waste during the dry season in Northern California. The expected source pattern was observed in measured upwind-downwind concentration differences of all three gases averaged over the study period despite substantial noise seen in the half-hourly emission calculations. Sources of uncertainty are investigated and temporal patterns analyzed. An in-situ zero-source test was conducted to examine the mass balance technique when the source of emissions was removed. Results from the micrometeorological mass balance measurements are compared with measurements taken using the more common open chamber technique.

Persistent atrial fibrillation vs paroxysmal atrial fibrillation: differences in management.

PubMed

Margulescu, Andrei D; Mont, Lluis

2017-08-01

Atrial fibrillation (AF) is the most common human arrhythmia. AF is a progressive disease, initially being nonsustained and induced by trigger activity, and progressing towards persistent AF through alteration of the atrial myocardial substrate. Treatment of AF aims to decrease the risk of stroke and improve the quality of life, by preventing recurrences (rhythm control) or controlling the heart rate during AF (rate control). In the last 20 years, catheter-based and, less frequently, surgical and hybrid ablation techniques have proven more successful compared with drug therapy in achieving rhythm control in patients with AF. However, the efficiency of ablation techniques varies greatly, being highest in paroxysmal and lowest in long-term persistent AF. Areas covered: In this review, we discuss the fundamental differences between paroxysmal and persistent AF and the potential impact of those differences on patient management, emphasizing the available therapeutic strategies to achieve rhythm control. Expert commentary: Treatment to prevent AF recurrences is suboptimal, particularly in patients with persistent AF. Emerging technologies, such as documentation of atrial fibrosis using magnetic resonance imaging and documentation of electrical substrate using advanced electrocardiographic imaging techniques are likely to provide valuable insights about patient-specific tailoring of treatments.

Acute Cutaneous Necrosis: A Guide to Early Diagnosis and Treatment.

PubMed

Karimi, Karen; Odhav, Ashika; Kollipara, Ramya; Fike, Jesse; Stanford, Carol; Hall, John C

Acute cutaneous necrosis is characterised by a wide range of aetiologies and is associated with significant morbidity and mortality, warranting complex considerations in management. Early recognition is imperative in diagnosis and management of sudden gangrenous changes in the skin. This review discusses major causes of cutaneous necrosis, examines the need for early assessment, and integrates techniques related to diagnosis and management. The literature, available via PubMed, on acute cutaneous necrotic syndromes was reviewed to summarise causes and synthesise appropriate treatment strategies to create a clinician's guide in the early diagnosis and management of acute cutaneous necrosis. Highlighted in this article are key features associated with common causes of acute cutaneous necrosis: warfarin-induced skin necrosis, heparin-induced skin necrosis, calciphylaxis, pyoderma gangrenosum, embolic phenomena, purpura fulminans, brown recluse spider bite, necrotising fasciitis, ecthyma gangrenosum, antiphospholipid syndrome, hypergammaglobulinemia, and cryoglobulinemia. This review serves to increase recognition of these serious pathologies and complications, allowing for prompt diagnosis and swift limb- or life-saving management.

Conservative Management for Stable High Ankle Injuries in Professional Football Players.

PubMed

Knapik, Derrick M; Trem, Anthony; Sheehan, Joseph; Salata, Michael J; Voos, James E

High ankle "syndesmosis" injuries are common in American football players relative to the general population. At the professional level, syndesmotic sprains represent a challenging and unique injury lacking a standardized rehabilitation protocol during conservative management. PubMed, Biosis Preview, SPORTDiscus, PEDro, and EMBASE databases were searched using the terms syndesmotic injuries, American football, conservative management, and rehabilitation. Clinical review. Level 3. When compared with lateral ankle sprains, syndesmosis injuries result in significantly prolonged recovery times and games lost. For stable syndesmotic injuries, conservative management features a brief period of immobilization and protected weightbearing followed by progressive strengthening exercises and running, and athletes can expect to return to competition in 2 to 6 weeks. Further research investigating the efficacy of dry needling and blood flow restriction therapy is necessary to evaluate the benefit of these techniques in the rehabilitation process. Successful conservative management of stable syndesmotic injuries in professional American football athletes requires a thorough understanding of the anatomy, injury mechanisms, diagnosis, and rehabilitation strategies utilized in elite athletes.

The role of neurologists and diagnostic tests in the management of distal symmetric polyneuropathy

PubMed Central

Callaghan, Brian C.; Kerber, Kevin A.; Lisabeth, Lynda L.; Morgenstern, Lewis B.; Longoria, Ruth; Rodgers, Ann; Longwell, Paxton; Feldman, Eva L.

2014-01-01

Importance Distal symmetric polyneuropathy (DSP) is a prevalent condition resulting in high costs from diagnostic testing. However, the role of neurologists and diagnostic tests on patient care is unknown. Objective To determine how often neurologists and diagnostic tests influence the diagnosis and management of DSP patients in a community setting. Design We utilized a validated case-capture method (ICD-9 screening technique with subsequent medical chart abstraction) to identify patients with a new DSP diagnosis (retrospective cohort). Using a structured data abstraction process, diagnostic testing, diagnoses rendered (before and after testing), and subsequent management were recorded. Setting Community neurologist’s outpatient offices in Corpus Christi, Texas. Participants Patients meeting the Toronto consensus criteria for probable DSP. Main Outcome Measure Changes in etiology and management after diagnostic testing by neurologists. Results Between 1/1/2010–3/31/2011, we identified 458 DSP patients followed for mean (SD) 435.3 (44.1) days. Neurologists identified a cause of DSP in 63.5% of cases prior to their diagnostic testing. Seventy-one patients (15.5%) had a new DSP cause discovered after testing by neurologists. The most common new diagnoses were pre-diabetes (N=28), B12 deficiency (N=20), diabetes (N=8), and thyroid disease (N=8). Management changes were common (63.1%), usually related to neuropathic pain management (77.5%). Disease modifying management changes occurred in 24.7% with diabetes management (N=45), starting vitamins (N=39), advising diet/exercise (N=33), and adjusting thyroid medications (N=10) the most common. Electrodiagnostic testing and MRIs of the neuroaxis rarely led to management changes. Conclusions and Relevance Neurologists diagnosed the cause of DSP in almost two-thirds of patients prior to their diagnostic testing. Inexpensive blood tests for diabetes, thyroid dysfunction, and B12 deficiency, allowed neurologists to identify a new etiology in 15.5% of patients. In contrast, expensive electrodiagnostic tests and MRIs rarely changed patient care. Neurologists also frequently made pain medication changes utilizing best evidence medications. PMID:25048157

Fitting an MSD (mini scleral design) rigid contact lens in advanced keratoconus with INTACS.

PubMed

Dalton, Kristine; Sorbara, Luigina

2011-12-01

Keratoconus is a bilateral degenerative disease characterized by a non-inflammatory, progressive central corneal ectasia (typically asymmetric) and decreased vision. In its early stages it may be managed with spectacles and soft contact lenses but more commonly it is managed with rigid contact lenses. In advanced stages, when contact lenses can no longer be fit, have become intolerable, or corneal damage is severe, a penetrating keratoplasty is commonly performed. Alternative surgical techniques, such as the use of intra-stromal corneal ring segments (INTACS) have been developed to try and improve the fit of rigid contact lenses in keratoconic patients and avoid penetrating keratoplasties. This case report follows through the fitting of rigid contact lenses in an advanced keratoconic cornea after an INTACS procedure and discusses clinical findings, treatment options, and the use of mini-scleral and scleral lens designs as they relate to the challenges encountered in managing such a patient. Mini-scleral and scleral lenses are relatively easy to fit, and can be of benefit to many patients, including advanced keratoconic patients, post-INTAC patients and post-penetrating keratoplasty patients. 2011 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.

Closing the gap on Achilles tendon rupture: A cadaveric study quantifying the tendon apposition achieved with commonly used immobilisation practices.

PubMed

Collins, Ruaraidh; Sudlow, Alexis; Loizou, Constantinos; Loveday, David T; Smith, George

2018-04-01

The relative benefits of surgical and conservative treatment of Achilles tendon rupture are widely debated. With modern conservative management protocols, the re-rupture risk appears to fall to one similar to surgical repair with negligible loss of function. Conservative management typically employs a period of time in an equinus cast with sequential ankle dorsiflexion in a functional orthosis. The optimal duration of immobilisation and rate of dorsiflexion is unknown. We aimed to quantify the change in Achilles tendon approximation achieved in common immobilisation techniques to assist the design of rehabilitation protocols. Twelve fresh-frozen cadaveric specimens had 2.5cm of Achilles tendon excised. The gap between the tendon ends were measured via windowed full equinus casts and compared with functional boots with successively removed heel wedges. The greatest tendon apposition was achieved with the equinus cast. Each wedge removed decreased the reapproximation by approximately 5mm. This paper supports the early use of maximal equinus casting in early management of acute Achilles tendon ruptures. Copyright © 2017 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

Anesthesia and perioperative management of colorectal surgical patients - A clinical review (Part 1).

PubMed

Patel, Santosh; Lutz, Jan M; Panchagnula, Umakanth; Bansal, Sujesh

2012-04-01

Colorectal surgery is commonly performed for colorectal cancer and other pathology such as diverticular and inflammatory bowel disease. Despite significant advances, such as laparoscopic techniques and multidisciplinary recovery programs, morbidity and mortality remain high and vary among surgical centers. The use of scoring systems and assessment of functional capacity may help in identifying high-risk patients and predicting complications. An understanding of perioperative factors affecting colon blood flow and oxygenation, suppression of stress response, optimal fluid therapy, and multimodal pain management are essential. These fundamental principles are more important than any specific choice of anesthetic agents. Anesthesiologists can significantly contribute to enhance recovery and improve the quality of perioperative care.

Management of the failed posterior/multidirectional instability patient.

PubMed

Forsythe, Brian; Ghodadra, Neil; Romeo, Anthony A; Provencher, Matthew T

2010-09-01

Although the results of operative treatment of posterior and multidirectional instability (P-MDI) of the shoulder have improved, they are not as reliable as those treated for anterior instability of the shoulder. This may be attributed to the complexities in the classification, etiology, and physical examination of a patient with suspected posterior and multidirectional instability. Failure to address the primary and concurrent lesion adequately and the development of pain and/or stiffness are contributing factors to the failure of P-MDI procedures. Other pitfalls include errors in history and physical examination, failure to recognize concomitant pathology, and problems with the surgical technique or implant failure. Patulous capsular tissues and glenoid version also play in role management of failed P-MDI patients. With an improved understanding of pertinent clinical complaints and physical examination findings and the advent of arthroscopic techniques and improved implants, successful strategies for the nonoperative and operative management of the patient after a failed posterior or multidirectional instability surgery may be elucidated. This article highlights the common presentation, physical findings, and radiographic workup in a patient that presents after a failed P-MDI repair and offers strategies for revision surgical repair.

Management of hepatoblastoma: an update.

PubMed

Kremer, Nathalie; Walther, Ashley E; Tiao, Gregory M

2014-06-01

To summarize the current standards and guidelines for the diagnosis and management of hepatoblastoma, a rare pediatric liver tumor. Hepatoblastoma is the most common malignant liver tumor in childhood. International collaborative efforts have led to uniform implementation of the pretreatment extent of disease (PRETEXT) staging system as a means to establish consensus classification and assess upfront resectability. Additionally, current histopathological classification, in light of more advanced molecular profiling and immunohistochemical techniques and integration of tumor biomarkers into risk stratification, is reviewed. Multimodal therapy is composed of chemotherapy and surgical intervention. Achievement of complete surgical resection plays a key role in successful treatment for hepatoblastoma. Overall, outcomes have greatly improved over the past four decades because of advances in chemotherapeutic agents and administration protocols as well as innovations of surgical approach, including the use of vascular exclusion, ultrasonic dissection techniques, and liver transplantation. Challenges remain in management of high-risk patients as well as patients with recurrent or metastatic disease. Eventually, a more individualized approach to treating the different types of the heterogeneous spectrum of hepatoblastoma, in terms of different chemotherapeutic protocols and timing as well as type and extent of surgery, may become the basis of successful treatment in the more complex or advanced types of hepatoblastoma.

Prevention, identification, and management of post-operative penile implant complications of infection, hematoma, and device malfunction

PubMed Central

O’Rourke, Timothy K.; Erbella, Alexander; Zhang, Yu

2017-01-01

Penile prosthesis implant surgery is an effective management approach for a number of urological conditions, including medication refractory erectile dysfunction (ED). Complications encountered post-operatively include infection, bleeding/hematoma, and device malfunction. Since the 1970s, modifications to these devices have reduced complication rates through improvement in antisepsis and design using antibiotic coatings, kink-resistant tubing, lock-out valves to prevent autoinflation, and modified reservoir shapes. Device survival and complication rates have been investigated predominately by retrospective database-derived studies. This review article focuses on the identification and management of post-operative complications following penile prosthetic and implant surgery. Etiology for ED, surgical technique, and prosthesis type are variable among studies. The most common post-operative complications of infection, bleeding, and device malfunction may be minimized by adherence to consistent technique and standard protocol. Novel antibiotic coatings and standard antibiotic regimen may reduce infection rates. Meticulous hemostasis and intraoperative testing of devices may further reduce need for revision surgery. Additional prospective studies with consistent reporting of outcomes and comparison of surgical approach and prosthesis type in patients with variable ED etiology would be beneficial. PMID:29238663

Aerospace management techniques: Commercial and governmental applications

NASA Technical Reports Server (NTRS)

Milliken, J. G.; Morrison, E. J.

1971-01-01

A guidebook for managers and administrators is presented as a source of useful information on new management methods in business, industry, and government. The major topics discussed include: actual and potential applications of aerospace management techniques to commercial and governmental organizations; aerospace management techniques and their use within the aerospace sector; and the aerospace sector's application of innovative management techniques.

Transient ischaemic attacks due to a pulsating mass in the neck produced after incision and drainage of parapharyngeal abscess.

PubMed

Khan, Mohammad Iqbal; Tariq, Mohammad; Rashid, Danyal

2008-01-01

Carotid endarterectomy is the most commonly performed vascular surgical procedure. One of the complications of carotid endarterectomy is Pseudoaneurysm of the carotid artery frequently managed by endo-vascular technique. Pseudoaneurysm caused by other aetiological factors is rare entity. Penetrating trauma and neck surgery are known but very rare causes of pseudo aneurysm of the carotid artery. We have successfully managed a case of carotid artery pseudoaneurysm caused by incision and drainage of parapharyngeal abscess. This surgery also leads to the palsy of right vagus nerve causing complete hoarseness of voice. The patient presented with Transit Ischaemic Attacks (TIA) and amurosis fugos. Resection of aneurysm and reconstruction of right carotid artery lead to complete recovery. Vocal cord palsy was managed by Vox implant injection leading to full recovery.

Disease management interventions: what's in the black box?

PubMed

Linden, Ariel; Roberts, Nancy

2004-01-01

In discussing evaluation techniques to assess disease management (DM) program outcomes, it is often assumed that DM program interventions are premised on sound clinical judgment, an understanding of the disease process, and knowledge of the psychosocial models of behavioral change that must be used to effect those processes and ultimately improve the health outcomes that are being evaluated. This paper describes eight commonly used behavioral change models applied in the healthcare industry today. They represent programs designed to address individual, interpersonal, and community level factors as well as "packaged" comprehensive approaches. These models illustrate the breadth of approaches to consider when designing or assessing DM program interventions. Careful consideration of the type of behavioral change desired and the theories of how to effect such change should be an integral part of designing disease management program interventions.

Methods for exploring uncertainty in groundwater management predictions

USGS Publications Warehouse

Guillaume, Joseph H. A.; Hunt, Randall J.; Comunian, Alessandro; Fu, Baihua; Blakers, Rachel S; Jakeman, Anthony J.; Barreteau, Olivier; Hunt, Randall J.; Rinaudo, Jean-Daniel; Ross, Andrew

2016-01-01

Models of groundwater systems help to integrate knowledge about the natural and human system covering different spatial and temporal scales, often from multiple disciplines, in order to address a range of issues of concern to various stakeholders. A model is simply a tool to express what we think we know. Uncertainty, due to lack of knowledge or natural variability, means that there are always alternative models that may need to be considered. This chapter provides an overview of uncertainty in models and in the definition of a problem to model, highlights approaches to communicating and using predictions of uncertain outcomes and summarises commonly used methods to explore uncertainty in groundwater management predictions. It is intended to raise awareness of how alternative models and hence uncertainty can be explored in order to facilitate the integration of these techniques with groundwater management.

Subgaleal Retention Sutures: Internal Pressure Dressing Technique for Dolenc Approach.

PubMed

Burrows, Anthony M; Rayan, Tarek; Van Gompel, Jamie J

2017-08-01

Extradural approach to the cavernous sinus, the "Dolenc" approach recognizing its developing Dr. Vinko Dolenc, is a critically important skull base approach. However, resection of the lateral wall of the cavernous sinus, most commonly for cavernous sinus meningiomas, results commonly in a defect that often cannot be reconstructed in a water-tight fashion. This may result in troublesome pseudomeningocele postoperatively. To describe a technique designed to mitigate the development of pseudomeningocele. We found the Dolenc approach critical for resection of cavernous lesions. However, a number of pseudomeningoceles were managed with prolonged external pressure wrapping in the early cohort. Therefore, we incorporated subgaleal to muscular sutures, which were designed to close this potential space and retrospectively analyzed our results. Twenty-one patients treated with a Dolenc approach and resection of the lateral wall of the cavernous sinus over a 2-year period were included. Prior to incorporation of this technique, 12 patients were treated and 3 (25%) experienced postoperative pseudomeningoceles requiring multiple clinic visits and frequent dressing. After incorporation of subgaleal retention sutures, no patient (0%) experienced this complication. Although basic, subgaleal to temporalis muscle retention sutures likely aid in eliminating this potential dead space, thereby preventing patient distress postoperatively. This technique is simple and further emphasizes the importance of dead space elimination in complex closures. Copyright © 2017 by the Congress of Neurological Surgeons

WE-G-BRC-02: Risk Assessment for HDR Brachytherapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Mayadev, J.

2016-06-15

Failure Mode and Effects Analysis (FMEA) originated as an industrial engineering technique used for risk management and safety improvement of complex processes. In the context of radiotherapy, the AAPM Task Group 100 advocates FMEA as the framework of choice for establishing clinical quality management protocols. However, there is concern that widespread adoption of FMEA in radiation oncology will be hampered by the perception that implementation of the tool will have a steep learning curve, be extremely time consuming and labor intensive, and require additional resources. To overcome these preconceptions and facilitate the introduction of the tool into clinical practice, themore » medical physics community must be educated in the use of this tool and the ease in which it can be implemented. Organizations with experience in FMEA should share their knowledge with others in order to increase the implementation, effectiveness and productivity of the tool. This session will include a brief, general introduction to FMEA followed by a focus on practical aspects of implementing FMEA for specific clinical procedures including HDR brachytherapy, physics plan review and radiosurgery. A description of common equipment and devices used in these procedures and how to characterize new devices for safe use in patient treatments will be presented. This will be followed by a discussion of how to customize FMEA techniques and templates to one’s own clinic. Finally, cases of common failure modes for specific procedures (described previously) will be shown and recommended intervention methodologies and outcomes reviewed. Learning Objectives: Understand the general concept of failure mode and effect analysis Learn how to characterize new equipment for safety Be able to identify potential failure modes for specific procedures and learn mitigation techniques Be able to customize FMEA examples and templates for use in any clinic.« less

WE-G-BRC-01: Risk Assessment for Radiosurgery

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kim, G.

2016-06-15

Failure Mode and Effects Analysis (FMEA) originated as an industrial engineering technique used for risk management and safety improvement of complex processes. In the context of radiotherapy, the AAPM Task Group 100 advocates FMEA as the framework of choice for establishing clinical quality management protocols. However, there is concern that widespread adoption of FMEA in radiation oncology will be hampered by the perception that implementation of the tool will have a steep learning curve, be extremely time consuming and labor intensive, and require additional resources. To overcome these preconceptions and facilitate the introduction of the tool into clinical practice, themore » medical physics community must be educated in the use of this tool and the ease in which it can be implemented. Organizations with experience in FMEA should share their knowledge with others in order to increase the implementation, effectiveness and productivity of the tool. This session will include a brief, general introduction to FMEA followed by a focus on practical aspects of implementing FMEA for specific clinical procedures including HDR brachytherapy, physics plan review and radiosurgery. A description of common equipment and devices used in these procedures and how to characterize new devices for safe use in patient treatments will be presented. This will be followed by a discussion of how to customize FMEA techniques and templates to one’s own clinic. Finally, cases of common failure modes for specific procedures (described previously) will be shown and recommended intervention methodologies and outcomes reviewed. Learning Objectives: Understand the general concept of failure mode and effect analysis Learn how to characterize new equipment for safety Be able to identify potential failure modes for specific procedures and learn mitigation techniques Be able to customize FMEA examples and templates for use in any clinic.« less

WE-G-BRC-03: Risk Assessment for Physics Plan Review

DOE Office of Scientific and Technical Information (OSTI.GOV)

Parker, S.

2016-06-15

Failure Mode and Effects Analysis (FMEA) originated as an industrial engineering technique used for risk management and safety improvement of complex processes. In the context of radiotherapy, the AAPM Task Group 100 advocates FMEA as the framework of choice for establishing clinical quality management protocols. However, there is concern that widespread adoption of FMEA in radiation oncology will be hampered by the perception that implementation of the tool will have a steep learning curve, be extremely time consuming and labor intensive, and require additional resources. To overcome these preconceptions and facilitate the introduction of the tool into clinical practice, themore » medical physics community must be educated in the use of this tool and the ease in which it can be implemented. Organizations with experience in FMEA should share their knowledge with others in order to increase the implementation, effectiveness and productivity of the tool. This session will include a brief, general introduction to FMEA followed by a focus on practical aspects of implementing FMEA for specific clinical procedures including HDR brachytherapy, physics plan review and radiosurgery. A description of common equipment and devices used in these procedures and how to characterize new devices for safe use in patient treatments will be presented. This will be followed by a discussion of how to customize FMEA techniques and templates to one’s own clinic. Finally, cases of common failure modes for specific procedures (described previously) will be shown and recommended intervention methodologies and outcomes reviewed. Learning Objectives: Understand the general concept of failure mode and effect analysis Learn how to characterize new equipment for safety Be able to identify potential failure modes for specific procedures and learn mitigation techniques Be able to customize FMEA examples and templates for use in any clinic.« less

DOE Office of Scientific and Technical Information (OSTI.GOV)

NONE

Failure Mode and Effects Analysis (FMEA) originated as an industrial engineering technique used for risk management and safety improvement of complex processes. In the context of radiotherapy, the AAPM Task Group 100 advocates FMEA as the framework of choice for establishing clinical quality management protocols. However, there is concern that widespread adoption of FMEA in radiation oncology will be hampered by the perception that implementation of the tool will have a steep learning curve, be extremely time consuming and labor intensive, and require additional resources. To overcome these preconceptions and facilitate the introduction of the tool into clinical practice, themore » medical physics community must be educated in the use of this tool and the ease in which it can be implemented. Organizations with experience in FMEA should share their knowledge with others in order to increase the implementation, effectiveness and productivity of the tool. This session will include a brief, general introduction to FMEA followed by a focus on practical aspects of implementing FMEA for specific clinical procedures including HDR brachytherapy, physics plan review and radiosurgery. A description of common equipment and devices used in these procedures and how to characterize new devices for safe use in patient treatments will be presented. This will be followed by a discussion of how to customize FMEA techniques and templates to one’s own clinic. Finally, cases of common failure modes for specific procedures (described previously) will be shown and recommended intervention methodologies and outcomes reviewed. Learning Objectives: Understand the general concept of failure mode and effect analysis Learn how to characterize new equipment for safety Be able to identify potential failure modes for specific procedures and learn mitigation techniques Be able to customize FMEA examples and templates for use in any clinic.« less

Wildland Arson as Clandestine Resource Management: A Space-Time Permutation Analysis and Classification of Informal Fire Management Regimes in Georgia, USA

NASA Astrophysics Data System (ADS)

Coughlan, Michael R.

2016-05-01

Forest managers are increasingly recognizing the value of disturbance-based land management techniques such as prescribed burning. Unauthorized, "arson" fires are common in the southeastern United States where a legacy of agrarian cultural heritage persists amidst an increasingly forest-dominated landscape. This paper reexamines unauthorized fire-setting in the state of Georgia, USA from a historical ecology perspective that aims to contribute to historically informed, disturbance-based land management. A space-time permutation analysis is employed to discriminate systematic, management-oriented unauthorized fires from more arbitrary or socially deviant fire-setting behaviors. This paper argues that statistically significant space-time clusters of unauthorized fire occurrence represent informal management regimes linked to the legacy of traditional land management practices. Recent scholarship has pointed out that traditional management has actively promoted sustainable resource use and, in some cases, enhanced biodiversity often through the use of fire. Despite broad-scale displacement of traditional management during the 20th century, informal management practices may locally circumvent more formal and regionally dominant management regimes. Space-time permutation analysis identified 29 statistically significant fire regimes for the state of Georgia. The identified regimes are classified by region and land cover type and their implications for historically informed disturbance-based resource management are discussed.

Wildland Arson as Clandestine Resource Management: A Space-Time Permutation Analysis and Classification of Informal Fire Management Regimes in Georgia, USA.

PubMed

Coughlan, Michael R

2016-05-01

Forest managers are increasingly recognizing the value of disturbance-based land management techniques such as prescribed burning. Unauthorized, "arson" fires are common in the southeastern United States where a legacy of agrarian cultural heritage persists amidst an increasingly forest-dominated landscape. This paper reexamines unauthorized fire-setting in the state of Georgia, USA from a historical ecology perspective that aims to contribute to historically informed, disturbance-based land management. A space-time permutation analysis is employed to discriminate systematic, management-oriented unauthorized fires from more arbitrary or socially deviant fire-setting behaviors. This paper argues that statistically significant space-time clusters of unauthorized fire occurrence represent informal management regimes linked to the legacy of traditional land management practices. Recent scholarship has pointed out that traditional management has actively promoted sustainable resource use and, in some cases, enhanced biodiversity often through the use of fire. Despite broad-scale displacement of traditional management during the 20th century, informal management practices may locally circumvent more formal and regionally dominant management regimes. Space-time permutation analysis identified 29 statistically significant fire regimes for the state of Georgia. The identified regimes are classified by region and land cover type and their implications for historically informed disturbance-based resource management are discussed.

Do Groundwater Management Plans Work? A statistical evaluation of the effectiveness of groundwater management plans towards achieving water supply and environmental objectives under a changing climate.

NASA Astrophysics Data System (ADS)

White, E.; Peterson, T. J.; Costelloe, J. F.; Western, A. W.; Carrara, E.

2017-12-01

Regulation of groundwater through the use of management plans is becoming increasingly prevalent as global groundwater levels decline. But plans are seldom systematically and quantitatively assessed for effectiveness. Instead, the state of an aquifer is commonly considered a proxy for plan effectiveness despite a lack of casaulity. Groundwater managers face myraid challenges such as finite resources, conflicting uses and the uncertainty inherent in any groundwater investigation. Groundwater models have been used to provide insights into what may happen to the aquifer under various levels of stress. Generally, these models simulate the impact of predefined stresses for a certain time-span. However, this is not how management occurs in reality. Managers only see a fraction of the aquifer and use this limited knowledgeto make aquifer-wide decisions. Also, management changes over time in response to aquifer state, and groundwater management plans commonly contain trigger levels in monitoring wells that prompt management intervention. In this way there is a feedback between the aquifer state and management that is rarely captured by groundwater management models. To capture this management/aquifer feedback, groundwater management was structured as a systems control problem, and using this framework, a testability assessment rubric developed. The rubric was applied to 15 Australian groundwater management plans and 47% of plans were found to be testable. To numerically quantify the effectiveness of groundwater managment, the impact of extraction restrictions was probabilistically assessed by simulating "the act of management" of a simple unconfined groundwater system using MODFLOW and Flopy. Water managers were privy only to head levels in a varying number of grid cells assigned as monitoring wells, and used that limited information to make allocation decisions at each time step. Extraction rates for each simulated management period were determined based upon the observed heads from the previous management period and adjusted depending upon triggers outlined in the management plan. The effectiveness of water restrictions as a management technique for the purpose of maintaining supply reliability under various decision making frequencies, aquifer response times and climate scenarios was explored.

Researching Mental Health Disorders in the Era of Social Media: Systematic Review.

PubMed

Wongkoblap, Akkapon; Vadillo, Miguel A; Curcin, Vasa

2017-06-29

Mental illness is quickly becoming one of the most prevalent public health problems worldwide. Social network platforms, where users can express their emotions, feelings, and thoughts, are a valuable source of data for researching mental health, and techniques based on machine learning are increasingly used for this purpose. The objective of this review was to explore the scope and limits of cutting-edge techniques that researchers are using for predictive analytics in mental health and to review associated issues, such as ethical concerns, in this area of research. We performed a systematic literature review in March 2017, using keywords to search articles on data mining of social network data in the context of common mental health disorders, published between 2010 and March 8, 2017 in medical and computer science journals. The initial search returned a total of 5386 articles. Following a careful analysis of the titles, abstracts, and main texts, we selected 48 articles for review. We coded the articles according to key characteristics, techniques used for data collection, data preprocessing, feature extraction, feature selection, model construction, and model verification. The most common analytical method was text analysis, with several studies using different flavors of image analysis and social interaction graph analysis. Despite an increasing number of studies investigating mental health issues using social network data, some common problems persist. Assembling large, high-quality datasets of social media users with mental disorder is problematic, not only due to biases associated with the collection methods, but also with regard to managing consent and selecting appropriate analytics techniques. ©Akkapon Wongkoblap, Miguel A Vadillo, Vasa Curcin. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 29.06.2017.

Comparison of commercial analytical techniques for measuring chlorine dioxide in urban desalinated drinking water.

PubMed

Ammar, T A; Abid, K Y; El-Bindary, A A; El-Sonbati, A Z

2015-12-01

Most drinking water industries are closely examining options to maintain a certain level of disinfectant residual through the entire distribution system. Chlorine dioxide is one of the promising disinfectants that is usually used as a secondary disinfectant, whereas the selection of the proper monitoring analytical technique to ensure disinfection and regulatory compliance has been debated within the industry. This research endeavored to objectively compare the performance of commercially available analytical techniques used for chlorine dioxide measurements (namely, chronoamperometry, DPD (N,N-diethyl-p-phenylenediamine), Lissamine Green B (LGB WET) and amperometric titration), to determine the superior technique. The commonly available commercial analytical techniques were evaluated over a wide range of chlorine dioxide concentrations. In reference to pre-defined criteria, the superior analytical technique was determined. To discern the effectiveness of such superior technique, various factors, such as sample temperature, high ionic strength, and other interferences that might influence the performance were examined. Among the four techniques, chronoamperometry technique indicates a significant level of accuracy and precision. Furthermore, the various influencing factors studied did not diminish the technique's performance where it was fairly adequate in all matrices. This study is a step towards proper disinfection monitoring and it confidently assists engineers with chlorine dioxide disinfection system planning and management.

ESPGHAN-NASPGHAN Guidelines for the Evaluation and Treatment of Gastrointestinal and Nutritional Complications in Children With Esophageal Atresia-Tracheoesophageal Fistula.

PubMed

Krishnan, Usha; Mousa, Hayat; Dall'Oglio, Luigi; Homaira, Nusrat; Rosen, Rachel; Faure, Christophe; Gottrand, Frédéric

2016-11-01

Esophageal atresia (EA) is one of the most common congenital digestive anomalies. With improvements in surgical techniques and intensive care treatments, the focus of care of these patients has shifted from mortality to morbidity and quality-of-life issues. These children face gastrointestinal (GI) problems not only in early childhood but also through adolescence and adulthood. There is, however, currently a lack of a systematic approach to the care of these patients. The GI working group of International Network on Esophageal Atresia comprises members from ESPGHAN/NASPGHAN and was charged with the task of developing uniform evidence-based guidelines for the management of GI complications in children with EA. Thirty-six clinical questions addressing the diagnosis, treatment, and prognosis of the common GI complications in patients with EA were formulated. Questions on the diagnosis, and treatment of gastroesophageal reflux, management of "cyanotic spells," etiology, investigation and management of dysphagia, feeding difficulties, anastomotic strictures, congenital esophageal stenosis in EA patients were addressed. The importance of excluding eosinophilic esophagitis and associated GI anomalies in symptomatic patients with EA is discussed as is the quality of life of these patients and the importance of a systematic transition of care to adulthood. A systematic literature search was performed from inception to March 2014 using Embase, MEDLINE, the Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Clinical Trials, and PsychInfo databases. The approach of the Grading of Recommendations Assessment, Development and Evaluation was applied to evaluate outcomes. During 2 consensus meetings, all recommendations were discussed and finalized. The group members voted on each recommendation, using the nominal voting technique. Expert opinion was used where no randomized controlled trials were available to support the recommendation.

Contemporary behavior management techniques in clinical pediatric dentistry: out with the old and in with the new?

PubMed

Oliver, Kelly; Manton, David John

2015-01-01

Effective behavior management guides children through the complex social context of dentistry utilizing techniques based on a current understanding of the social, emotional, and cognitive development of children. Behavior management techniques facilitate effective communication and establish social and behavioral guidelines for the dental environment. Contemporary parenting styles, expectations, and attitudes of modern parents and society have influenced the use of behavior management techniques with a prevailing emphasis on communicative techniques and pharmacological management over aversive techniques.

Interventional Radiology in Paediatrics.

PubMed

Chippington, Samantha J; Goodwin, Susie J

2015-01-01

As in adult practice, there is a growing role for paediatric interventional radiology expertise in the management of paediatric pathologies. This review is targeted for clinicians who may refer their patients to paediatric interventional radiology services, or who are responsible for patients who are undergoing paediatric interventional radiology procedures. The article includes a brief overview of the indications for intervention, techniques involved and the commonest complications. Although some of the procedures described are most commonly performed in a tertiary paediatric centre, many are performed in most Children's hospitals.

Cervical Radiculopathy due to Cervical Degenerative Diseases : Anatomy, Diagnosis and Treatment

PubMed Central

Kim, Kyoung-Tae

2010-01-01

A cervical radiculopathy is the most common symptom of cervical degenerative disease and its natural course is generally favorable. With a precise diagnosis using appropriate tools, the majority of patients will respond well to conservative treatment. Cervical radiculopathy with persistent radicular pain after conservative treatment and progressive or profound motor weakness may require surgery. Options for surgical management are extensive. Each technique has strengths and weaknesses, so the choice will depend on the patient's clinical profile and the surgeon's judgment. PMID:21430971

Nursing care of the brain injury patient on a locked neurobehavioral unit.

PubMed

Becker, Christine

2012-01-01

Behavioral problems after a brain injury can be extremely challenging for those working with brain injured people. Nursing staff must be familiar with commonly used post brain injury medications and their effects, behavioral management plans, appropriate use of restrictive devices, and verbal or physical crisis intervention techniques when necessary. Rehabilitation nurses caring for brain injured patients on a locked neurobehavioral unit must maintain continual training and specific competence in this environment to ensure patient and staff safety. © 2012 Association of Rehabilitation Nurses.

Management of pain through autogenic training.

PubMed

Kanji, N

2000-08-01

Physical and emotional pain are an inevitable part of human existence and are without natural antidotes. In view of this, and in the light of increasing professional reluctance to depend on analgesics, this paper proposes the widespread application of autogenic training, a relaxation technique which has been seen to confront pain very effectively, and also to reduce substantially drugs dependency. It analyses autogenic training in respect of some of the more common pain-allied disorders such as childbirth, headaches and migraines, back pain, cancer and palliative care, and cardiology.

Psychological approaches for the nursing management of chronic pain: part 2.

PubMed

Richardson, Clifford; Adams, Nicola; Poole, Helen

2006-09-01

The aim of this article was to present the ways that nurses can integrate psychological approaches into their management of chronic pain conditions using a biopsychosocial framework. Communication, the importance of the patient-practitioner interaction, the role of education and provision of information, reassurance and reduction of anxiety and the use of coping strategies training in the management of chronic pain are reviewed alongside the key skills of nursing. This is the second part of a two-part article. Part 1 was a discussion of psychosocial factors associated with chronic pain conditions and the psychological approaches used in the management of these conditions. It is identified that key nursing skills often equate to the requirements of the psychological approaches, therefore specific techniques from a cognitive-behavioural framework can be readily applied, integrated and used by nurses in the management of chronic pain conditions. Commonly utilized nursing skills are similar to those required for cognitive-behavioural therapy. It is reasonable to assume therefore that nurses can and should be involved in effectively managing the psychological aspects associated with chronic pain conditions.

Trends in Shoulder Stabilization Techniques Used in the United States Based on a Large Private-Payer Database.

PubMed

Riff, Andrew J; Frank, Rachel M; Sumner, Shelby; Friel, Nicole; Bach, Bernard R; Verma, Nikhil N; Romeo, Anthony A

2017-12-01

Arthroscopic stabilization is the most broadly used surgical procedure in the United States for management of recurrent shoulder instability. Latarjet coracoid transfer has been considered a salvage surgical procedure for failed arthroscopic repairs or cases of significant glenoid bone loss; however, with recent literature suggesting reduced risk of recurrent instability with Latarjet, several surgeons have advocated its broader utilization as a primary operation for treatment of shoulder instability. To determine trends in shoulder stabilization techniques used in the United States. Cross-sectional study. A retrospective analysis of a publicly available national insurance database was performed to identify shoulder stabilization procedures performed over 9 years (2007-2015). The following Current Procedural Terminology codes were searched: 29806 (arthroscopic stabilization), 23455 (open capsulolabral repair), 23466 (open capsular shift), 23462 (Latarjet coracoid transfer), and 23460 (open anterior capsulorrhaphy with other bone block augmentation). Outcomes of interest included (1) trends in the use of each technique throughout the study interval, (2) age and sex distributions of patients undergoing each technique, and (3) regional predilections for the use of each technique. Arthroscopic stabilization was the most broadly used shoulder stabilization procedure in the database (87%), followed by open Bankart (7%), Latarjet (3.2%), open capsular shift (2.6%), and alternative bone block procedure (0.8%). Throughout the study period, the incidence of arthroscopic stabilization and Latarjet increased (8% and 15% per year, respectively); the incidence of open capsular shift remained relatively constant; and the incidence of open Bankart decreased (9% per year). Arthroscopic stabilization, open Bankart, and Latarjet each had similar sex-based distributions (roughly 70% male), while open capsular shift and alternative bone block were relatively more common in females (54% and 50% male, respectively). The incidence of arthroscopic stabilization and Latarjet were greatest in the South and lowest in the Northeast. Arthroscopic stabilization remains the most commonly utilized stabilization technique in the United States. The use of the Latarjet procedure is steadily increasing and now rivals open Bankart stabilization among the most commonly used open stabilization techniques.

Surgical management of gynecomastia: experience of a general surgery center.

PubMed

Longheu, A; Medas, F; Corrias, F; Farris, S; Tatti, A; Pisano, G; Erdas, E; Calò, P G

2016-01-01

Gynecomastia is a common finding in male population of all ages. The aim of our study was to present our experience and goals in surgical treatment of gynecomastia. Clinical records of patients affected by gynecomastia referred to our Department of Surgery between September 2008 and January 2015 were analyzed. 50 patients were included in this study. Gynecomastia was monolateral in 12 patients (24%) and bilateral in 38 (76%); idiopathic in 41 patients (82%) and secondary in 9 (18%). 39 patients (78%) underwent surgical operation under general anaesthesia, 11 (22%) under local anaesthesia. 3 patients (6%) presented recurrent disease. Webster technique was performed in 28 patients (56%), Davidson technique in 16 patients (32%); in 2 patients (4%) Pitanguy technique was performed and in 4 patients (8%) a mixed surgical technique was performed. Mean surgical time was 80.72±35.14 minutes, median postoperative stay was 1.46±0.88 days. 2 patients (4%) operated using Davidson technique developed a hematoma, 1 patient (2%) operated with the same technique developed hypertrophic scar. Several surgical techniques are described for surgical correction of gynecomastia. If performed by skilled general surgeons surgical treatment of gynecomastia is safe and permits to reach satisfactory aesthetic results.

Endoscopic ultrasound and endoscopic retrograde cholangiopancreatography: Can they be successfully combined?

PubMed

Gornals, Joan B; Esteban, José Miguel; Guarner-Argente, Carlos; Marra-Lopez, Carlos; Repiso, Alejandro; Sendino, Oriol; Loras, Carme

2016-11-01

Endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) have much in common, including their main indications (biliopancreatic disorders), powerful therapeutic capacities and a steep learning curve. Over the years they have evolved from novel diagnostic procedures to interventional therapeutic techniques, but along different paths (different scopes or devices and endoscopists specializing exclusively in one or the other technique). However, EUS has gradually developed into a therapeutic technique that requires skills in the use of ERCP devices and stents, leading some ERCP specialists to explore the therapeutic potential of EUS. The corresponding literature, which has grown exponentially, includes recent experiments on combining the two techniques, which have gradually come to be used in routine care in a number of centers, with positive technical, clinical and financial outcomes. We review EUS and ERCP as individual or combined procedures for managing biliopancreatic disorders. Copyright © 2016 Elsevier España, S.L.U. y AEEH y AEG. All rights reserved.

Non invasive blood flow assessment in diabetic foot ulcer using laser speckle contrast imaging technique

NASA Astrophysics Data System (ADS)

Jayanthy, A. K.; Sujatha, N.; Reddy, M. Ramasubba; Narayanamoorthy, V. B.

2014-03-01

Measuring microcirculatory tissue blood perfusion is of interest for both clinicians and researchers in a wide range of applications and can provide essential information of the progress of treatment of certain diseases which causes either an increased or decreased blood flow. Diabetic ulcer associated with alterations in tissue blood flow is the most common cause of non-traumatic lower extremity amputations. A technique which can detect the onset of ulcer and provide essential information on the progress of the treatment of ulcer would be of great help to the clinicians. A noninvasive, noncontact and whole field laser speckle contrast imaging (LSCI) technique has been described in this paper which is used to assess the changes in blood flow in diabetic ulcer affected areas of the foot. The blood flow assessment at the wound site can provide critical information on the efficiency and progress of the treatment given to the diabetic ulcer subjects. The technique may also potentially fulfill a significant need in diabetic foot ulcer screening and management.

Efficient methods and readily customizable libraries for managing complexity of large networks.

PubMed

Dogrusoz, Ugur; Karacelik, Alper; Safarli, Ilkin; Balci, Hasan; Dervishi, Leonard; Siper, Metin Can

2018-01-01

One common problem in visualizing real-life networks, including biological pathways, is the large size of these networks. Often times, users find themselves facing slow, non-scaling operations due to network size, if not a "hairball" network, hindering effective analysis. One extremely useful method for reducing complexity of large networks is the use of hierarchical clustering and nesting, and applying expand-collapse operations on demand during analysis. Another such method is hiding currently unnecessary details, to later gradually reveal on demand. Major challenges when applying complexity reduction operations on large networks include efficiency and maintaining the user's mental map of the drawing. We developed specialized incremental layout methods for preserving a user's mental map while managing complexity of large networks through expand-collapse and hide-show operations. We also developed open-source JavaScript libraries as plug-ins to the web based graph visualization library named Cytsocape.js to implement these methods as complexity management operations. Through efficient specialized algorithms provided by these extensions, one can collapse or hide desired parts of a network, yielding potentially much smaller networks, making them more suitable for interactive visual analysis. This work fills an important gap by making efficient implementations of some already known complexity management techniques freely available to tool developers through a couple of open source, customizable software libraries, and by introducing some heuristics which can be applied upon such complexity management techniques to ensure preserving mental map of users.

76 FR 44604 - Draft Anacostia Park Wetland and Resident Canada Goose Management Plan/Environmental Impact...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-26

... the current wetland and goose management techniques which include: Invasive species management, trash... techniques. Proposed extensive wetland restoration opportunities could include: Managing invasive species.... Some of the wetland management techniques could include managing invasive species and [[Page 44605...

Ten-Year Experience of Managing Giant Duodenal Ulcer Perforations with Triple Tube Ostomy at Tertiary Hospital of North India.

PubMed

Ali, Wasif Mohammad; Ansari, M M; Rizvi, Syed Amjad Ali; Rabb, A Z; Mansoor, Tariq; Harris, Syed Hassan; Akhtar, Mohd Sadiq

2018-02-01

Duodenal ulcer perforations have been known since 1600 AD. It is a common surgical emergency and every surgeon will encounter it. The perforation size of >2 cm has been used as the criteria for defining Giant duodenal ulcers. The management of giant duodenal perforations in hemodynamically unstable patient with comorbid condition is taxing because of high incidence of the postoperative leak and mortality. We have used the simple technique of Triple Tube Ostomy after the primary closure of the defect with encouraging results. It is a retrospective study done at the J. N medical college AMU Aligarh from May 2005 to May 2015. Hemodynamically unstable patients who have presented to the emergency with preoperative diagnoses of giant duodenal ulcer perforation and had undergone triple tube ostomy with primary repair of the perforation were included in the study. There were 34 patients of giant duodenal perforation who presented in shock. All of them underwent triple-tube-ostomy after primary repair of the duodenum. Thirty-two patients recovered with two mortalities (5.8 %). Several definite surgical techniques have been described for the management of giant duodenal ulcer perforation but they are complex, have very high morbidity and mortality rate and require an expert surgeon. A close retrospective scrutiny of the patients suggests that simple triple-tube-ostomy technique which is based on the principle of damage control surgery has good postoperative results Therefore, we recommend it as the procedure of choice in these patients.

Visualizing whole-brain DTI tractography with GPU-based Tuboids and LoD management.

PubMed

Petrovic, Vid; Fallon, James; Kuester, Falko

2007-01-01

Diffusion Tensor Imaging (DTI) of the human brain, coupled with tractography techniques, enable the extraction of large-collections of three-dimensional tract pathways per subject. These pathways and pathway bundles represent the connectivity between different brain regions and are critical for the understanding of brain related diseases. A flexible and efficient GPU-based rendering technique for DTI tractography data is presented that addresses common performance bottlenecks and image-quality issues, allowing interactive render rates to be achieved on commodity hardware. An occlusion query-based pathway LoD management system for streamlines/streamtubes/tuboids is introduced that optimizes input geometry, vertex processing, and fragment processing loads, and helps reduce overdraw. The tuboid, a fully-shaded streamtube impostor constructed entirely on the GPU from streamline vertices, is also introduced. Unlike full streamtubes and other impostor constructs, tuboids require little to no preprocessing or extra space over the original streamline data. The supported fragment processing levels of detail range from texture-based draft shading to full raycast normal computation, Phong shading, environment mapping, and curvature-correct text labeling. The presented text labeling technique for tuboids provides adaptive, aesthetically pleasing labels that appear attached to the surface of the tubes. Furthermore, an occlusion query aggregating and scheduling scheme for tuboids is described that reduces the query overhead. Results for a tractography dataset are presented, and demonstrate that LoD-managed tuboids offer benefits over traditional streamtubes both in performance and appearance.

Scrotal reconstruction and testicular prosthetics

PubMed Central

Lucas, Jacob W.; Lester, Kyle M.; Chen, Andrew

2017-01-01

Scrotal surgery encompasses a wide-variety of surgical techniques for an even wider variety of indications. In this manuscript, we review our indications, techniques, and pit-falls for various reconstructive scrotal surgeries as-well-as surgical tips for placement of testicular prostheses. Penoscrotal webbing (PSW) is an abnormal, often-problematic distal insertion of scrotal skin onto the ventral penile shaft. There are several effective and straightforward techniques used to revise this condition, which include simple scrotoplasty, single- or double-Z-plasty, or the VY-flap scrotoplasty. Reconstruction is also commonly indicated following scrotal skin loss caused by infection, trauma, lymphedema, hidradenitis, and cancer. Although initial management of these conditions often involves scrotal skin removal, repair of expansive scrotal skin loss can be technically difficult and can be accomplished by using one of several skin flaps or skin grafting. Split-thickness skin grafting of scrotal defects can be accomplished easily, and provides durable results. PMID:28904904

Evaluation of new Deflux administration techniques: intraureteric HIT and Double HIT for the endoscopic correction of vesicoureteral reflux.

PubMed

Kirsch, Andrew J; Arlen, Angela M

2014-09-01

Vesicoureteral reflux (VUR) is one of the most common urologic diagnoses affecting children, and optimal treatment requires an individualized approach that considers potential risks. Management options include observation with or without continuous antibiotic prophylaxis and surgical correction via endoscopic, open or laparoscopic/robotic approaches. Endoscopic correction of VUR is an outpatient procedure associated with decreased morbidity compared with ureteral reimplantation. The concept of ureteral hydrodistention and intraluminal submucosal injection (Hydrodistention Implantation Technique [HIT]) has led to improved success rates in eliminating VUR compared with the subureteral transurethral injection technique. Further modifications now include use of proximal and distal intraluminal injections (Double HIT) that result in coaptation of both the ureteral tunnel and orifice. Endoscopic injection of dextranomer/hyaluronic acid copolymer, via the HIT and Double HIT, has emerged as a highly successful, minimally invasive alternative to open surgical correction, with minimal associated morbidity.

Q methodology: a new way of assessing employee satisfaction.

PubMed

Chinnis, A S; Summers, D E; Doerr, C; Paulson, D J; Davis, S M

2001-05-01

As yet another nursing shortage faces the country, the issue of the satisfaction of nurses again becomes of critical concern to nursing managers in the interest of staff retention. The authors describe the use of the statistical technique Q methodology to assess the needs of nurses and other medical staff at a level one, tertiary care emergency department in the United States. Using the Q method, the authors were able to identify different, unique viewpoints concerning employee needs among the study population, as well as commonly shared views. This level of detail, not obtainable using more traditional statistical techniques, can aid in the design of more effective strategies aimed at fulfilling the needs of an organization's staff to increase their satisfaction.

Development of a methodology for selecting criteria and indicators of sustainable forest management: a case study on participatory assessment.

PubMed

Mendoza, G A; Prabhu, R

2000-12-01

This paper describes an application of multiple criteria analysis (MCA) in assessing criteria and indicators adapted for a particular forest management unit. The methods include: ranking, rating, and pairwise comparisons. These methods were used in a participatory decision-making environment where a team representing various stakeholders and professionals used their expert opinions and judgements in assessing different criteria and indicators (C&I) on the one hand, and how suitable and applicable they are to a forest management unit on the other. A forest concession located in Kalimantan, Indonesia, was used as the site for the case study. Results from the study show that the multicriteria methods are effective tools that can be used as structured decision aids to evaluate, prioritize, and select sets of C&I for a particular forest management unit. Ranking and rating approaches can be used as a screening tool to develop an initial list of C&I. Pairwise comparison, on the other hand, can be used as a finer filter to further reduce the list. In addition to using these three MCA methods, the study also examines two commonly used group decision-making techniques, the Delphi method and the nominal group technique. Feedback received from the participants indicates that the methods are transparent, easy to implement, and provide a convenient environment for participatory decision-making.

Optimal management strategies for biodiversity within a powerline right-of-way

USGS Publications Warehouse

Perry, M.C.; Osenton, P.C.; Fallon, F.W.; Fallon, J.E.; Williams, James R.= (Randy); Goodrich-Mahoney, John W.; Wisniewski, Jan R.; Wisniewski, Joe

1997-01-01

Management techniques used to control vegetation along a new 8.5 km- (5.3 mile) long powerline right-of-way located at Patuxent Research Refuge are being evaluated to identify changes in habitat that affect wildlife. Techniques include: complete mow, strip mow, low volume foliar spray, selective basal spray, and tree topping. One hundred and one bird species were recorded during line transect sampling along the right-of-way. The eastern towhee had the highest frequency of occurrence followed by the field sparrow and the common yellowthroat. The field sparrow had the highest numbers per visit followed by the eastern towhee and eastern bluebird. Fifteen species were recorded in numbers greater than ten individuals per visit in at least one season of the year. Nine species of mammals were trapped in live traps during the study and four other mammal species were observed but not captured. Twelve species of amphibians and six species of reptiles were trapped in pitfall or funnel traps. Differences in the distribution of species seemed to be related to the physical and hydrological features of the right-of-way. Although no major differences in the distribution of wildlife species resulted from the vegetation management, differences are expected in the future as vegetation differences become more pronounced. Data from this study will be of value to resource managers attempting to provide optimal habitat for biodiversity.

Surgical management of anomalous pulmonary venous connection to the superior vena cava - early results

PubMed Central

Chandra, Dinesh; Gupta, Anubhav; Nath, Ranjit K.; kazmi, Aamir; Grover, Vijay; Gupta, Vijay K.

2013-01-01

Background The anatomical variability in patients with anomalous pulmonary venous connection to superior vena cava presents a surgical challenge. The problem is further compounded by the common occurrence of postoperative complications like arrhythmias and obstruction of the superior vena cava or pulmonary veins. We present our experience of managing this subset using the two patch and Warden's techniques. Patients and methods Between June 2011 and September 2012, 7 patients with APVC to the SVC were operated in our institute. After delineating the anatomy, five of them had a two patch repair and two were managed with Warden's technique. Results There was no in-hospital mortality or early mortality over a mean follow-up of 9.66 ± 3.88 months (range 6–15 months). All the patients on follow-up had unobstructed pulmonary venous and SVC drainage on echocardiography and all of them were in normal sinus rhythm. Conclusions Anomalous pulmonary venous connection to superior vena cava is a challenging subset of patients in whom the surgical management needs to be individualized. The detailed anatomy must be delineated using echocardiography with or without CT angiography before deciding the surgical plan. This entity can be repaired with excellent immediate and early results. However, these patients must be closely followed up for complications like systemic and pulmonary venous obstruction and sinus node dysfunction. PMID:24206880

Effects of scale of movement, detection probability, and true population density on common methods of estimating population density

DOE PAGES

Keiter, David A.; Davis, Amy J.; Rhodes, Olin E.; ...

2017-08-25

Knowledge of population density is necessary for effective management and conservation of wildlife, yet rarely are estimators compared in their robustness to effects of ecological and observational processes, which can greatly influence accuracy and precision of density estimates. For this study, we simulate biological and observational processes using empirical data to assess effects of animal scale of movement, true population density, and probability of detection on common density estimators. We also apply common data collection and analytical techniques in the field and evaluate their ability to estimate density of a globally widespread species. We find that animal scale of movementmore » had the greatest impact on accuracy of estimators, although all estimators suffered reduced performance when detection probability was low, and we provide recommendations as to when each field and analytical technique is most appropriately employed. The large influence of scale of movement on estimator accuracy emphasizes the importance of effective post-hoc calculation of area sampled or use of methods that implicitly account for spatial variation. In particular, scale of movement impacted estimators substantially, such that area covered and spacing of detectors (e.g. cameras, traps, etc.) must reflect movement characteristics of the focal species to reduce bias in estimates of movement and thus density.« less

Effects of scale of movement, detection probability, and true population density on common methods of estimating population density

DOE Office of Scientific and Technical Information (OSTI.GOV)

Keiter, David A.; Davis, Amy J.; Rhodes, Olin E.

Knowledge of population density is necessary for effective management and conservation of wildlife, yet rarely are estimators compared in their robustness to effects of ecological and observational processes, which can greatly influence accuracy and precision of density estimates. For this study, we simulate biological and observational processes using empirical data to assess effects of animal scale of movement, true population density, and probability of detection on common density estimators. We also apply common data collection and analytical techniques in the field and evaluate their ability to estimate density of a globally widespread species. We find that animal scale of movementmore » had the greatest impact on accuracy of estimators, although all estimators suffered reduced performance when detection probability was low, and we provide recommendations as to when each field and analytical technique is most appropriately employed. The large influence of scale of movement on estimator accuracy emphasizes the importance of effective post-hoc calculation of area sampled or use of methods that implicitly account for spatial variation. In particular, scale of movement impacted estimators substantially, such that area covered and spacing of detectors (e.g. cameras, traps, etc.) must reflect movement characteristics of the focal species to reduce bias in estimates of movement and thus density.« less

MR Imaging Applications in Mild Traumatic Brain Injury: An Imaging Update

PubMed Central

Wu, Xin; Kirov, Ivan I.; Gonen, Oded; Ge, Yulin; Grossman, Robert I.

2016-01-01

Mild traumatic brain injury (mTBI), also commonly referred to as concussion, affects millions of Americans annually. Although computed tomography is the first-line imaging technique for all traumatic brain injury, it is incapable of providing long-term prognostic information in mTBI. In the past decade, the amount of research related to magnetic resonance (MR) imaging of mTBI has grown exponentially, partly due to development of novel analytical methods, which are applied to a variety of MR techniques. Here, evidence of subtle brain changes in mTBI as revealed by these techniques, which are not demonstrable by conventional imaging, will be reviewed. These changes can be considered in three main categories of brain structure, function, and metabolism. Macrostructural and microstructural changes have been revealed with three-dimensional MR imaging, susceptibility-weighted imaging, diffusion-weighted imaging, and higher order diffusion imaging. Functional abnormalities have been described with both task-mediated and resting-state blood oxygen level–dependent functional MR imaging. Metabolic changes suggesting neuronal injury have been demonstrated with MR spectroscopy. These findings improve understanding of the true impact of mTBI and its pathogenesis. Further investigation may eventually lead to improved diagnosis, prognosis, and management of this common and costly condition. © RSNA, 2016 PMID:27183405

The Influence of Proximity to a National Forest on Emotions and Fire-Management Decisions

NASA Astrophysics Data System (ADS)

Vining, Joanne; Merrick, Melinda S.

2008-02-01

Because American national forests are managed for all citizens, it is important that researchers explore the differences and similarities between citizens living both near and far from publicly managed land. We surveyed residents living at various distances from nationally managed land to collect resident perceptions of different forest fire-management techniques, to determine public preferences for these techniques, and to examine the motivations behind these preferences. Participants both close to and far away from national forests tended to favor a multipronged approach to fire management by preferring the use of a combination of two or more fire-management techniques. There were no significant differences by proximity in participants’ self-rated emotions, types of fire-management techniques preferred, or the reasons and rationales for their preferred fire-management technique(s), indicating that the proximity variable may not be as significant as previously thought.

The influence of proximity to a national forest on emotions and fire-management decisions.

PubMed

Vining, Joanne; Merrick, Melinda S

2008-02-01

Because American national forests are managed for all citizens, it is important that researchers explore the differences and similarities between citizens living both near and far from publicly managed land. We surveyed residents living at various distances from nationally managed land to collect resident perceptions of different forest fire-management techniques, to determine public preferences for these techniques, and to examine the motivations behind these preferences. Participants both close to and far away from national forests tended to favor a multipronged approach to fire management by preferring the use of a combination of two or more fire-management techniques. There were no significant differences by proximity in participants' self-rated emotions, types of fire-management techniques preferred, or the reasons and rationales for their preferred fire-management technique(s), indicating that the proximity variable may not be as significant as previously thought.

Lateral Patellar Instability in the Skeletally Mature Patient: Evaluation and Surgical Management.

PubMed

Diduch, David R; Kandil, Abdurrahman; Burrus, M Tyrrell

2018-05-18

Lateral patellar instability is a common disease process that affects all types of patients. Depending on the patient's anatomy and the results of preoperative imaging, surgical management options include medial patellofemoral ligament reconstruction, tibial tubercle osteotomy, and sulcus-deepening trochleoplasty. Medial patellofemoral ligament reconstruction or repair is useful for almost all patients, whereas tibial tubercle osteotomy is helpful to correct a lateralized tibial tubercle and the associated elevated lateral pull of the extensor mechanism. For a select subset of patients with severe trochlear dysplasia, a sulcus-deepening trochleoplasty can be a useful option to prevent future patellar instability. Many technical considerations exist for each procedure, and in most situations, no consensus exists to direct surgeons on the superior technique.

Cutaneous Scar Prevention and Management

PubMed Central

Al-Shaqsi, Sultan; Al-Bulushi, Taimoor

2016-01-01

Cutaneous scarring is common after trauma, surgery and infection and occurs when normal skin tissue is replaced by fibroblastic tissue during the healing process. The pathophysiology of scar formation is not yet fully understood, although the degree of tension across the wound edges and the speed of cell growth are believed to play central roles. Prevention of scars is essential and can be achieved by attention to surgical techniques and the use of measures to reduce cell growth. Grading and classifying scars is important to determine available treatment strategies. This article presents an overview of the current therapies available for the prevention and treatment of scars. It is intended to be a practical guide for surgeons and other health professionals involved with and interested in scar management. PMID:26909210

Pediatric Dysphagia: Physiology, Assessment, and Management.

PubMed

Dodrill, Pamela; Gosa, Memorie M

2015-01-01

Infancy and childhood represent a time of unparalleled physical growth and cognitive development. In order for infants and children to reach their linear and neurological growth potential, they must be able to reliably and safely consume sufficient energy and nutrients. Swallowing difficulties (dysphagia) in pediatric populations can have a detrimental effect on dietary intake and, thus, growth and development. As a result, it is imperative to accurately identify and appropriately manage dysphagia in pediatric populations. This article provides an overview of dysphagia in children, as well as common causes of childhood swallowing difficulties, populations at risk for pediatric dysphagia, techniques used to assess swallowing in pediatric patients, and the current treatment options available for infants and children with dysphagia. © 2015 S. Karger AG, Basel.

Surgical management of abnormal uterine bleeding in fertile age women.

PubMed

Finco, Andrea; Centini, Gabriele; Lazzeri, Lucia; Zupi, Errico

2015-07-01

Abnormal uterine bleeding is a common gynecological disease and represents one of the most frequent reasons for hospital admission to a specialist unit, often requiring further surgical treatment. Following the so-called PALM-COEIN system we will attempt to further clarify the surgical treatments available today. The first group (PALM) is characterized by structural lesions, which may be more appropriately treated by means of surgical management. Although hysterectomy remains the definitive and decisive choice, there are many alternative techniques available. These minimally invasive procedures offer the opportunity for a more conservative approach. Precise and accurate counseling facilitates better patient selection, based on the patient's desires, age and disease type, allowing treatment to be individually tailored to each woman.

Hemoptysis.

PubMed

Corder, Robert

2003-05-01

Hemoptysis is a common complaint the emergency physician encounters. Most cases are minor and treatable or self-limited. In many cases a cause is never determined. Massive hemoptysis is an occasional occurrence that must be assessed and managed swiftly. The initial approach is no different than that for any bleeding or respiratory or hemodynamically unstable patient. The emergency physician must stabilize, localize, and stop bleeding, and include required specialists to achieve that purpose. The management suggestions presented in this article are simplistic. The emergence of improved CT technology and new bronchoscopic and angiographic techniques has provided safe and effective alternatives to surgery for many causes of hemoptysis. Surgery, however, continues to be the treatment of choice for some. Being familiar with the broad list of causes is imperative to keeping an approach organized.

Gamification in Stress Management Apps: A Critical App Review

PubMed Central

Christmann, Corinna A; Bleser, Gabriele

2017-01-01

Background In today’s society, stress is more and more often a cause of disease. This makes stress management an important target of behavior change programs. Gamification has been suggested as one way to support health behavior change. However, it remains unclear to which extend available gamification techniques are integrated in stress management apps, and if their occurrence is linked to the use of elements from behavior change theory. Objective The aim of this study was to investigate the use of gamification techniques in stress management apps and the cooccurrence of these techniques with evidence-based stress management methods and behavior change techniques. Methods A total of 62 stress management apps from the Google Play Store were reviewed on their inclusion of 17 gamification techniques, 15 stress management methods, and 26 behavior change techniques. For this purpose, an extended taxonomy of gamification techniques was constructed and applied by 2 trained, independent raters. Results Interrater-reliability was high, with agreement coefficient (AC)=.97. Results show an average of 0.5 gamification techniques for the tested apps and reveal no correlations between the use of gamification techniques and behavior change techniques (r=.17, P=.20), or stress management methods (r=.14, P=.26). Conclusions This leads to the conclusion that designers of stress management apps do not use gamification techniques to influence the user’s behaviors and reactions. Moreover, app designers do not exploit the potential of combining gamification techniques with behavior change theory. PMID:28592397

A technique for estimating seed production of common moist soil plants

USGS Publications Warehouse

Laubhan, Murray K.

1992-01-01

Seeds of native herbaceous vegetation adapted to germination in hydric soils (i.e., moist-soil plants) provide waterfowl with nutritional resources including essential amino acids, vitamins, and minerals that occur only in small amounts or are absent in other foods. These elements are essential for waterfowl to successfully complete aspects of the annual cycle such as molt and reproduction. Moist-soil vegetation also has the advantages of consistent production of foods across years with varying water availability, low management costs, high tolerance to diverse environmental conditions, and low deterioration rates of seeds after flooding. The amount of seed produced differs among plant species and varies annually depending on environmental conditions and management practices. Further, many moist-soil impoundments contain diverse vegetation, and seed production by a particular plant species usually is not uniform across an entire unit. Consequently, estimating total seed production within an impoundment is extremely difficult. The chemical composition of seeds also varies among plant species. For example, beggartick seeds contain high amounts of protein but only an intermediate amount of minerals. In contrast, barnyardgrass is a good source of minerals but is low in protein. Because of these differences, it is necessary to know the amount of seed produced by each plant species if the nutritional resources provided in an impoundment are to be estimated. The following technique for estimating seed production takes into account the variation resulting from different environmental conditions and management practices as well as differences in the amount of seed produced by various plant species. The technique was developed to provide resource managers with the ability to make quick and reliable estimates of seed production. Although on-site information must be collected, the amount of field time required is small (i.e., about 1 min per sample); sampling normally is accomplished on an area within a few days. Estimates of seed production derived with this technique are used, in combination with other available information, to determine the potential number of waterfowl use-days available and to evaluate the effects of various management strategies on a particular site.

Crisis Management Systems: A Case Study for Aspect-Oriented Modeling

NASA Astrophysics Data System (ADS)

Kienzle, Jörg; Guelfi, Nicolas; Mustafiz, Sadaf

The intent of this document is to define a common case study for the aspect-oriented modeling research community. The domain of the case study is crisis management systems, i.e., systems that help in identifying, assessing, and handling a crisis situation by orchestrating the communication between all parties involved in handling the crisis, by allocating and managing resources, and by providing access to relevant crisis-related information to authorized users. This document contains informal requirements of crisis management systems (CMSs) in general, a feature model for a CMS product line, use case models for a car crash CMS (CCCMS), a domain model for the CCCMS, an informal physical architecture description of the CCCMS, as well as some design models of a possible object-oriented implementation of parts of the CCCMS backend. AOM researchers who want to demonstrate the power of their AOM approach or technique can hence apply the approach at the most appropriate level of abstraction.

Clarity: An Open Source Manager for Laboratory Automation

PubMed Central

Delaney, Nigel F.; Echenique, José Rojas; Marx, Christopher J.

2013-01-01

Software to manage automated laboratories interfaces with hardware instruments, gives users a way to specify experimental protocols, and schedules activities to avoid hardware conflicts. In addition to these basics, modern laboratories need software that can run multiple different protocols in parallel and that can be easily extended to interface with a constantly growing diversity of techniques and instruments. We present Clarity: a laboratory automation manager that is hardware agnostic, portable, extensible and open source. Clarity provides critical features including remote monitoring, robust error reporting by phone or email, and full state recovery in the event of a system crash. We discuss the basic organization of Clarity; demonstrate an example of its implementation for the automated analysis of bacterial growth; and describe how the program can be extended to manage new hardware. Clarity is mature; well documented; actively developed; written in C# for the Common Language Infrastructure; and is free and open source software. These advantages set Clarity apart from currently available laboratory automation programs. PMID:23032169

A restatement of the natural science evidence concerning catchment-based `natural' flood management in the UK

NASA Astrophysics Data System (ADS)

Dadson, Simon J.; Hall, Jim W.; Murgatroyd, Anna; Acreman, Mike; Bates, Paul; Beven, Keith; Heathwaite, Louise; Holden, Joseph; Holman, Ian P.; Lane, Stuart N.; O'Connell, Enda; Penning-Rowsell, Edmund; Reynard, Nick; Sear, David; Thorne, Colin; Wilby, Rob

2017-03-01

Flooding is a very costly natural hazard in the UK and is expected to increase further under future climate change scenarios. Flood defences are commonly deployed to protect communities and property from flooding, but in recent years flood management policy has looked towards solutions that seek to mitigate flood risk at flood-prone sites through targeted interventions throughout the catchment, sometimes using techniques which involve working with natural processes. This paper describes a project to provide a succinct summary of the natural science evidence base concerning the effectiveness of catchment-based `natural' flood management in the UK. The evidence summary is designed to be read by an informed but not technically specialist audience. Each evidence statement is placed into one of four categories describing the nature of the underlying information. The evidence summary forms the appendix to this paper and an annotated bibliography is provided in the electronic supplementary material.

Successful management of Barth syndrome: a systematic review highlighting the importance of a flexible and multidisciplinary approach.

PubMed

Reynolds, Stacey

2015-01-01

This review describes and summarizes the available evidence related to the treatment and management of Barth syndrome. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards were used to identify articles published between December 2004 and January 2015. The Cochrane Population, Intervention, Control, Outcome, Study Design (PICOS) approach was used to guide the article selection and evaluation process. Of the 128 articles screened, 28 articles matched the systematic review inclusion criteria. The results of this review indicate the need for a flexible and multidisciplinary approach to manage the symptoms most commonly associated with Barth syndrome. It is recommended that a comprehensive care team should include individuals with Barth syndrome, their family members and caregivers, as well as medical, rehabilitative, nutritional, psychological, and educational professionals. The evidence for specific treatments, therapies, and techniques for individuals with Barth syndrome is currently lacking in both quality and quantity.

A restatement of the natural science evidence concerning catchment-based 'natural' flood management in the UK.

PubMed

Dadson, Simon J; Hall, Jim W; Murgatroyd, Anna; Acreman, Mike; Bates, Paul; Beven, Keith; Heathwaite, Louise; Holden, Joseph; Holman, Ian P; Lane, Stuart N; O'Connell, Enda; Penning-Rowsell, Edmund; Reynard, Nick; Sear, David; Thorne, Colin; Wilby, Rob

2017-03-01

Flooding is a very costly natural hazard in the UK and is expected to increase further under future climate change scenarios. Flood defences are commonly deployed to protect communities and property from flooding, but in recent years flood management policy has looked towards solutions that seek to mitigate flood risk at flood-prone sites through targeted interventions throughout the catchment, sometimes using techniques which involve working with natural processes. This paper describes a project to provide a succinct summary of the natural science evidence base concerning the effectiveness of catchment-based 'natural' flood management in the UK. The evidence summary is designed to be read by an informed but not technically specialist audience. Each evidence statement is placed into one of four categories describing the nature of the underlying information. The evidence summary forms the appendix to this paper and an annotated bibliography is provided in the electronic supplementary material.

Agile Data Management with the Global Change Information System

NASA Astrophysics Data System (ADS)

Duggan, B.; Aulenbach, S.; Tilmes, C.; Goldstein, J.

2013-12-01

We describe experiences applying agile software development techniques to the realm of data management during the development of the Global Change Information System (GCIS), a web service and API for authoritative global change information under development by the US Global Change Research Program. Some of the challenges during system design and implementation have been : (1) balancing the need for a rigorous mechanism for ensuring information quality with the realities of large data sets whose contents are often in flux, (2) utilizing existing data to inform decisions about the scope and nature of new data, and (3) continuously incorporating new knowledge and concepts into a relational data model. The workflow for managing the content of the system has much in common with the development of the system itself. We examine various aspects of agile software development and discuss whether or how we have been able to use them for data curation as well as software development.

Data sharing and intellectual property in a genomic epidemiology network: policies for large-scale research collaboration.

PubMed Central

Chokshi, Dave A.; Parker, Michael; Kwiatkowski, Dominic P.

2006-01-01

Genomic epidemiology is a field of research that seeks to improve the prevention and management of common diseases through an understanding of their molecular origins. It involves studying thousands of individuals, often from different populations, with exacting techniques. The scale and complexity of such research has required the formation of research consortia. Members of these consortia need to agree on policies for managing shared resources and handling genetic data. Here we consider data-sharing and intellectual property policies for an international research consortium working on the genomic epidemiology of malaria. We outline specific guidelines governing how samples and data are transferred among its members; how results are released into the public domain; when to seek protection for intellectual property; and how intellectual property should be managed. We outline some pragmatic solutions founded on the basic principles of promoting innovation and access. PMID:16710548

Endotherapy for severe and complete pharyngo-esophageal post-radiation stenosis using wires, balloons and pharyngo-esophageal puncture (PEP) (with videos).

PubMed

Tang, Shou-jiang; Singh, Shailender; Truelson, John M

2010-01-01

Pharyngo-esophageal stenosis (PES) and upper esophageal stricture are common in patients who receive radiation therapy for laryngeal and hypopharyngeal cancers. In severe or complete stenosis, the patients generally have complete dysphagia with inability to swallow their saliva. Diagnostic and therapeutic esophagogastroduodenoscopy (EGD) plays an important role in investigating the dysphagia and in managing the underlying stenosis. We translate endoscopic retrograde cholangiopancreatography (ERCP) techniques and skills in approaching pancreaticobiliary obstruction in the management of severe and complete PES. We select and report three cases of severe or complete PES in which flexible endoscopic therapy was successfully provided by using fluoroscopy, ERCP wire guides, endoscopic balloons, and by performing pharyngo-esophageal puncture (PEP). We propose the term PEP in managing complete PES. We believe this approach can offer safety and efficiency with very high success rate.

Risk of urinary retention after nerve-sparing surgery for deep infiltrating endometriosis: A systematic review and meta-analysis.

PubMed

de Resende, José Anacleto Dutra; Cavalini, Luciana Tricai; Crispi, Claudio Peixoto; de Freitas Fonseca, Marlon

2017-01-01

Recently, nerve-sparing (NS) techniques have been incorporated in surgeries for deep infiltrating endometriosis (DIE) to prevent urinary complications. Our aim was to perform a systematic review and meta-analysis to assess the risk of urinary retention after NS surgery for DIE compared with classical (non-NS) techniques. Following the MOOSE guidelines for systematic reviews of observational studies, data were collected from published research articles that compared NS techniques with non-NS techniques in DIE surgery, with regard to post-operative urinary complications. randomized clinical trials, intervention or observational (cohort and case-control) studies assessing women who underwent surgery for painful DIE. cancer surgery and women submitted to bladder or ureteral resections. The respective relative risks (RR) and 95% confidence intervals (CI) were extracted and a forest plot was generated to show individual and combined estimates. Preliminarily, 1,270 potentially relevant studies were identified from which four studies were selected. A meta-analysis was performed to assess the risk of urinary retention at discharge and 90 days after surgery. We found a common RR of 0.19 [95%CI: 0.03-1.17; (I 2  = 50.20%; P = 0.09)] for need of self-catheterization at discharge in the NS group in relation to the conventional technique. Based on two studies, common RR for persistent urinary retention (after 90 days) was 0.16 [95%CI: 0.03-0.84]. Our results suggest significant advantages of the NS technique when considering the RR of persistent urinary retention. Controlled studies evaluating the best approach to manage the urinary tract after complex surgery for DIE are needed. Neurourol. Urodynam. 36:57-61, 2017. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.

Plantar fasciitis

PubMed Central

Cutts, S; Obi, N; Pasapula, C; Chan, W

2012-01-01

INTRODUCTION In this article we look at the aetiology of plantar fasciitis, the other common differentials for heel pain and the evidence available to support each of the major management options. We also review the literature and discuss the condition. METHODS A literature search was performed using PubMed and MEDLINE®. The following keywords were used, singly or in combination: ‘plantar fasciitis’, ‘plantar heel pain’, ‘heel spur’. To maximise the search, backward chaining of reference lists from retrieved papers was also undertaken. FINDINGS Plantar fasciitis is a common and often disabling condition. Because the natural history of plantar fasciitis is not understood, it is difficult to distinguish between those patients who recover spontaneously and those who respond to formal treatment. Surgical release of the plantar fascia is effective in the small proportion of patients who do not respond to conservative measures. New techniques such as endoscopic plantar release and extracorporeal shockwave therapy may have a role but the limited availability of equipment and skills means that most patients will continue to be treated by more traditional techniques. PMID:23131221

Effectiveness of streambank-stabilization techniques along the Kenai River, Alaska

USGS Publications Warehouse

Dorava, Joseph M.

1999-01-01

The Kenai River in southcentral Alaska is the State's most popular sport fishery and an economically important salmon river that generates as much as $70 million annually. Boatwake-induced streambank erosion and the associated damage to riparian and riverine habitat present a potential threat to this fishery. Bank-stabilization techniques commonly in use along the Kenai River were selected for evaluation of their effectiveness at attenuating boatwakes and retarding streambank erosion. Spruce trees cabled to the bank and biodegradable man-made logs (called 'bio-logs') pinned to the bank were tested because they are commonly used techniques along the river. These two techniques were compared for their ability to reduce wake heights that strike the bank and to reduce erosion of bank material, as well as for the amount and quality of habitat they provide for juvenile chinook salmon. Additionally, an engineered bank-stabilization project was evaluated because this method of bank protection is being encouraged by managers of the river. During a test that included 20 controlled boat passes, the spruce trees and the bio-log provided a similar reduction in boatwake height and bank erosion; however, the spruce trees provided a greater amount of protective habitat than the bio-log. The engineered bank-stabilization project eroded less during nine boat passes and provided more protective cover than the adjacent unprotected natural bank. Features of the bank-stabilization techniques, such as tree limbs and willow plantings that extended into the water from the bank, attenuated the boatwakes, which helped reduce erosion. These features also provided protective cover to juvenile salmon.

Mandibular fractures in children: analysis of 61 cases and review of the literature.

PubMed

Glazer, Michael; Joshua, Ben Zion; Woldenberg, Yitzhak; Bodner, Lipa

2011-01-01

The purpose was to evaluate the incidence, etiology, site and patterns, management and treatment methods, and outcome of pediatric patients with mandibular fractures. Pediatric patients (1.5-16 years old) with mandibular fractures, treated at the Soroka University Medical Center were included in the study. Age, gender, etiology, site and type of fracture, associated injuries, mode of treatment, outcome, complications, and follow up were evaluated. The cases were divided into 3 age groups: Group A: 1.5-5 years, Group B: 6-11 years, and Group C: 12-16 years. Sixty one patients were included in the study. The male to female ratio was 2:1. Motor vehicle accident was the most common cause. Associated trauma was more common in young children. The condyle was involved in 54% of the fractures. Closed reduction and intermaxillary fixation was the most common treatment used. Complications were rare. Management of mandibular fracture in the pediatric age group is a challenge. The anatomical complexity of the developing mandible and teeth strongly suggest the use of surgical techniques that are different from those routinely used in adults. The conservative approach is recommended. Whenever possible closed reduction should be the treatment of choice. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Chronic occupational repetitive strain injury.

PubMed

O'Neil, B A; Forsythe, M E; Stanish, W D

2001-02-01

To review common repetitive strain injuries (RSIs) that occur in the workplace, emphasizing diagnosis, treatment, and etiology of these conditions. A MEDLINE search from January 1966 to June 1999 focused on articles published since 1990 because RSIs are relatively new diagnoses. MeSH headings that were explored using the thesaurus included "cumulative trauma disorder," "overuse injury," and "repetitive strain injury." The search was limited to English articles only, and preference was given to randomized controlled trials. Repetitive strain injuries result from repeated stress to the body's soft tissue structures including muscles, tendons, and nerves. They often occur in patients who perform repetitive movements either in their jobs or in extracurricular activities. Common RSIs include tendon-related disorders, such as rotator cuff tendonitis, and peripheral nerve entrapment disorders, such as carpal tunnel syndrome. A careful history and physical examination often lead to the diagnosis, but newer imaging techniques, such as magnetic resonance imaging and ultrasound, can help in refractory cases. Conservative management with medication, physiotherapy, or bracing is the mainstay of treatment. Surgery is reserved for cases that do not respond to treatment. Repetitive strain injury is common; primary care physicians must establish a diagnosis and, more importantly, its relationship to occupation. Treatment can be offered by family physicians who refer to specialists for cases refractory to conservative management.

A combined randomised and observational study of surgery for fractures in the distal radius in the elderly (CROSSFIRE)—a study protocol

PubMed Central

Harris, Ian, A; Naylor, Justine, M; Buchbinder, Rachelle; Ivers, Rebecca; Balogh, Zsolt; Smith, Paul; Mittal, Rajat; Xuan, Wei; Howard, Kirsten; Vafa, Arezoo; Yates, Piers; Rieger, Bertram; Smith, Geoff; Elkinson, Ilia; Kim, Woosung; Chehade, Mellick; Sungaran, Jai; Latendresse, Kim; Wong, James; Viswanathan, Sameer; Richardson, Martin; Shrestha, Kush; Drobetz, Herwig; Tran, Phong; Loveridge, Jeremy; Page, Richard; Hau, Raphael; Bingham, Roger; Mulford, Jonathan; Incoll, Ian

2017-01-01

Fractures of the distal radius are common and occur in all age groups. The incidence is high in older populations due to osteoporosis and increased falls risk. Considerable practice variation exists in the management of distal radius fractures in older patients ranging from closed reduction with cast immobilisation to open reduction with plate fixation. Plating is currently the most common surgical treatment. While there is evidence showing no significant advantage for some forms of surgical fixation over conservative treatment, and no difference between different surgical techniques, there is a lack of evidence comparing two of the most common treatments used: closed reduction and casting versus plating. Surgical management involves significant costs and risks compared with conservative management. High-level evidence is required to address practice variation, justify costs and to provide the best clinical outcomes for patients. Methods and analysis This pragmatic, multicentre randomised comparative effectiveness trial aims to determine whether plating leads to better pain and function and is more cost-effective than closed reduction and casting of displaced distal radius fractures in adults aged 60 years and older. The trial will compare the two techniques but will also follow consenting patients who are unwilling to be randomised in a separate, observational cohort. Inclusion of non-randomised patients addresses selection bias, provides practice and outcome insights about standard care, and improves the generalisability of the results from the randomised trial. Ethics and dissemination CROSSFIRE(Combined Randomised and Observational Study of Surgery for Fractures In the distal Radius in the Elderly) was reviewed and approved by The Hunter New England HREC (HNEHREC Reference No: 16/02/17/3.04). The results of the trial will be published in a peer-reviewed journal and will be disseminated via various forms of media. Results will be incorporated in clinical recommendations and practice guidelines produced by professional bodies. Registration CROSSFIRE has been registered with the Australian and New Zealand Clinical Trials Registry (ANZCTR: ACTRN12616000969460). PMID:28645976

A combined randomised and observational study of surgery for fractures in the distal radius in the elderly (CROSSFIRE)-a study protocol.

PubMed

Harris, Ian A; Naylor, Justine M; Lawson, Andrew; Buchbinder, Rachelle; Ivers, Rebecca; Balogh, Zsolt; Smith, Paul; Mittal, Rajat; Xuan, Wei; Howard, Kirsten; Vafa, Arezoo; Yates, Piers; Rieger, Bertram; Smith, Geoff; Elkinson, Ilia; Kim, Woosung; Chehade, Mellick; Sungaran, Jai; Latendresse, Kim; Wong, James; Viswanathan, Sameer; Richardson, Martin; Shrestha, Kush; Drobetz, Herwig; Tran, Phong; Loveridge, Jeremy; Page, Richard; Hau, Raphael; Bingham, Roger; Mulford, Jonathan; Incoll, Ian

2017-06-23

Fractures of the distal radius are common and occur in all age groups. The incidence is high in older populations due to osteoporosis and increased falls risk. Considerable practice variation exists in the management of distal radius fractures in older patients ranging from closed reduction with cast immobilisation to open reduction with plate fixation. Plating is currently the most common surgical treatment. While there is evidence showing no significant advantage for some forms of surgical fixation over conservative treatment, and no difference between different surgical techniques, there is a lack of evidence comparing two of the most common treatments used: closed reduction and casting versus plating. Surgical management involves significant costs and risks compared with conservative management. High-level evidence is required to address practice variation, justify costs and to provide the best clinical outcomes for patients. This pragmatic, multicentre randomised comparative effectiveness trial aims to determine whether plating leads to better pain and function and is more cost-effective than closed reduction and casting of displaced distal radius fractures in adults aged 60 years and older. The trial will compare the two techniques but will also follow consenting patients who are unwilling to be randomised in a separate, observational cohort. Inclusion of non-randomised patients addresses selection bias, provides practice and outcome insights about standard care, and improves the generalisability of the results from the randomised trial. CROSSFIRE(Combined Randomised and Observational Study of Surgery for Fractures In the distal Radius in the Elderly) was reviewed and approved by The Hunter New England HREC (HNEHREC Reference No: 16/02/17/3.04). The results of the trial will be published in a peer-reviewed journal and will be disseminated via various forms of media. Results will be incorporated in clinical recommendations and practice guidelines produced by professional bodies. CROSSFIRE has been registered with the Australian and New Zealand Clinical Trials Registry (ANZCTR: ACTRN12616000969460). © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Expanding the Use of Time-Based Metering: Multi-Center Traffic Management Advisor

NASA Technical Reports Server (NTRS)

Landry, Steven J.; Farley, Todd; Hoang, Ty

2005-01-01

Time-based metering is an efficient air traffic management alternative to the more common practice of distance-based metering (or "miles-in-trail spacing"). Despite having demonstrated significant operational benefit to airspace users and service providers, time-based metering is used in the United States for arrivals to just nine airports and is not used at all for non-arrival traffic flows. The Multi-Center Traffic Management Advisor promises to bring time-based metering into the mainstream of air traffic management techniques. Not constrained to operate solely on arrival traffic, Multi-Center Traffic Management Advisor is flexible enough to work in highly congested or heavily partitioned airspace for any and all traffic flows in a region. This broader and more general application of time-based metering is expected to bring the operational benefits of time-based metering to a much wider pool of beneficiaries than is possible with existing technology. It also promises to facilitate more collaborative traffic management on a regional basis. This paper focuses on the operational concept of the Multi-Center Traffic Management Advisor, touching also on its system architecture, field test results, and prospects for near-term deployment to the United States National Airspace System.

Extending battery life: A low-cost practical diagnostic technique for lithium-ion batteries

NASA Astrophysics Data System (ADS)

Merla, Yu; Wu, Billy; Yufit, Vladimir; Brandon, Nigel P.; Martinez-Botas, Ricardo F.; Offer, Gregory J.

2016-11-01

Modern applications of lithium-ion batteries such as smartphones, hybrid & electric vehicles and grid scale electricity storage demand long lifetime and high performance which typically makes them the limiting factor in a system. Understanding the state-of-health during operation is important in order to optimise for long term durability and performance. However, this requires accurate in-operando diagnostic techniques that are cost effective and practical. We present a novel diagnosis method based upon differential thermal voltammetry demonstrated on a battery pack made from commercial lithium-ion cells where one cell was deliberately aged prior to experiment. The cells were in parallel whilst being thermally managed with forced air convection. We show for the first time, a diagnosis method capable of quantitatively determining the state-of-health of four cells simultaneously by only using temperature and voltage readings for both charge and discharge. Measurements are achieved using low-cost thermocouples and a single voltage measurement at a frequency of 1 Hz, demonstrating the feasibility of implementing this approach on real world battery management systems. The technique could be particularly useful under charge when constant current or constant power is common, this therefore should be of significant interest to all lithium-ion battery users.

Environmental Electrokinetics for a sustainable subsurface.

PubMed

Lima, A T; Hofmann, A; Reynolds, D; Ptacek, C J; Van Cappellen, P; Ottosen, L M; Pamukcu, S; Alshawabekh, A; O'Carroll, D M; Riis, C; Cox, E; Gent, D B; Landis, R; Wang, J; Chowdhury, A I A; Secord, E L; Sanchez-Hachair, A

2017-08-01

Soil and groundwater are key components in the sustainable management of the subsurface environment. Source contamination is one of its main threats and is commonly addressed using established remediation techniques such as in-situ chemical oxidation (ISCO), in-situ chemical reduction (ISCR; most notably using zero-valent iron [ZVI]), enhanced in-situ bioremediation (EISB), phytoremediation, soil-washing, pump-and-treat, soil vapour extraction (SVE), thermal treatment, and excavation and disposal. Decades of field applications have shown that these techniques can successfully treat or control contaminants in higher permeability subsurface materials such as sands, but achieve only limited success at sites where low permeability soils, such as silts and clays, prevail. Electrokinetics (EK), a soil remediation technique mostly recognized in in-situ treatment of low permeability soils, has, for the last decade, been combined with more conventional techniques and can significantly enhance the performance of several of these remediation technologies, including ISCO, ISCR, EISB and phytoremediation. Herein, we discuss the use of emerging EK techniques in tandem with conventional remediation techniques, to achieve improved remediation performance. Furthermore, we highlight new EK applications that may come to play a role in the sustainable treatment of the contaminated subsurface. Copyright © 2017 Elsevier Ltd. All rights reserved.

A Survey on Nickel Titanium Rotary Instruments and their Usage Techniques by Endodontists in India.

PubMed

Patil, Thimmanagowda N; Saraf, Prahlad A; Penukonda, Raghavendra; Vanaki, Sneha S; Kamatagi, Laxmikant

2017-05-01

The preference and usage of nickel titanium rotary instruments varies from individual to individual based on their technique, experience with the rotary systems and the clinical situation. Very limited information is available to explain the adoption of changing concepts with respect to nickel titanium rotary instruments pertaining to the endodontists in India. The aim of this study was to conduct a questionnaire survey to acquire the knowledge concerning different NiTi rotary instruments and their usage techniques by endodontists in India. A Survey questionnaire was designed which consisted of 32 questions regarding designation, demographics, experience with rotary instruments, usage of different file systems, usage techniques, frequency of reuse, occurrence of file fracture, reasons and their management was distributed by hand in the national postgraduate convention and also disseminated via electronic medium to 400 and 600 endodontists respectively. Information was collected from each individual to gain insight into the experiences and beliefs of endodontists concerning the new endodontic technology of rotary NiTi instrumentation based on their clinical experience with the rotary systems. The questions were designed to ascertain the problems, patterns of use and to identify areas of perceived or potential concern regarding the rotary instruments and the data acquired was statistically evaluated using Fisher's-exact test and the Chi-Square test. Overall 63.8% (638) endodontists responded. ProTaper was one of the most commonly used file system followed by M two and ProTaper Next. There was a significant co relation between the years of experience and the file re use frequency, preparation technique, file separation, management of file separation. A large number of Endodontists prefer to reuse the rotary NiTi instruments. As there was an increase in the experience, the incidence of file separation reduced with increasing number of re use frequency and with experience, the management of separated file was better.

A Survey on Nickel Titanium Rotary Instruments and their Usage Techniques by Endodontists in India

PubMed Central

Saraf, Prahlad A; Penukonda, Raghavendra; Vanaki, Sneha S; Kamatagi, Laxmikant

2017-01-01

Introduction The preference and usage of nickel titanium rotary instruments varies from individual to individual based on their technique, experience with the rotary systems and the clinical situation. Very limited information is available to explain the adoption of changing concepts with respect to nickel titanium rotary instruments pertaining to the endodontists in India. Aim The aim of this study was to conduct a questionnaire survey to acquire the knowledge concerning different NiTi rotary instruments and their usage techniques by endodontists in India. Materials and Methods A Survey questionnaire was designed which consisted of 32 questions regarding designation, demographics, experience with rotary instruments, usage of different file systems, usage techniques, frequency of reuse, occurrence of file fracture, reasons and their management was distributed by hand in the national postgraduate convention and also disseminated via electronic medium to 400 and 600 endodontists respectively. Information was collected from each individual to gain insight into the experiences and beliefs of endodontists concerning the new endodontic technology of rotary NiTi instrumentation based on their clinical experience with the rotary systems. The questions were designed to ascertain the problems, patterns of use and to identify areas of perceived or potential concern regarding the rotary instruments and the data acquired was statistically evaluated using Fisher’s-exact test and the Chi-Square test. Results Overall 63.8% (638) endodontists responded. ProTaper was one of the most commonly used file system followed by M two and ProTaper Next. There was a significant co relation between the years of experience and the file re use frequency, preparation technique, file separation, management of file separation. Conclusion A large number of Endodontists prefer to reuse the rotary NiTi instruments. As there was an increase in the experience, the incidence of file separation reduced with increasing number of re use frequency and with experience, the management of separated file was better. PMID:28658903

Medical undergraduates’ use of behaviour change talk: the example of facilitating weight management

PubMed Central

2013-01-01

Background Obesity, an increasing problem worldwide, is a leading cause of morbidity and mortality. Management principally requires lifestyle (i.e. behavioural) changes. An evidence-base exists of behaviour change techniques for weight loss; however, in routine practice doctors are often unsure about effective treatments and commonly use theoretically-unfounded communication strategies (e.g. information-giving). It is not known if communication skills teaching during undergraduate training adequately prepares future doctors to engage in effective behaviour change talk with patients. The aim of the study was to examine which behaviour change techniques medical undergraduates use to facilitate lifestyle adjustments in obese patients. Methods Forty-eight medical trainees in their clinical years of a UK medical school conducted two simulated consultations each. Both consultations involved an obese patient scenario where weight loss was indicated. Use of simulated patients (SPs) ensured standardisation of key variables (e.g. barriers to behaviour change). Presentation of scenario order was counterbalanced. Following each consultation, students assessed the techniques they perceived themselves to have used. SPs rated the extent to which they intended to make behavioural changes and why. Anonymised transcripts of the audiotaped consultations were coded by independent assessors, blind to student and SP ratings, using a validated behaviour change taxonomy. Results Students reported using a wide range of evidence-based techniques. In contrast, codings of observed communication behaviours were limited. SPs behavioural intention varied and a range of helpful elements of student’s communication were revealed. Conclusions Current skills-based communication programmes do not adequately prepare future doctors for the growing task of facilitating weight management. Students are able to generalise some communication skills to these encounters, but are over confident and have limited ability to use evidence-based theoretically informed techniques. They recognise this as a learning need. Educators will need to tackle the challenges of integrating theoretically informed and evidence based behaviour change talk within medical training. PMID:23347344

Stress Management Apps With Regard to Emotion-Focused Coping and Behavior Change Techniques: A Content Analysis

PubMed Central

Hoffmann, Alexandra; Bleser, Gabriele

2017-01-01

Background Chronic stress has been shown to be associated with disease. This link is not only direct but also indirect through harmful health behavior such as smoking or changing eating habits. The recent mHealth trend offers a new and promising approach to support the adoption and maintenance of appropriate stress management techniques. However, only few studies have dealt with the inclusion of evidence-based content within stress management apps for mobile phones. Objective The aim of this study was to evaluate stress management apps on the basis of a new taxonomy of effective emotion-focused stress management techniques and an established taxonomy of behavior change techniques. Methods Two trained and independent raters evaluated 62 free apps found in Google Play with regard to 26 behavior change and 15 emotion-focused stress management techniques in October 2015. Results The apps included an average of 4.3 behavior change techniques (SD 4.2) and 2.8 emotion-focused stress management techniques (SD 2.6). The behavior change technique score and stress management technique score were highly correlated (r=.82, P=.01). Conclusions The broad variation of different stress management strategies found in this sample of apps goes in line with those found in conventional stress management interventions and self-help literature. Moreover, this study provided a first step toward more detailed and standardized taxonomies, which can be used to investigate evidence-based content in stress management interventions and enable greater comparability between different intervention types. PMID:28232299

Gamification in Stress Management Apps: A Critical App Review.

PubMed

Hoffmann, Alexandra; Christmann, Corinna A; Bleser, Gabriele

2017-06-07

In today's society, stress is more and more often a cause of disease. This makes stress management an important target of behavior change programs. Gamification has been suggested as one way to support health behavior change. However, it remains unclear to which extend available gamification techniques are integrated in stress management apps, and if their occurrence is linked to the use of elements from behavior change theory. The aim of this study was to investigate the use of gamification techniques in stress management apps and the cooccurrence of these techniques with evidence-based stress management methods and behavior change techniques. A total of 62 stress management apps from the Google Play Store were reviewed on their inclusion of 17 gamification techniques, 15 stress management methods, and 26 behavior change techniques. For this purpose, an extended taxonomy of gamification techniques was constructed and applied by 2 trained, independent raters. Interrater-reliability was high, with agreement coefficient (AC)=.97. Results show an average of 0.5 gamification techniques for the tested apps and reveal no correlations between the use of gamification techniques and behavior change techniques (r=.17, P=.20), or stress management methods (r=.14, P=.26). This leads to the conclusion that designers of stress management apps do not use gamification techniques to influence the user's behaviors and reactions. Moreover, app designers do not exploit the potential of combining gamification techniques with behavior change theory. ©Alexandra Hoffmann, Corinna A Christmann, Gabriele Bleser. Originally published in JMIR Serious Games (http://games.jmir.org), 07.06.2017.

Nonampullary duodenal adenoma: Current understanding of its diagnosis, pathogenesis, and clinical management

PubMed Central

Lim, Chul-Hyun; Cho, Young-Seok

2016-01-01

Nonampullary duodenal adenomas are relatively common in familial adenomatous polyposis (FAP), but nonampullary sporadic duodenal adenomas (SDAs) are rare. Emerging evidence shows that duodenal adenomas, regardless of their anatomic location and whether they are sporadic or FAP-related, share morphologic and molecular features with colorectal adenomas. The available data suggest that duodenal adenomas develop to duodenal adenocarcinomas via similar mechanisms. The optimal approach for management of duodenal adenomas remains to be determined. The techniques for endoscopic resection of duodenal adenoma include snare polypectomy, endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), and argon plasma coagulation ablation. EMR may facilitate removal of large duodenal polyps. Although several studies have reported cases of successful ESD for duodenal adenomas, the procedure is technically difficult to perform safely because of the anatomical properties of the duodenum. Although current clinical practice recommends endoscopic resection of all large duodenal adenomas in patients with FAP, endoscopic treatment is usually insufficient to guarantee a polyp-free duodenum. Surgery is indicated for FAP patients with severe polyposis or nonampullary SDAs or FAP-related polyps not amenable to endoscopic resection. Further studies are needed to develop newer endoscopic techniques to guide diagnostic and therapeutic decisions for future management of nonampullary duodenal adenomas. PMID:26811631

Understanding fear and anxiety in patients at the time of an exacerbation of chronic obstructive pulmonary disease: a qualitative study

PubMed Central

Halpin, David; Hyland, Michael; Blake, Susan; Seamark, Clare; Pinnuck, Margaret; Ward, David; Whalley, Ben; Greaves, Colin; Hawkins, Adam

2015-01-01

Objectives To determine the importance of fear and anxiety at the time of an exacerbation of chronic obstructive pulmonary disease. To assess the influence of carers and health professionals on this fear and anxiety. Design A qualitative study to elicit the views of patients and their carers during a hospital admission for exacerbations of chronic obstructive pulmonary disease. Setting Interviews were conducted in a District General Hospital. Participants Twenty patients were interviewed shortly after admission to hospital with an exacerbation. Main outcome measures Key themes were identified using cross-sectional thematic analysis of transcripts where commonalities and differences were identified. Results Four themes emerged: panic and fear; anxiety management techniques used during an exacerbation; intervention from family members and carers; response to medical services. Conclusion Panic and fear are important emotions prior to admission. Many patients recognised the link between panic-fear and a worsening of symptoms, and some were able to use self-management techniques to reduce their panic-fear. Some relatives were seen as helping and others exacerbating the symptoms of panic-fear. The emergency services were seen as positive: providing reassurance and a sense of safety. How best to help patients with chronic obstructive pulmonary disease manage panic and fear remains a challenge. PMID:26664734

Understanding fear and anxiety in patients at the time of an exacerbation of chronic obstructive pulmonary disease: a qualitative study.

PubMed

Halpin, David; Hyland, Michael; Blake, Susan; Seamark, Clare; Pinnuck, Margaret; Ward, David; Whalley, Ben; Greaves, Colin; Hawkins, Adam; Seamark, David

2015-12-01

To determine the importance of fear and anxiety at the time of an exacerbation of chronic obstructive pulmonary disease. To assess the influence of carers and health professionals on this fear and anxiety. A qualitative study to elicit the views of patients and their carers during a hospital admission for exacerbations of chronic obstructive pulmonary disease. Interviews were conducted in a District General Hospital. Twenty patients were interviewed shortly after admission to hospital with an exacerbation. Key themes were identified using cross-sectional thematic analysis of transcripts where commonalities and differences were identified. Four themes emerged: panic and fear; anxiety management techniques used during an exacerbation; intervention from family members and carers; response to medical services. Panic and fear are important emotions prior to admission. Many patients recognised the link between panic-fear and a worsening of symptoms, and some were able to use self-management techniques to reduce their panic-fear. Some relatives were seen as helping and others exacerbating the symptoms of panic-fear. The emergency services were seen as positive: providing reassurance and a sense of safety. How best to help patients with chronic obstructive pulmonary disease manage panic and fear remains a challenge.

Stereotactic Body Radiotherapy in the Management of Oligometastatic Disease.

PubMed

Ahmed, Kamran A; Torres-Roca, Javier F

2016-01-01

The treatment of oligometastatic disease has become common as imaging techniques have advanced and the management of systemic disease has improved. Use of highly targeted, hypofractionated regimens of stereotactic body radiotherapy (SBRT) is now a primary management option for patients with oligometastatic disease. The properties of SBRT are summarized and the results of retrospective and prospective studies of SBRT use in the management of oligometastases are reviewed. Future directions of SBRT, including optimizing dose and fractionation schedules, are also discussed. SBRT can deliver highly conformal, dosed radiation treatments for ablative tumors in a few treatment sessions. Phase 1/2 trials and retrospective institutional results support use of SBRT as a treatment option for oligometastatic disease metastasized to the lung, liver, and spine, and SBRT offers adequate toxicity profiles with good rates of local control. Future directions will involve optimizing dose and fractionation schedules for select histologies to improve rates of local control while limiting toxicity to normal structures. SBRT offers an excellent management option for patients with oligometastases. However, additional research is still needed to optimize dose and fractionation schedules.

Diet and gastroesophageal reflux disease: role in pathogenesis and management.

PubMed

Sethi, Sajiv; Richter, Joel E

2017-03-01

Gastroesophageal reflux disease (GERD) is a common disease that presents with a variety of symptoms including heartburn and acid regurgitation. Although dietary modification is currently regarded as first-line therapy for the disease, the role of diet in the pathogenesis and management of GERD is still poorly understood. The present article aims to review recent literature that examines the relationship of diet and GERD. Increased awareness of medications side effects and widespread overuse has brought nonpharmacological therapies to the forefront for the management of GERD. Recent findings have established the important role of nutrition for the managements of symptoms of GERD. Increasing scientific evidence has produced objective data on the role of certain trigger foods, whereas population studies endorse decreased reflux symptoms by following certain diets. Obesity has been linked with increased symptoms of GERD as well. Furthermore, the importance of lifestyle techniques such as head of bed elevation and increased meal to sleep time may provide nonpharmacologic methods for effective symptom control in GERD. We provide a comprehensive review on the association between diet and its role in the development and management of GERD.

Management of Charcot–Marie–Tooth disease: improving long-term care with a multidisciplinary approach

PubMed Central

McCorquodale, Donald; Pucillo, Evan M; Johnson, Nicholas E

2016-01-01

Charcot–Marie–Tooth (CMT) disease is the most common inherited neuropathy and one of the most common inherited diseases in humans. The diagnosis of CMT is traditionally made by the neurologic specialist, yet the optimal management of CMT patients includes genetic counselors, physical and occupational therapists, physiatrists, orthotists, mental health providers, and community resources. Rapidly developing genetic discoveries and novel gene discovery techniques continue to add a growing number of genetic subtypes of CMT. The first large clinical natural history and therapeutic trials have added to our knowledge of each CMT subtype and revealed how CMT impacts patient quality of life. In this review, we discuss several important trends in CMT research factors that will require a collaborative multidisciplinary approach. These include the development of large multicenter patient registries, standardized clinical instruments to assess disease progression and disability, and increasing recognition and use of patient-reported outcome measures. These developments will continue to guide strategies in long-term multidisciplinary efforts to maintain quality of life and preserve functionality in CMT patients. PMID:26855581

The role of radiology in head and neck tumours in children

PubMed Central

McHugh, Kieran

2010-01-01

Abstract Head and neck malignancy is rare in children. However, distinguishing malignant tumours from the more common and numerous benign causes of neck masses in childhood is crucial as many malignant conditions have an excellent prognosis with appropriate oncological management. Ultrasound, computed tomography and magnetic resonance imaging all have crucial roles in the diagnosis of head and neck malignancy in children and there is an emerging role for positron emission tomography, particularly in the management and follow-up of lymphoma. We describe the imaging appearances of the common malignant tumours arising in the extracranial head and neck in children, focusing on lymphoma, rhabdomyosarcoma and nasopharyngeal carcinoma. The clinical presentation and radiological appearances of benign tumours in the head and neck in children may overlap with those seen in malignant disease. We describe the imaging appearances of juvenile angiofibroma, vascular abnormalities involving the extracranial head and neck and cervical teratomas. Advances in both imaging techniques and cancer staging systems, many of the latter aimed at avoiding over-treatment and treatment-related complications, will lead to an increasingly central role for imaging in childhood head and neck cancer. PMID:20199940

Solid Waste Management Practices in the Eastern Province of Saudi Arabia

NASA Astrophysics Data System (ADS)

Khan, Hasin U.; Husain, Tahir; Khan, Suhail M.

1987-11-01

Solid waste management practices in the Eastern Province of Saudi Arabia are reviewed. The officials of various municipalities and agencies responsible for collecting and disposing of municipal waste were interviewed. The refuse generation rate found is in the range of 1.61 2.72 kg per capita per day. The refuse composition data indicate a high percentage of glass, metals, and wood. For storage purposes, 0.2-m3 barrels are used in residential areas and 0.75 to 1.50 m3-capacity containers are used in commerical areas. The present solid-waste collection system is labor-intensive, and a significant part of the budget is spent on collection and haul operations. The unit collection and haul cost is much higher than the unit disposal cost of refuse. The direct haul of refuse is the common practice, and the use of transfer stations has not yet been considered. It is also observed that the disposal methods used at these sites are not in line with modern techniques for refuse disposal. Landfilling and combined burning and landfilling are the common disposal methods at all the sites.

Complex Intraoral Reconstruction Using a Single Free Anterolateral Thigh Flap and Supermicrosurgery After Corrosive Ingestion in a 14-Month-Old Child.

PubMed

El Fahar, Mohammed H

2018-05-01

Oral chemical burn injuries induce more damage to the underlying tissues with extensive scarring. It is very well known that alkali causes severe liquefaction necrosis and injury to the deeper tissues. Pediatric facial burns must be managed thoroughly and always require complex reconstruction, which is a challenging process. So, any reconstructive surgeon must be aware of all the deformities that may have significant functional and aesthetic impact on the burn survivors especially children. Few medical studies addressed pediatric microsurgical reconstruction for oral burn injuries induced by chemical materials. Anterolateral thigh (ALT) free flap is a common flap with a multitude of indications. The purpose of this article is to present the youngest case in the medical literature of caustic intraoral scarring managed with a very thin free anterolateral thigh flap in a 14-month-old child who underwent reconstruction of his inner cheek, the angle of the mouth and tongue using supermicrosurgery techniques. Further development of the surgical techniques is required to establish early and safe intraoral pediatric microsurgery with a long-term follow-up.

Characteristics of patients with autistic disorder (AD) presenting for dental treatment: a survey and chart review.

PubMed

Klein, U; Nowak, A J

1999-01-01

A group of 43 patients with AD (mean age, 13.5; SD, 5.9 yrs) was identified from the University Hospital School Pediatric Dentistry Clinic. We reviewed the patients' charts to obtain demographic data, dental findings, and the management techniques used for treatment. The patients were divided into groups according to Frankl's categories of behavior, ranging from definitely negative to positive. Descriptive data are provided for each group. Commonly used communications and pharmacological management techniques, as well as physical restraints, enabled us to treat all the patients in the traditional dental setting, when simple procedures were planned. Treatment under general anesthesia in the operating room was necessary in 37% of all patients when comprehensive care was required or difficult procedures were carried out. A questionnaire was also sent out to the caregivers to gather data on patients' nutrition and eating/chewing habits. In the sample surveyed, two-thirds of the individuals reportedly exhibited a normal eating pattern, while 14% pouched food. Soft, sweet, or sticky foods were preferred by 41% of the patients.

Controlling for Response Bias in Self-Ratings of Personality: A Comparison of Impression Management Scales and the Overclaiming Technique.

PubMed

Müller, Sascha; Moshagen, Morten

2018-04-12

Self-serving response distortions pose a threat to the validity of personality scales. A common approach to deal with this issue is to rely on impression management (IM) scales. More recently, the overclaiming technique (OCT) has been proposed as an alternative and arguably superior measure of such biases. In this study (N = 162), we tested these approaches in the context of self- and other-ratings using the HEXACO personality inventory. To the extent that the OCT and IM scales can be considered valid measures of response distortions, they are expected to account for inflated self-ratings in particular for those personality dimensions that are prone to socially desirable responding. However, the results show that neither the OCT nor IM account for overly favorable self-ratings. The validity of IM as a measure of response biases was further scrutinized by a substantial correlation with other-rated honesty-humility. As such, this study questions the use of both the OCT and IM to assess self-serving response distortions.

Regional reconstruction of flash flood history in the Guadarrama range (Central System, Spain).

PubMed

Rodriguez-Morata, C; Ballesteros-Cánovas, J A; Trappmann, D; Beniston, M; Stoffel, M

2016-04-15

Flash floods are a common natural hazard in Mediterranean mountain environments and responsible for serious economic and human disasters. The study of flash flood dynamics and their triggers is a key issue; however, the retrieval of historical data is often limited in mountain regions as a result of short time series and the systematic lack of historical data. In this study, we attempt to overcome data deficiency by supplementing existing records with dendrogeomorphic techniques which were employed in seven mountain streams along the northern slopes of the Guadarrama Mountain range. Here we present results derived from the tree-ring analysis of 117 samples from 63 Pinus sylvestris L. trees injured by flash floods, to complement existing flash flood records covering the last ~200years and comment on their hydro-meteorological triggers. To understand the varying number of reconstructed flash flood events in each of the catchments, we also performed a comparative analysis of geomorphic catchment characteristics, land use evolution and forest management. Furthermore, we discuss the limitations of dendrogeomorphic techniques applied in managed forests. Copyright © 2016 Elsevier B.V. All rights reserved.

Late Complications of Chest Wall Reconstruction: Management of Painful Sternal Nonunion

PubMed Central

Chepla, Kyle J.; Salgado, Christopher J.; Tang, Cathy J.; Mardini, Samir; Evans, Karen K.

2011-01-01

Although rare, sternal nonunion after median sternotomy or traumatic injury is associated with a high rate of morbidity. Pain and sternal clicking are two of the most common complaints and reasons these patients seek evaluation and treatment. Diagnosis of sternal nonunion is based on a thorough history and physical examination and can be confirmed with subsequent radiographic imaging. The treatment for symptomatic sternal nonunion requires stable fixation of the bony fragments and chest wall after the debridement of all nonviable bony and soft tissue by the cardiothoracic or reconstructive surgery team. Multiple fixation techniques have been described and incorporate a wide variety of materials including combinations of wires, cables, pins, bands, staples, and plates. Most recently, several new commercially available plating systems have demonstrated low recurrence and complication rates and resolution of the patient's symptoms on follow-up evaluation. Included in this review are three cases demonstrating the management of symptomatic sternal nonunion using these new techniques and review the history, diagnosis, risk factor, and classification, as well as several of the previously described fixation methods. PMID:22294948

Effectiveness of two different behavioral modification techniques among 5-7-year-old children: A randomized controlled trial.

PubMed

Vishwakarma, Aruna Prashanth; Bondarde, Prashant Arjun; Patil, Sudha Bhimangouda; Dodamani, Arun Suresh; Vishwakarma, Prashanth Yachrappa; Mujawar, Shoeb A

2017-01-01

Dental fear is a common, essential, and inevitable emotion that appears as a response to the stressful situation, which raises children's anxiety level, resulting in reduced demand for pediatric dental care. (1) To compare and evaluate the effectiveness of customized tell-play-do (TPD) technique with live modeling for behavior management of children. (2) To compare the behavioral modification techniques in managing the children during their dental visits. Ninety-eight children aged 5-7 years were enrolled in the study and randomly allocated into two groups. Phase I: first visit. Group I - children were conditioned to receive various dental procedures using live modeling followed by oral prophylaxis. Group II - TPD technique was introduced with customized playing dental objects followed by oral prophylaxis. Phase II: second visit. After 7 days interval, all the study subjects were subjected to rotary restorative treatment. Heart rate, Facial Image Scale (FIS), and Venham-6-point index were used before intervention, after intervention, and during dental procedure to quantify the anxious behavior. All 98 children after intervention underwent oral prophylaxis on first visit and rotary restorative treatment on second visit. The average pulse rate, FIS, and Venham scale scores were significantly lower among children who received TPD intervention when compared to those who received live modeling intervention. Unpaired t-test at 5% level of significance was considered as statistical significance. TPD is effective in reducing children's fear and anxiety about dental treatment, children enjoy playing with customized dental object. Thus, to promote adaptive behavior, TPD could be an alternate behavioral modification technique during pediatric dentistry.

The surgical management of chronic subdural hematoma.

PubMed

Ducruet, Andrew F; Grobelny, Bartosz T; Zacharia, Brad E; Hickman, Zachary L; DeRosa, Peter L; Andersen, Kristen N; Anderson, Kristen; Sussman, Eric; Carpenter, Austin; Connolly, E Sander

2012-04-01

Chronic subdural hematoma (cSDH) is an increasingly common neurological disease process. Despite the wide prevalence of cSDH, there remains a lack of consensus regarding numerous aspects of its clinical management. We provide an overview of the epidemiology and pathophysiology of cSDH and discuss several controversial management issues, including the timing of post-operative resumption of anticoagulant medications, the effectiveness of anti-epileptic prophylaxis, protocols for mobilization following evacuation of cSDH, as well as the comparative effectiveness of the various techniques of surgical evacuation. A PubMed search was carried out through October 19, 2010 using the following keywords: "subdural hematoma", "craniotomy", "burr-hole", "management", "anticoagulation", "seizure prophylaxis", "antiplatelet", "mobilization", and "surgical evacuation", alone and in combination. Relevant articles were identified and back-referenced to yield additional papers. A meta-analysis was then performed comparing the efficacy and complications associated with the various methods of cSDH evacuation. There is general agreement that significant coagulopathy should be reversed expeditiously in patients presenting with cSDH. Although protocols for gradual resumption of anti-coagulation for prophylaxis of venous thrombosis may be derived from guidelines for other neurosurgical procedures, further prospective study is necessary to determine the optimal time to restart full-dose anti-coagulation in the setting of recently drained cSDH. There is also conflicting evidence to support seizure prophylaxis in patients with cSDH, although the existing literature supports prophylaxis in patients who are at a higher risk for seizures. The published data regarding surgical technique for cSDH supports primary twist drill craniostomy (TDC) drainage at the bedside for patients who are high-risk surgical candidates with non-septated cSDH and craniotomy as a first-line evacuation technique for cSDH with significant membranes. Larger prospective studies addressing these aspects of cSDH management are necessary to establish definitive recommendations.

MO-E-18A-01: Imaging: Best Practices In Pediatric Imaging

DOE Office of Scientific and Technical Information (OSTI.GOV)

Willis, C; Strauss, K; MacDougall, R

This imaging educational program will focus on solutions to common pediatric imaging challenges. The speakers will present collective knowledge on best practices in pediatric imaging from their experience at dedicated children's hospitals. Areas of focus will include general radiography, the use of manual and automatic dose management in computed tomography, and enterprise-wide radiation dose management in the pediatric practice. The educational program will begin with a discussion of the complexities of exposure factor control in pediatric projection radiography. Following this introduction will be two lectures addressing the challenges of computed tomography (CT) protocol optimization in the pediatric population. The firstmore » will address manual CT protocol design in order to establish a managed radiation dose for any pediatric exam on any CT scanner. The second CT lecture will focus on the intricacies of automatic dose modulation in pediatric imaging with an emphasis on getting reliable results in algorithmbased technique selection. The fourth and final lecture will address the key elements needed to developing a comprehensive radiation dose management program for the pediatric environment with particular attention paid to new regulations and obligations of practicing medical physicists. Learning Objectives: To understand how general radiographic techniques can be optimized using exposure indices in order to improve pediatric radiography. To learn how to establish diagnostic dose reference levels for pediatric patients as a function of the type of examination, patient size, and individual design characteristics of the CT scanner. To learn how to predict the patient's radiation dose prior to the exam and manually adjust technique factors if necessary to match the patient's dose to the department's established dose reference levels. To learn how to utilize manufacturer-provided automatic dose modulation technology to consistently achieve patient doses within the department's established size-based diagnostic reference range. To understand the key components of an enterprise-wide pediatric dose management program that integrates the expanding responsibilities of medial physicists in the new era of dose monitoring.« less

Back pain and scoliosis in children: When to image, what to consider.

PubMed

Calloni, Sonia F; Huisman, Thierry Agm; Poretti, Andrea; Soares, Bruno P

2017-10-01

Back pain and scoliosis in children most commonly present as benign and self-limited entities. However, persistent back pain and/or progressive scoliosis should always be taken seriously in children. Dedicated diagnostic work-up should exclude etiologies that may result in significant morbidity. Clinical evaluation and management require a comprehensive history and physical and neurological examination. A correct imaging approach is important to define a clear diagnosis and should be reserved for children with persistent symptoms or concerning clinical and laboratory findings. This article reviews the role of different imaging techniques in the diagnostic approach to back pain and scoliosis, and offers a comprehensive review of the main imaging findings associated with common and uncommon causes of back pain and scoliosis in the pediatric population.

Rural household chicken management and challenges in the Upper River Region of the Gambia.

PubMed

Olaniyan, Olawale Festus; Camara, Samba

2018-06-23

Systematic assessment and documentation of extensive livestock production systems are necessary to design or review breeding programs, extension services, and policies. This study therefore examined management practices and challenges concerning village chicken production in the Upper River Region of the Gambia. The data gathered with 45-variable semi-structured questionnaires were analyzed based on the household head's education status and gender. Illiteracy level was high, and only 38% indicated that they attended certain schools. There was a significant relationship (p < 0.05) and phi coefficient of 0.35 between household heads' education status and record keeping. None of the examined management practices had a statistically significant relationship (p > 0.05) with household heads' gender. Children (10-14 years) were mostly responsible for providing care to the chickens. Foundation and replacement stocks were mainly acquired through purchase (78%). Many households (74%) indicated supplementary feeding of their flocks but only 34% provided separate houses apart from the household dwellings. Newcastle (68%) was the most common disease. Sick birds were recognized by restlessness (34%) and diarrhea (28%). External parasites were mainly controlled through local practices (52%) while the most common way to dispose dead birds was to throw them away (88%). Up to 90% indicated no formal training on disease management and access to extension agents was also low (20%). Control of chicken movement was occasionally done to protect birds from predators (60%) and then, to avoid contagious diseases (38%). Individual farmers and their associations need to be supported by stakeholders to access relevant information and uptake improved management techniques.

Stress Management Apps With Regard to Emotion-Focused Coping and Behavior Change Techniques: A Content Analysis.

PubMed

Christmann, Corinna Anna; Hoffmann, Alexandra; Bleser, Gabriele

2017-02-23

Chronic stress has been shown to be associated with disease. This link is not only direct but also indirect through harmful health behavior such as smoking or changing eating habits. The recent mHealth trend offers a new and promising approach to support the adoption and maintenance of appropriate stress management techniques. However, only few studies have dealt with the inclusion of evidence-based content within stress management apps for mobile phones. The aim of this study was to evaluate stress management apps on the basis of a new taxonomy of effective emotion-focused stress management techniques and an established taxonomy of behavior change techniques. Two trained and independent raters evaluated 62 free apps found in Google Play with regard to 26 behavior change and 15 emotion-focused stress management techniques in October 2015. The apps included an average of 4.3 behavior change techniques (SD 4.2) and 2.8 emotion-focused stress management techniques (SD 2.6). The behavior change technique score and stress management technique score were highly correlated (r=.82, P=.01). The broad variation of different stress management strategies found in this sample of apps goes in line with those found in conventional stress management interventions and self-help literature. Moreover, this study provided a first step toward more detailed and standardized taxonomies, which can be used to investigate evidence-based content in stress management interventions and enable greater comparability between different intervention types. ©Corinna Anna Christmann, Alexandra Hoffmann, Gabriele Bleser. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 23.02.2017.

Induction motor control

NASA Technical Reports Server (NTRS)

Hansen, Irving G.

1990-01-01

Electromechanical actuators developed to date have commonly utilized permanent magnet (PM) synchronous motors. More recently switched reluctance (SR) motors have been advocated due to their robust characteristics. Implications of work which utilizes induction motors and advanced control techniques are discussed. When induction motors are operated from an energy source capable of controlling voltages and frequencies independently, drive characteristics are obtained which are superior to either PM or SR motors. By synthesizing the machine frequency from a high frequency carrier (nominally 20 kHz), high efficiencies, low distortion, and rapid torque response are available. At this time multiple horsepower machine drives were demonstrated, and work is on-going to develop a 20 hp average, 40 hp peak class of aerospace actuators. This effort is based upon high frequency power distribution and management techniques developed by NASA for Space Station Freedom.

Induction motor control

NASA Technical Reports Server (NTRS)

Hansen, Irving G.

1990-01-01

Electromechanical actuators developed to date have commonly ultilized permanent magnet (PM) synchronous motors. More recently switched reluctance (SR) motors have been advocated due to their robust characteristics. Implications of work which utilized induction motors and advanced control techniques are discussed. When induction motors are operated from an energy source capable of controlling voltages and frequencies independently, drive characteristics are obtained which are superior to either PM or SR motors. By synthesizing the machine frequency from a high-frequency carrier (nominally 20 kHz), high efficiencies, low distortion, and rapid torque response are available. At this time multiple horsepower machine drives were demonstrated, and work is on-going to develop a 20 hp average, 40 hp peak class of aerospace actuators. This effort is based upon high-frequency power distribution and management techniques developed by NASA for Space Station Freedom.

Hirschsprung's disease management: from multi staged operation to single staged transanal pull-through.

PubMed

Wang, J X; Dahal, G R

2009-06-01

Hirschsprung's disease (HD) is a common congenital disease of colorectum. Although it was described more than one century ago, the effective treatment was established only half a century later. The initially treatment consisted of preoperative diverting colostomy, followed by definite pull-through and closure of colostomy on later date. A variety of procedures like Swenson, Duhamel, Rehbein and Soave were evolved with time. With the better understanding of pathogenesis and improvement on surgical technique, now the operation has become less extensive. In recent days, the classical 3 staged procedure is replaced by single staged procedure. All the procedure can be completed transanally. Since De la Torre in 1998, first reported total transanal endorectal pull-through, it became the most popular technique for the treatment of HD.

Ultrasound control of magnet growing rod distraction in early onset scoliosis.

PubMed

Pérez Cervera, T; Lirola Criado, J F; Farrington Rueda, D M

2016-01-01

The growing rod technique is currently one of the most common procedures used in the management of early onset scoliosis. However, in order to preserve spine growth and control the deformity it requires frequent surgeries to distract the rods. Magnetically driven growing rods have recently been introduced with same treatment goal, but without the inconvenience of repeated surgical distractions. One of the limitations of this technical advance is an increase in radiation exposure due to the increase in distraction frequency compared to conventional growing rods. An improvement of the original technique is presented, proposing a solution to the inconvenience of multiple radiation exposure using ultrasound technology to control the distraction process of magnetically driven growing rods. Copyright © 2014 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

Using object-oriented analysis to design a multi-mission ground data system

NASA Technical Reports Server (NTRS)

Shames, Peter

1995-01-01

This paper describes an analytical approach and descriptive methodology that is adapted from Object-Oriented Analysis (OOA) techniques. The technique is described and then used to communicate key issues of system logical architecture. The essence of the approach is to limit the analysis to only service objects, with the idea of providing a direct mapping from the design to a client-server implementation. Key perspectives on the system, such as user interaction, data flow and management, service interfaces, hardware configuration, and system and data integrity are covered. A significant advantage of this service-oriented approach is that it permits mapping all of these different perspectives on the system onto a single common substrate. This services substrate is readily represented diagramatically, thus making details of the overall design much more accessible.

Earth Science Data Analytics: Bridging Tools and Techniques with the Co-Analysis of Large, Heterogeneous Datasets

NASA Technical Reports Server (NTRS)

Kempler, Steve; Mathews, Tiffany

2016-01-01

The continuum of ever-evolving data management systems affords great opportunities to the enhancement of knowledge and facilitation of science research. To take advantage of these opportunities, it is essential to understand and develop methods that enable data relationships to be examined and the information to be manipulated. This presentation describes the efforts of the Earth Science Information Partners (ESIP) Federation Earth Science Data Analytics (ESDA) Cluster to understand, define, and facilitate the implementation of ESDA to advance science research. As a result of the void of Earth science data analytics publication material, the cluster has defined ESDA along with 10 goals to set the framework for a common understanding of tools and techniques that are available and still needed to support ESDA.

Ascending transaqueductal cystoventriculoperitoneal shunting in Dandy-Walker malformation: technical note.

PubMed

Unal, Omer Faruk; Aras, Yavuz; Aydoseli, Aydin; Akcakaya, Mehmet Osman

2012-01-01

The optimal treatment for Dandy-Walker malformation is still controversial. Ventriculoperitoneal shunting, cystoperitoneal shunting or combinations are the most common surgical options in the management of this clinical entity. Endoscopic procedures like ventriculocystostomy, 3rd ventriculostomy or endoscopy-assisted shunt surgeries have become the focus of recent publications. We describe a new transcystic endoscopic technique, with the usage of a single ascending transaqueductal shunt catheter with additional holes, whereby both the posterior fossa cyst and supratentorial ventricular compartments are drained effectively. By using this new technique complications associated with combined shunting can be avoided. In addition, by equalizing the pressure within the supra- and infratentorial compartments, the upward or downward herniations associated with single-catheter shunting can be prevented. Copyright © 2013 S. Karger AG, Basel.

A Technique for the Management of Concomitant Scaphotrapezoid Arthritis in Patients With Thumb Metacarpotrapezial Arthritis: Interposition Arthroplasty With a Capitate Suture Anchor.

PubMed

Warganich, Tibor; Shin, Alexander Y

2017-06-01

Scaphotrapezoid (ST) arthritis is a common source of pain and disability that typically presents with concomitant basilar thumb arthritis. ST arthritis is often under recognized and under diagnosed as a source of continued pain after successful basilar thumb arthroplasty. Untreated, symptomatic ST arthritis can cause failure of an otherwise successfully executed thumb carpometacarpal arthroplasty due to persistent pain, which is frustrating to the patient and surgeon. Although multiple surgical treatment options have been described for basilar thumb carpometacarpal joint arthritis, there is no gold standard for the treatment of ST arthritis. We describe a surgical technique with a minimal trapezoid excision and interpositional arthroplasty using an acellular allograft secured with a suture anchor in the capitate.

Endoscopic Assisted Combined Transantral and Subciliary Approach in Treatment of Orbital Floor Fracture: A Case Report.

PubMed

Anehosur, Venkatesh; Harish, K

2018-06-01

Management of orbital floor fracture remains the most debated topic in maxillofacial field. There are many approaches to reconstruct orbital floor fractures and restore orbital position and function, but many have the drawback of incomplete visualization, especially of the posterior part of the orbit. Pain, diplopia and enophthalmos are the most common presenting symptoms in patients who sustained orbital blow out fracture. The main aim in treating orbital fracture is to reduce the prolapsed orbital tissue and reconstruct the floor which will improve diplopia and enophthalmos. As minimally invasive surgical techniques are gaining popularity, it is possible to reconstruct the orbital fracture defects using endoscopes. Endoscopic assisted combined transantral and subciliary technique provides better surgical access and outcome in the treatment of orbital floor fracture.

Study on parallel and distributed management of RS data based on spatial database

NASA Astrophysics Data System (ADS)

Chen, Yingbiao; Qian, Qinglan; Wu, Hongqiao; Liu, Shijin

2009-10-01

With the rapid development of current earth-observing technology, RS image data storage, management and information publication become a bottle-neck for its appliance and popularization. There are two prominent problems in RS image data storage and management system. First, background server hardly handle the heavy process of great capacity of RS data which stored at different nodes in a distributing environment. A tough burden has put on the background server. Second, there is no unique, standard and rational organization of Multi-sensor RS data for its storage and management. And lots of information is lost or not included at storage. Faced at the above two problems, the paper has put forward a framework for RS image data parallel and distributed management and storage system. This system aims at RS data information system based on parallel background server and a distributed data management system. Aiming at the above two goals, this paper has studied the following key techniques and elicited some revelatory conclusions. The paper has put forward a solid index of "Pyramid, Block, Layer, Epoch" according to the properties of RS image data. With the solid index mechanism, a rational organization for different resolution, different area, different band and different period of Multi-sensor RS image data is completed. In data storage, RS data is not divided into binary large objects to be stored at current relational database system, while it is reconstructed through the above solid index mechanism. A logical image database for the RS image data file is constructed. In system architecture, this paper has set up a framework based on a parallel server of several common computers. Under the framework, the background process is divided into two parts, the common WEB process and parallel process.

Study on parallel and distributed management of RS data based on spatial data base

NASA Astrophysics Data System (ADS)

Chen, Yingbiao; Qian, Qinglan; Liu, Shijin

2006-12-01

With the rapid development of current earth-observing technology, RS image data storage, management and information publication become a bottle-neck for its appliance and popularization. There are two prominent problems in RS image data storage and management system. First, background server hardly handle the heavy process of great capacity of RS data which stored at different nodes in a distributing environment. A tough burden has put on the background server. Second, there is no unique, standard and rational organization of Multi-sensor RS data for its storage and management. And lots of information is lost or not included at storage. Faced at the above two problems, the paper has put forward a framework for RS image data parallel and distributed management and storage system. This system aims at RS data information system based on parallel background server and a distributed data management system. Aiming at the above two goals, this paper has studied the following key techniques and elicited some revelatory conclusions. The paper has put forward a solid index of "Pyramid, Block, Layer, Epoch" according to the properties of RS image data. With the solid index mechanism, a rational organization for different resolution, different area, different band and different period of Multi-sensor RS image data is completed. In data storage, RS data is not divided into binary large objects to be stored at current relational database system, while it is reconstructed through the above solid index mechanism. A logical image database for the RS image data file is constructed. In system architecture, this paper has set up a framework based on a parallel server of several common computers. Under the framework, the background process is divided into two parts, the common WEB process and parallel process.

Nonpharmacologic Treatment for Fibromyalgia: Patient Education, Cognitive-Behavioral Therapy, Relaxation Techniques, and Complementary and Alternative Medicine

PubMed Central

Hassett, Afton L.; Gevirtz, Richard N.

2009-01-01

Due to the dynamic and complex nature of chronic pain, successful treatment usually requires addressing behavioral, cognitive and affective processes. Many adjunctive interventions have been implemented in fibromyalgia (FM) treatment, but few are supported by controlled trials. Herein, some of the more commonly used nonpharmacologic interventions for FM will be described and the evidence for efficacy presented. Clinical observations and suggestions will also be offered including using the principles outlined in the acronym “ExPRESS” to organize a comprehensive, nonpharmacologic pain management approach. PMID:19647150

Surgical management of cosmetic mucogingival defects.

PubMed

Dym, Harry; Tagliareni, Jonathan M

2012-01-01

Mucogingival conditions are deviations from the normal anatomic relationship between the gingival margin and the mucogingival junction. Mucogingival surgery is plastic surgery designed to correct defects in the gingiva surrounding the teeth. Common mucogingival conditions are recession, absence, or reduction of keratinized tissue, and probing depths extending beyond the mucogingival junction. Surgical techniques used to augment cosmetic mucogingival defects include the free gingival autograft, the subepithelial connective tissue graft, rotational flaps, lateral sliding flaps, coronally repositioned flaps, and the use of acellular dermal matrix grafts. Copyright © 2012 Elsevier Inc. All rights reserved.

Dynamic VM Provisioning for TORQUE in a Cloud Environment

NASA Astrophysics Data System (ADS)

Zhang, S.; Boland, L.; Coddington, P.; Sevior, M.

2014-06-01

Cloud computing, also known as an Infrastructure-as-a-Service (IaaS), is attracting more interest from the commercial and educational sectors as a way to provide cost-effective computational infrastructure. It is an ideal platform for researchers who must share common resources but need to be able to scale up to massive computational requirements for specific periods of time. This paper presents the tools and techniques developed to allow the open source TORQUE distributed resource manager and Maui cluster scheduler to dynamically integrate OpenStack cloud resources into existing high throughput computing clusters.

[Intraoperative ultrasonography, dissection with ultra-shears and trans-cystic choledochoscopy during laparoscopic approach in obstructive lithiasis icterus case].

PubMed

Alecu, L; Corodeanu, G; Costan, I; Lungu, C; Staicu, A

2001-01-01

The authors present the case of a 48 years old male with lithiasis obstructive icterus who was operated by laparoscopic transcystic approach with choledochoscopy. This minimally invasive technique was very spectacular trough the using of laparoscopic ultrasonography, dissection with Ultra-Shears device and transcystic choledochoscopy. Careful watching of abdominal laparoscopic view and transcystic choledochoscopic view is the particularity of laparoscopic transcystic management of choledocholithiasis. This metod don't let us to explore the biliary tract before the junction between common bile duct and cystic duct.

Neuromodulation in bladder dysfunction.

PubMed

Hasan, S T; Neal, D E

1998-10-01

Neuromodulation is one option for the management of a wide variety of lower urinary tract disorders, including non-neuropathic and neuropathic bladder dysfunctions. The mechanisms of action of the reported techniques remain unclear; urodynamic changes are minimal, but symptomatic improvements are common. Although the treatment is relatively free from side-effects compared with more aggressive surgical options, the placebo effect is likely to be significant. Its exact cost effectiveness is unclear, but the technology is a welcome addition to the range of treatment options for lower urinary tract dysfunctions, such as urgency and urge incontinence.

NASA/ESA CV-990 spacelab simulation

NASA Technical Reports Server (NTRS)

Reller, J. O., Jr.

1976-01-01

Simplified techniques were applied to conduct an extensive spacelab simulation using the airborne laboratory. The scientific payload was selected to perform studies in upper atmospheric physics and infrared astronomy. The mission was successful and provided extensive data relevant to spacelab objectives on overall management of a complex international payload; experiment preparation, testing, and integration; training for proxy operation in space; data handling; multiexperimenter use of common experimenter facilities (telescopes); multiexperiment operation by experiment operators; selection criteria for spacelab experiment operators; and schedule requirements to prepare for such a spacelab mission.

[Infectious complications in patients undergoing a heart transplant].

PubMed

Bouza, E; Muñoz, P

1995-01-01

Infectious complications are, with rejection, the main cause of morbidity and mortality in heart transplantation recipients. Adequate management of these patients requires an adequate knowledge of risk factors, of most common infectious syndromes and of relevant microorganism, as long as of their resistance pattern. Among the first group, we may mention lower respiratory tract infections, mediastinitis and meningitis, and among the microorganisms, Citomegalovirus, Aspergillus and Toxoplasma gondii. The impressive development of diagnostical techniques and of prophylactic and therapeutical possibilities suggest the convenience of a multidisciplinar approach to these complications.

Dynamic Distraction External Fixation for Contracture of the Metacarpophalangeal Joint.

PubMed

Seigerman, Daniel A; Tan, Virak

2015-12-01

Metacarpophalangeal (MP) joint contractures are common after traumatic injury, and can be difficult to manage. After surgical capsulectomy, it remains challenging to maintain motion that was obtained at the time of surgery. Our group uses a novel, prefabricated digital external fixator to provide both distraction, and motion therapy across the MP joint after surgical treatment of MP contracture. The purpose of this technique is to demonstrate the effectiveness of an adjunctive dynamic distraction external fixator for the maintenance of joint motion after surgical treatment of MP contractures of the border digits.

Necrotizing pancreatitis: challenges and solutions.

PubMed

Bendersky, Victoria A; Mallipeddi, Mohan K; Perez, Alexander; Pappas, Theodore N

2016-01-01

Acute pancreatitis is a common disease that can progress to gland necrosis, which imposes significant risk of morbidity and mortality. In general, the treatment for pancreatitis is a supportive therapy. However, there are several reasons to escalate to surgery or another intervention. This review discusses the pathophysiology as well as medical and interventional management of necrotizing pancreatitis. Current evidence suggests that patients are best served by delaying interventions for at least 4 weeks, draining as a first resort, and debriding recalcitrant tissue using minimally invasive techniques to promote or enhance postoperative recovery while reducing wound-related complications.

Development and characterization of an IPMC hair-like transducer

NASA Astrophysics Data System (ADS)

Akle, Barbar J.; Challita, Elio; Khairalah, Nady

2015-04-01

Hair-like sensors are very common in natural and biological systems. Such sensors are used to measure acoustic pressures, fluid flows, and chemical concentrations among others. Hair-like actuators are also used to control fluid flows and perform temperature management. This study presents a manufacturing technique for a hair-like IPMC transducer. A thorough study is presented on the building process of the sensor. The method used to control the diameter and the electrodes thickness of the transducer is developed. The sensing behavior of the manufactured transducers is experimentally characterized.

Feline aggression toward family members: a guide for practitioners.

PubMed

Bain, Melissa; Stelow, Elizabeth

2014-05-01

Feline aggression toward people is a common and potentially dangerous problem. Proper diagnosis of the underlying cause of the aggression is key in effective treatment. A complete history, including information on the people in the home, other pets, and specific incidents, is necessary to make this diagnosis. A comprehensive treatment plan typically includes management, enhancement of the cat's living environment, techniques for replacing the aggressive behavior with more appropriate behaviors, and, potentially, medication. The treatment plan must reflect the abilities and commitment of the owner. Copyright © 2014 Elsevier Inc. All rights reserved.

Does random urine drug testing reduce illicit drug use in chronic pain patients receiving opioids?

PubMed

Manchikanti, Laxmaiah; Manchukonda, Rajeev; Pampati, Vidyasagar; Damron, Kim S; Brandon, Doris E; Cash, Kim A; McManus, Carla D

2006-04-01

Prescription drug abuse and illicit drug use are common in chronic pain patients. Adherence monitoring with screening tests, and urine drug testing, periodic monitoring with prescription monitoring programs, has become a common practice in recent years. Random drug testing for appropriate use of opioids and use of illicit drugs is often used in pain management practices. Thus, it is expected that random urine drug testing will deter use of illicit drugs, and also improve compliance. To study the prevalence of illicit drug use in patients receiving opioids for chronic pain management and to compare the results of illicit drug use with the results from a previous study. A prospective, consecutive study. Interventional pain management practice setting in the United States. A total of 500 consecutive patients on opioids, considered to be receiving stable doses of opioids supplemental to their interventional techniques, were studied by random drug testing. Testing was performed by rapid drug screen. Results were considered positive if one or more of the monitored illicit drugs including cocaine, marijuana (THC), methamphetamine or amphetamines were present. Illicit drug use was evident in 80 patients, or 16%, with marijuana in 11%, cocaine in 5%, and methamphetamine and/or amphetamines in 2%. When compared with previous data, the overall illicit drug use was significantly less. Illicit drug use in elderly patients was absent. The prevalence of illicit drug abuse in patients with chronic pain receiving opioids continues to be a common occurence. This study showed significant reductions in overall illicit drug use with adherence monitoring combined with random urine drug testing.

The development of an audit technique to assess the quality of safety barrier management.

PubMed

Guldenmund, Frank; Hale, Andrew; Goossens, Louis; Betten, Jeroen; Duijm, Nijs Jan

2006-03-31

This paper describes the development of a management model to control barriers devised to prevent major hazard scenarios. Additionally, an audit technique is explained that assesses the quality of such a management system. The final purpose of the audit technique is to quantify those aspects of the management system that have a direct impact on the reliability and effectiveness of the barriers and, hence, the probability of the scenarios involved. First, an outline of the management model is given and its elements are explained. Then, the development of the audit technique is described. Because the audit technique uses actual major hazard scenarios and barriers within these as its focus, the technique achieves a concreteness and clarity that many other techniques often lack. However, this strength is also its limitation, since the full safety management system is not covered with the technique. Finally, some preliminary experiences obtained from several test sites are compiled and discussed.

Surgical management of gynecomastia: experience of a general surgery center

PubMed Central

LONGHEU, A.; MEDAS, F.; CORRIAS, F.; FARRIS, S.; TATTI, A.; PISANO, G.; ERDAS, E.; CALÒ, P.G.

2016-01-01

Aim Gynecomastia is a common finding in male population of all ages. The aim of our study was to present our experience and goals in surgical treatment of gynecomastia. Patients and Methods Clinical records of patients affected by gynecomastia referred to our Department of Surgery between September 2008 and January 2015 were analyzed. 50 patients were included in this study. Results Gynecomastia was monolateral in 12 patients (24%) and bilateral in 38 (76%); idiopathic in 41 patients (82%) and secondary in 9 (18%). 39 patients (78%) underwent surgical operation under general anaesthesia, 11 (22%) under local anaesthesia. 3 patients (6%) presented recurrent disease. Webster technique was performed in 28 patients (56%), Davidson technique in 16 patients (32%); in 2 patients (4%) Pitanguy technique was performed and in 4 patients (8%) a mixed surgical technique was performed. Mean surgical time was 80.72±35.14 minutes, median postoperative stay was 1.46±0.88 days. 2 patients (4%) operated using Davidson technique developed a hematoma, 1 patient (2%) operated with the same technique developed hypertrophic scar. Conclusions Several surgical techniques are described for surgical correction of gynecomastia. If performed by skilled general surgeons surgical treatment of gynecomastia is safe and permits to reach satisfactory aesthetic results. PMID:27938530

Fluctuations in alliance and use of techniques over time: A bidirectional relation between use of "common factors" techniques and the development of the working alliance.

PubMed

Solomonov, Nili; McCarthy, Kevin S; Keefe, John R; Gorman, Bernard S; Blanchard, Mark; Barber, Jacques P

2018-01-01

The aim of this study was twofold: (a) Investigate whether therapists are consistent in their use of therapeutic techniques throughout supportive-expressive therapy (SET) and (b) Examine the bi-directional relation between therapists' use of therapeutic techniques and the working alliance over the course of SET. Thirty-seven depressed patients were assigned to 16 weeks of SET as part of a larger randomized clinical trial (Barber, Barrett, Gallop, Rynn, & Rickels, ). Working Alliance Inventory-Short Form (WAI-SF) was collected at Weeks 2, 4, and 8. Use of therapeutic interventions was rated by independent observers using the Multitheoretical List of Therapeutic Interventions (MULTI). Intraclass correlation coefficients assessed therapists' consistency in use of techniques. A cross-lagged path analysis estimated the working alliance inventory- Multitheoretical List of Therapeutic Interventions bidirectional relation across time. Therapists were moderately consistent in their use of prescribed techniques (psychodynamic, process-experiential, and person-centred). However, they were inconsistent, or more flexible, in their use of "common factors" techniques (e.g., empathy, active listening, hope, and encouragements). A positive bidirectional relation was found between use of common factors techniques and the working alliance, such that initial high levels of common factors (but not prescribed) techniques predicted higher alliance later on and vice versa. Therapists tend to modulate their use of common factors techniques across treatment. Additionally, when a strong working alliance is developed early in treatment, therapists tend to use more common factors later on. Moreover, high use of common factors techniques is predictive of later improvement in the alliance. Copyright © 2017 John Wiley & Sons, Ltd.

Fast Track Study

NASA Technical Reports Server (NTRS)

1996-01-01

The NASA Fast Track Study supports the efforts of a Special Study Group (SSG) made up of members of the Advanced Project Management Class number 23 (APM-23) that met at the Wallops Island Management Education Center from April 28 - May 8, 1996. Members of the Class expressed interest to Mr. Vem Weyers in having an input to the NASA Policy Document (NPD) 7120.4, that will replace NASA Management Institute (NMI) 7120.4, and the NASA Program/Project Management Guide. The APM-23 SSG was tasked with assisting in development of NASA policy on managing Fast Track Projects, defined as small projects under $150 million and completed within three years. 'Me approach of the APM-23 SSG was to gather data on successful projects working in a 'Better, Faster, Cheaper' environment, within and outside of NASA and develop the Fast Track Project section of the NASA Program/Project Management Guide. Fourteen interviews and four other data gathering efforts were conducted by the SSG, and 16 were conducted by Strategic Resources, Inc. (SRI), including five interviews at the Jet Propulsion Laboratory (JPL) and one at the Applied Physics Laboratory (APL). The interviews were compiled and analyzed for techniques and approaches commonly used to meet severe cost and schedule constraints.

Wyoming Landscape Conservation Initiative data management and integration

USGS Publications Warehouse

Latysh, Natalie; Bristol, R. Sky

2011-01-01

Six Federal agencies, two State agencies, and two local entities formally support the Wyoming Landscape Conservation Initiative (WLCI) and work together on a landscape scale to manage fragile habitats and wildlife resources amidst growing energy development in southwest Wyoming. The U.S. Geological Survey (USGS) was tasked with implementing targeted research and providing scientific information about southwest Wyoming to inform the development of WLCI habitat enhancement and restoration projects conducted by land management agencies. Many WLCI researchers and decisionmakers representing the Bureau of Land Management, U.S. Fish and Wildlife Service, the State of Wyoming, and others have overwhelmingly expressed the need for a stable, robust infrastructure to promote sharing of data resources produced by multiple entities, including metadata adequately describing the datasets. Descriptive metadata facilitates use of the datasets by users unfamiliar with the data. Agency representatives advocate development of common data handling and distribution practices among WLCI partners to enhance availability of comprehensive and diverse data resources for use in scientific analyses and resource management. The USGS Core Science Informatics (CSI) team is developing and promoting data integration tools and techniques across USGS and partner entity endeavors, including a data management infrastructure to aid WLCI researchers and decisionmakers.

Distribution and demography of San Francisco gartersnakes (Thamnophis sirtalis tetrataenia) at Mindego Ranch, Russian Ridge Open Space Preserve, San Mateo County, California

USGS Publications Warehouse

Kim, Richard; Halstead, Brian J.; Wylie, Glenn D.; Casazza, Michael L.

2018-04-26

San Francisco gartersnakes (Thamnophis sirtalis tetrataenia) are a subspecies of common gartersnakes endemic to the San Francisco Peninsula of northern California. Because of habitat loss and collection for the pet trade, San Francisco gartersnakes were listed as endangered under the precursor to the Federal Endangered Species Act. A population of San Francisco gartersnakes resides at Mindego Ranch, San Mateo County, which is part of the Russian Ridge Open Space Preserve owned and managed by the Midpeninsula Regional Open Space District (MROSD). Because the site contained non-native fishes and American bullfrogs (Lithobates catesbeianus), MROSD implemented management to eliminate or reduce the abundance of these non-native species in 2014. We monitored the population using capture-mark-recapture techniques to document changes in the population during and following management actions. Although drought confounded some aspects of inference about the effects of management, prey and San Francisco gartersnake populations generally increased following draining of Aquatic Feature 3. Continued management of the site to keep invasive aquatic predators from recolonizing or increasing in abundance, as well as vegetation management that promotes heterogeneous grassland/shrubland near wetlands, likely would benefit this population of San Francisco gartersnakes.

Literature Review of the Role of Ultrasound, Computed Tomography, and Transcatheter Arterial Embolization for the Treatment of Traumatic Splenic Injuries

DOE Office of Scientific and Technical Information (OSTI.GOV)

Vlies, Cornelis H. van der, E-mail: c.h.vandervlies@amc.n; Delden, Otto M. van, E-mail: o.m.vandelden@amc.n; Punt, Bastiaan J., E-mail: b.j.punt@asz.n

IntroductionThe spleen is the second most frequently injured organ following blunt abdominal trauma. Trends in management have changed over the years. Traditionally, laparotomy and splenectomy was the standard management. Presently, nonoperative management (NOM) of splenic injury is the most common management strategy in hemodynamically stable patients. Splenic injuries can be managed via simple observation (OBS) or with angiography and embolization (AE). Angio-embolization has shown to be a valuable alternative to observational management and has increased the success rate of nonoperative management in many series.DiagnosticsImproved imaging techniques and advances in interventional radiology have led to a better selection of patients whomore » are amenable to nonoperative management. Despite this, there is still a lot of debate about which patients are prone to NOM.Angiography and EmbolizationThe optimal patient selection is still a matter of debate and the role of CT and angio-embolization has not yet fully evolved. We discuss the role of sonography and CT features, such as contrast extravasation, pseudoaneurysms, arteriovenous fistulas, or hemoperitoneum, to determine the optimal patient selection for angiography and embolization. We also review the efficiency, technical considerations (proximal or selective embolization), logistics, and complication rates of AE for blunt traumatic splenic injuries.« less

Literature Review of the Role of Ultrasound, Computed Tomography, and Transcatheter Arterial Embolization for the Treatment of Traumatic Splenic Injuries

PubMed Central

van Delden, Otto M.; Punt, Bastiaan J.; Ponsen, Kees J.; Reekers, Jim A.; Goslings, J. Carel

2010-01-01

Introduction The spleen is the second most frequently injured organ following blunt abdominal trauma. Trends in management have changed over the years. Traditionally, laparotomy and splenectomy was the standard management. Presently, nonoperative management (NOM) of splenic injury is the most common management strategy in hemodynamically stable patients. Splenic injuries can be managed via simple observation (OBS) or with angiography and embolization (AE). Angio-embolization has shown to be a valuable alternative to observational management and has increased the success rate of nonoperative management in many series. Diagnostics Improved imaging techniques and advances in interventional radiology have led to a better selection of patients who are amenable to nonoperative management. Despite this, there is still a lot of debate about which patients are prone to NOM. Angiography and Embolization The optimal patient selection is still a matter of debate and the role of CT and angio-embolization has not yet fully evolved. We discuss the role of sonography and CT features, such as contrast extravasation, pseudoaneurysms, arteriovenous fistulas, or hemoperitoneum, to determine the optimal patient selection for angiography and embolization. We also review the efficiency, technical considerations (proximal or selective embolization), logistics, and complication rates of AE for blunt traumatic splenic injuries. PMID:20668852

National Athletic Trainers' Association Position Statement: Management of Acute Skin Trauma

PubMed Central

Beam, Joel W.; Buckley, Bernadette; Holcomb, William R.; Ciocca, Mario

2016-01-01

Objective: To present recommendations for the cleansing, debridement, dressing, and monitoring of acute skin trauma in patients. Background: Acute skin trauma is common during participation in athletic and recreational activities. Clinical decisions and intervention protocols after injury vary among athletic trainers and are often based on ritualistic practices. An understanding of cleansing, debridement, and dressing techniques; clinical features of infection and adverse reactions; and monitoring of acute skin trauma is critical for certified athletic trainers and other allied health and medical professionals to create a local wound environment that promotes healing and lessens the risk of complications. Recommendations: These guidelines are intended to provide the certified athletic trainer and others participating in athletic health care with specific knowledge about and recommendations for the management of acute skin trauma. PMID:28092169

Trends in hospitalization for atrial fibrillation: epidemiology, cost, and implications for the future.

PubMed

Sheikh, Azfar; Patel, Nileshkumar J; Nalluri, Nikhil; Agnihotri, Kanishk; Spagnola, Jonathan; Patel, Aashay; Asti, Deepak; Kanotra, Ritesh; Khan, Hafiz; Savani, Chirag; Arora, Shilpkumar; Patel, Nilay; Thakkar, Badal; Patel, Neil; Pau, Dhaval; Badheka, Apurva O; Deshmukh, Abhishek; Kowalski, Marcin; Viles-Gonzalez, Juan; Paydak, Hakan

2015-01-01

Atrial fibrillation (AF) is the most prevalent arrhythmia worldwide and the most common arrhythmia leading to hospitalization. Due to a substantial increase in incidence and prevalence of AF over the past few decades, it attributes to an extensive economic and public health burden. The increasing number of hospitalizations, aging population, anticoagulation management, and increasing trend for disposition to a skilled facility are drivers of the increasing cost associated with AF. There has been significant progress in AF management with the release of new oral anticoagulants, use of left atrial catheter ablation, and novel techniques for left atrial appendage closure. In this article, we aim to review the trends in epidemiology, hospitalization, and cost of AF along with its future implications on public health. Published by Elsevier Inc.

National Athletic Trainers' Association Position Statement: Management of Acute Skin Trauma.

PubMed

Beam, Joel W; Buckley, Bernadette; Holcomb, William R; Ciocca, Mario

2016-12-01

  To present recommendations for the cleansing, debridement, dressing, and monitoring of acute skin trauma in patients.   Acute skin trauma is common during participation in athletic and recreational activities. Clinical decisions and intervention protocols after injury vary among athletic trainers and are often based on ritualistic practices. An understanding of cleansing, debridement, and dressing techniques; clinical features of infection and adverse reactions; and monitoring of acute skin trauma is critical for certified athletic trainers and other allied health and medical professionals to create a local wound environment that promotes healing and lessens the risk of complications.   These guidelines are intended to provide the certified athletic trainer and others participating in athletic health care with specific knowledge about and recommendations for the management of acute skin trauma.

Functional Imaging for Prostate Cancer: Therapeutic Implications

PubMed Central

Aparici, Carina Mari; Seo, Youngho

2012-01-01

Functional radionuclide imaging modalities, now commonly combined with anatomical imaging modalities CT or MRI (SPECT/CT, PET/CT, and PET/MRI) are promising tools for the management of prostate cancer particularly for therapeutic implications. Sensitive detection capability of prostate cancer using these imaging modalities is one issue; however, the treatment of prostate cancer using the information that can be obtained from functional radionuclide imaging techniques is another challenging area. There are not many SPECT or PET radiotracers that can cover the full spectrum of the management of prostate cancer from initial detection, to staging, prognosis predictor, and all the way to treatment response assessment. However, when used appropriately, the information from functional radionuclide imaging improves, and sometimes significantly changes, the whole course of the cancer management. The limitations of using SPECT and PET radiotracers with regards to therapeutic implications are not so much different from their limitations solely for the task of detecting prostate cancer; however, the specific imaging target and how this target is reliably imaged by SPECT and PET can potentially make significant impact in the treatment of prostate cancer. Finally, while the localized prostate cancer is considered manageable, there is still significant need for improvement in noninvasive imaging of metastatic prostate cancer, in treatment guidance, and in response assessment from functional imaging including radionuclide-based techniques. In this review article, we present the rationale of using functional radionuclide imaging and the therapeutic implications for each of radionuclide imaging agent that have been studied in human subjects. PMID:22840598

Legacy data for a northern prairie grassland: Woodworth Study Area, North Dakota, 1963-89

USGS Publications Warehouse

Williams, Shelby H.; Austin, Jane E.

2014-01-01

Ecological data commonly become more valuable through time. Such legacy data provide baseline records of past biological, physical, and social information that provide historical perspective and are necessary for assessment of stasis or change. Legacy data collected at the Woodworth Study Area (WSA), a contiguous block of grasslands, croplands, and wetlands covering more than 1,000 hectares of the Prairie Pothole Region of North Dakota, are cataloged and summarized in this study. The WSA is one of the longest researched grassland sites in the Upper Midwest. It has an extensive history of settlement, land use, and management that provides a deeper context for future research. The WSA data include long-term vegetation transect records, land use history, habitat management records, geologic information, wetland hydrology and chemistry information, and spatial images. Substantial parts of these data have not been previously reported. The WSA is representative of many other lands purchased by the U.S. Fish and Wildlife Service in the Prairie Pothole Region from the 1930s to the 1970s; therefore, synthesized data from the WSA are broadly applicable to topics of concern in northern grasslands, such as increases in non-native plants, managing for biodiversity, and long-term effects of habitat management. New techniques are also described that were used to preserve these data for future analyses. The data preservation techniques are applicable to any project with data that should be preserved for 100 years or more.

Characteristics of healthy weight advertisements in three countries.

PubMed

Pettigrew, Simone; Talati, Zenobia; Henriques, Isla; Morley, Belinda; Ball, Kylie

2018-02-01

High rates of population obesity have resulted in the dissemination of mass media campaigns that focus on achieving and maintaining a healthy weight. The aim of the present study was to analyse advertising techniques used in such campaigns to identify common and differential approaches in three countries with similar cultures and rates of obesity (Australia, the United Kingdom and the United States). An Internet search was conducted to identify healthy weight television advertisements aired in the three countries. Seventy-two advertisements were located and coded according to the advertising techniques employed. Despite the cultural similarity and comparable obesity rates of the three countries, there were few consistencies in advertising techniques employed. A main focus of the ads was diet, but disparate approaches were used to convey the message in each country. The identified wide variation in advertising techniques may suggest that campaign managers would benefit from greater certainty about which advertising approaches are most effective in encouraging lifestyle behaviours associated with a healthy weight. Implications for public health: A more robust evidence base would be useful to guide the development of healthy weight campaigns. © 2017 The Authors.

Repair of distal biceps tendon rupture with the Biotenodesis screw.

PubMed

Khan, W; Agarwal, M; Funk, L

2004-04-01

Distal biceps tendon ruptures are uncommon injuries with only around 300 cases reported in the literature. Current management tends to favour anatomical reinsertion of the tendon into the radial tuberosity, especially in young and active individuals. These injuries are commonly repaired using either a single anterior incision with suture anchors or the Boyd-Anderson dual incision technique. We report the use of a bioabsorbable interference screw for the repair of distal biceps tendon rupture using a minimal incision technique. In this technique the avulsed tendon and a bioabsorbable screw are secured in a drill hole on the radial tuberosity using whip stitch and fibre wire sutures according to Biotenodesis system guidelines. The technique described requires minimal volar dissection that is associated with a reduced number of synostosis and posterior interosseous nerve injuries. The bioabsorbable interference screw has all the advantages of being biodegradable and has been shown to have greater pullout strength than suture anchors. It is also a reasonable alternative to titanium screws in terms of primary fixation strength. The strong fixation provided allows early active motion and return to previous activities as seen in our case.

Role of endoscopic retrograde cholangiopancreatography in the management of benign biliary strictures: What’s new?

PubMed Central

Ferreira, Rosa; Loureiro, Rui; Nunes, Nuno; Santos, António Alberto; Maio, Rui; Cravo, Marília; Duarte, Maria Antónia

2016-01-01

Benign biliary strictures comprise a heterogeneous group of diseases. The most common strictures amenable to endoscopic treatment are post-cholecystectomy, post-liver transplantation, related to primary sclerosing cholangitis and to chronic pancreatitis. Endoscopic treatment of benign biliary strictures is widely used as first line therapy, since it is effective, safe, noninvasive and repeatable. Endoscopic techniques currently used are dilation, multiple plastic stents insertion and fully covered self-expandable metal stents. The main indication for dilation alone is primary sclerosing cholangitis related strictures. In the vast majority of the remaining cases, temporary placement of multiple plastic stents with/without dilation is considered the treatment of choice. Although this approach is effective, it requires multiple endoscopic sessions due to the short duration of stent patency. Fully covered self-expandable metal stents appear as a good alternative to plastic stents, since they have an increased radial diameter, longer stent patency, easier insertion technique and similar efficacy. Recent advances in endoscopic technique and various devices have allowed successful treatment in most cases. The development of novel endoscopic techniques and devices is still ongoing. PMID:26962404

Surgical approaches for varicocele in pediatric patient

PubMed Central

Parrilli, Alejandra; Escolino, Maria; Esposito, Ciro

2016-01-01

Background Varicocele represents one of the most common surgically correctible urologic anomalies in adolescent males. The best procedure for the treatment of adolescent varicocele has not been established, but with recent advances in minimal access surgery, there have been many reports praising the safety and efficacy of laparoscopy and retroperitoneoscopy for the surgical correction of varicocele in adolescent. The aim of this review is to compare the results of Palomo’s technique, with retroperitoneoscopic and transperitoneoscopic approaches in adolescent, analyzing recurrence, testicular growth and complications. Methods A literature search on PubMed and Cochrane Database was conducted with regard to management of varicocele in adolescent population. Twenty two English language studies that compared outcome of different minimally invasive treatments or outcome of minimally invasive and traditional surgical treatments for adolescent diagnosed with varicocele were included. Results Intraoperative complications of minimally invasive approaches occur in early cases, but in pediatric urology these procedures would become more efficient with experience and these approaches continue to increase in number. Postoperative hydrocele is the most postoperative compliance of Palom technique, and reports have shown a wide range of variability for his incidence, depending on the technique used for surgical treatment. Literature showed an increase of testicular volume for real growth of testis after surgery, and an intratesticular improvement in sperm quality after minimally invasive approach. In laparoscopic approach reports have showed very low recurrence because allows better vision of collateral veins, and a lymphatic sparing technique permit to identify lymphatic vessels in 100% of cases. Conclusions The literature has shown that laparoscopic varicocelectomy is the surgical approach most commonly reported in adolescent patients, and that its use is increasing for better training for surgeons and the ability to avoid operational hydrocele that is a main complication after technical Palomo’s technique. PMID:27867844

[Medical and surgical treatments of congenital and acquired penile curvatures: a review].

PubMed

Guillot-Tantay, C; Phé, V; Chartier-Kastler, E; Mozer, P; Bitker, M-O; Rouprêt, M

2014-03-01

The aim of the current study was to provide an overview about the surgical and medical management of acquired and congenital penile's curvature. [corrected] A systematic review of the literature was done from the PubMed database by searching the following keywords alone or in combination: Congenital penile curvature; Congenital penile deviation; Acquired penile curvature; Acquired penile deviation; Peyronie's disease. The treatment of congenital curvature is only surgical. The most common technique is the Nesbit's technique which consists in making elliptical excisions of the tunica albuginea. There are also incison or plication procedures which are efficient as well. Acquired curvature is most of the time represented by the Peyronie's disease or is post-traumatic. Among oral treatments available, the Potaba is the only drug which has proved a significant reduction in penile plaque size. Injections of interferon and nicardipine have also shown their efficacy. Ionotophoresis and extracorporeal shock-wave therapy may be beneficial for penile pain. Other therapies (vacuum, traction devices, topical Verapamil) can be interesting but other studies are necessary to recommend them. Surgical treatment is recommended during the fibrotic phase. The most common technique is also the Nesbit's technique. In case of severe curvature (curve superior to 60°), small penis, major deformations, graft techniques can be used. Moreover, if there is a sexual dysfunction, penile prosthesis is recommended. Other studies are necessary to prove the efficacy of most of the drugs already available in the treatment of the penile curvature. It seems to be interesting to combine the different treatments to improve the results of those therapies. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

PDGFRA amplification is common in pediatric and adult high-grade astrocytomas and identifies a poor prognostic group in IDH1 mutant glioblastoma

PubMed Central

Phillips, Joanna J.; Aranda, Derick; Ellison, David W.; Judkins, Alexander R.; Croul, Sidney E.; Brat, Daniel J.; Ligon, Keith L.; Horbinski, Craig; Venneti, Sriram; Zadeh, Gelareh; Santi, Mariarita; Zhou, Shengmei; Appin, Christina L.; Sioletic, Stefano; Sullivan, Lisa M.; Martinez-Lage, Maria; Robinson, Aaron E.; Yong, William H.; Cloughesy, Timothy; Lai, Albert; Phillips, Heidi S.; Marshall, Roxanne; Mueller, Sabine; Haas-Kogan, Daphne A.; Molinaro, Annette M.; Perry, Arie

2013-01-01

High-grade astrocytomas (HGAs), corresponding to WHO grades III (AA) and IV (GBM), are biologically aggressive and their molecular classification is increasingly relevant to clinical management. PDGFRA amplification is common in HGAs, although its prognostic significance remains unclear. Using fluorescence in situ hybridization (FISH), the most sensitive technique for detecting PDGFRA copy number gains, we determined PDGFRA amplification status in 123 pediatric and 263 adult HGAs. A range of PDGFRA FISH patterns were identified and cases were scored as non-amplified (normal and polysomy) or amplified (low-level and high-level). PDGFRA amplification was frequent in pediatric (29.3%) and adult (20.9%) tumors. Amplification was not prognostic in pediatric HGAs. In adult tumors diagnosed initially as GBM, the presence of combined PDGFRA amplification and IDH1R132H mutation was a significant independent prognostic factor (p=0.01). In HGAs, PDGFRA amplification is common and can manifest as high-level and focal or low-level amplifications. Our data indicate that the latter is more prevalent than previously reported with copy number averaging techniques. To our knowledge, this is the largest survey of PDGFRA status in adult and pediatric HGAs and suggests PDGFRA amplification increases with grade and is associated with a less favorable prognosis in IDH1 mutant de novo GBMs. PMID:23438035

A technique for evisceration as an alternative to enucleation in birds of prey: 19 cases.

PubMed

Murray, Maureen; Pizzirani, Stefano; Tseng, Florina

2013-06-01

Ocular trauma is common in birds of prey presented to wildlife clinics and rehabilitation centers. Enucleation is the procedure most commonly described for treatment of end-stage ocular disease or chronically painful eyes in birds; however, there are several disadvantages and risks to this procedure. While evisceration has been suggested as an alternative, it has not been described for multiple cases or with long-term follow-up data in birds of prey. This report details an evisceration technique performed in 5 captive birds of prey of 4 different species (1 eastern screech owl [Megascops asio], 1 great horned owl [Bubo virginianus], 2 red-tailed hawks [Buteo jamaicensis], and 1 bald eagle [Haliaeetus leucocephalus]) with long-term follow-up information. In addition, this report describes 14 cases of free-living owls of 3 different species (1 great horned owl, 4 barred owls [Strix varia], and 9 eastern screech owls) on which this technique was performed from 2004 to 2011 and which were subsequently released to the wild. Because of the limited risk of complications and the less-severe disruption of facial symmetry, which may be particularly important in owls that are candidates for release to the wild, evisceration should be considered over enucleation in birds of prey that require surgical intervention for the management of severe sequelae to ocular trauma.

An Application of Instructional System Development to Determine Financial Management Education Needs for Logistics Management Positions.

DTIC Science & Technology

1976-09-01

The purpose of this research effort was to determine the financial management educational needs of USAF graduate logistics positions. Goal analysis...was used to identify financial management techniques and task analysis was used to develop a method to identify the use of financial management techniques...positions. The survey identified financial management techniques in five areas: cost accounting, capital budgeting, working capital, financial forecasting, and programming. (Author)

Practical and molecular evaluation of colorectal cancer: new roles for the pathologist in the era of targeted therapy.

PubMed

De Hertogh, Gert; Geboes, Karen Paula

2010-06-01

Colorectal cancer is the third most common cancer and the fourth most common cause of cancer death worldwide. Patient cases are discussed in multidisciplinary meetings to decide on the best management on an individual basis. Until recently, the main task of the pathologist in such teams was to provide clinically useful reports comprising staging of colorectal cancer in surgical specimens. The advent of total mesorectal excision and the application of anti-epidermal growth factor receptor (EGFR)-targeted therapies for selected patients with metastasized colorectal cancer have changed the role of the pathologist. To present the traditional role of the pathologist in the multidisciplinary team treating patients with colorectal cancer, to address the technique of total mesorectal excision and its implications for the evaluation of surgical specimens, to offer background information on the various EGFR-targeted therapies, and to review the currently investigated tissue biomarkers assumed to be predictive for efficacy of such therapies, with a focus on the role of the pathologist in determining the status of such biomarkers in individual tumors. This article is based on selected articles pertaining to biopsy evaluation of colorectal carcinoma and reviews of EGFR-targeted therapies for this cancer. All references are accessible via the PubMed database (US National Library of Medicine and the National Institutes of Health). Pathologists play an increasingly important role in the diagnosis and management of colorectal cancer because of the advent of new surgical techniques and of targeted therapies. It is expected that this role will increase further in the near future.

Cough Augmentation Techniques in the Critically Ill: A Canadian National Survey.

PubMed

Rose, Louise; Adhikari, Neill K; Poon, Joseph; Leasa, David; McKim, Douglas A

2016-10-01

Critically ill mechanically ventilated patients experience impaired airway clearance due to ineffective cough and impaired secretion mobilization. Cough augmentation techniques, including mechanical insufflation-exsufflation (MI-E), manually assisted cough, and lung volume recruitment, improve cough efficiency. Our objective was to describe use, indications, contraindications, interfaces, settings, complications, and barriers to use across Canada. An e-mail survey was sent to nominated local survey champions in eligible Canadian units (ICUs, weaning centers, and intermediate care units) with 4 telephone/e-mail reminders. The survey response rate was 157 of 238 (66%); 78 of 157 units (50%) used cough augmentation, with 50 (64%) using MI-E, 53 (68%) using manually assisted cough, and 62 (79%) using lung volume recruitment. Secretion clearance was the most common indication (MI-E, 92%; manually assisted cough, 88%; lung volume recruitment, 76%), although the most common units (44%) used it <50% of the time. Use during weaning from invasive (MI-E, 21%; manually assisted cough, 39%; lung volume recruitment, 3%) and noninvasive ventilation (MI-E, 21%; manually assisted cough, 33%; lung volume recruitment, 21%) was infrequent. The most common diagnoses were neuromuscular disease (97%) and spinal cord injury (83%). Pneumothorax was the most frequently identified absolute contraindication for MI-E (93%) and lung volume recruitment (83%); rib fracture was most frequently identified for manually assisted cough (69%). MI-E mean inspiratory pressure was 31 cm H2O, and expiratory pressure was -32 cm H2O. Mucus plugging requiring tracheostomy inner change was the most frequent complication for MI-E (23%), chest pain for manually assisted cough (36%), and hypotension for lung volume recruitment (17%). The most commonly cited barriers were lack of expertise (70%), knowledge (65%), and resources (52%). We found moderate adoption of cough augmentation techniques, particularly for secretion management. Lack of expertise and knowledge are potentially modifiable barriers addressed with educational interventions. Copyright © 2016 by Daedalus Enterprises.

[Rare tumors of the head and neck; on behalf of the REFCOR, the French Network of rare head and neck tumors].

PubMed

Baujat, Bertrand; Thariat, Juliette; Baglin, Anne Catherine; Costes, Valérie; Testelin, Sylvie; Reyt, Emile; Janot, François

2014-05-01

Malignant tumors of the upper aerodigestive tract may be rare by their histology (sarcoma, variants of conventional squamous cell carcinomas) and/or location (sinuses, salivary glands, ear, of various histologies themselves). They represent less than 10% of head and neck neoplasms. The confirmation of their diagnosis often requires a medical expertise and sometimes biomolecular techniques complementary to classical histology and immunohistochemistry. Due to their location, their treatment often requires a specific surgical technique. Radiation therapy is indicated based on histoclinical characteristics common to other head and neck neoplasms but also incorporate grade. Further, the technique must often be adapted to take into account the proximity of organs at risk. For most histologies, chemotherapy is relatively inefficient but current molecular advances may allow to consider pharmaceutical developments in the coming years. The REFCOR, the French Network of head and neck cancers aims to organize and promote the optimal management of these rare and heterogeneous diseases, to promote research and clinical trials.

A Component Approach to Collaborative Scientific Software Development: Tools and Techniques Utilized by the Quantum Chemistry Science Application Partnership

DOE PAGES

Kenny, Joseph P.; Janssen, Curtis L.; Gordon, Mark S.; ...

2008-01-01

Cutting-edge scientific computing software is complex, increasingly involving the coupling of multiple packages to combine advanced algorithms or simulations at multiple physical scales. Component-based software engineering (CBSE) has been advanced as a technique for managing this complexity, and complex component applications have been created in the quantum chemistry domain, as well as several other simulation areas, using the component model advocated by the Common Component Architecture (CCA) Forum. While programming models do indeed enable sound software engineering practices, the selection of programming model is just one building block in a comprehensive approach to large-scale collaborative development which must also addressmore » interface and data standardization, and language and package interoperability. We provide an overview of the development approach utilized within the Quantum Chemistry Science Application Partnership, identifying design challenges, describing the techniques which we have adopted to address these challenges and highlighting the advantages which the CCA approach offers for collaborative development.« less

Chronic Achilles tendinopathy: a case study of treatment incorporating active and passive tissue warm-up, Graston Technique®, ART®, eccentric exercise, and cryotherapy

PubMed Central

Miners, Andrew L.; Bougie, Tracy L.

2011-01-01

Objective To describe the subjective pain and functional improvements of a patient with chronic Achilles tendinopathy following a treatment plan incorporating active and passive tissue warm-up, followed respectively by soft tissue mobilization utilizing both Graston Technique® and Active Release Techniques®, eccentric exercise, and static stretching in combination with cryotherapy. Background The primary characterization of chronic Achilles tendinopathy is gradual onset of pain and dysfunction focused in one or both Achilles tendons arising secondary to a history of repetitive use or excessive overload. Intervention and Outcome Conservative treatment is commonly the initial strategy for patient management. Tissue heating, soft tissue mobilization, eccentric training, and static stretching with cryotherapy were implemented to reduce pain and improve function. Summary A specific protocol of heat, soft tissue mobilization, eccentric exercise, stretching, and cryotherapy appeared to facilitate a rapid and complete recovery from chronic Achilles tendinopathy. PMID:22131563

Scabies: Advances in Noninvasive Diagnosis.

PubMed

Micali, Giuseppe; Lacarrubba, Francesco; Verzì, Anna Elisa; Chosidow, Olivier; Schwartz, Robert A

2016-06-01

Scabies is a common, highly contagious skin parasitosis caused by Sarcoptes scabiei var. hominis. Early identification and prompt treatment of infested subjects is essential, as missed diagnosis may result in outbreaks, considerable morbidity, and significantly increased economic burden. The standard diagnostic technique consists of mites' identification by microscopic examination of scales obtained by skin scraping. This is a time-consuming and risk-associated procedure that is also not suitable to a busy practice. In recent years, some advanced and noninvasive techniques such as videodermatoscopy, dermatoscopy, reflectance confocal microscopy, and optical coherence tomography have demonstrated improved efficacy in the diagnosis of scabies. Their advantages include rapid, noninvasive mass screening and post-therapeutic follow-up, with no physical risk. A greater knowledge of these techniques among general practitioners and other specialists involved in the intake care of overcrowded populations vulnerable to scabies infestations is now viewed as urgent and important in the management of outbreaks, as well as in consideration of the recent growing inflow of migrants in Europe from North Africa.

Scabies: Advances in Noninvasive Diagnosis

PubMed Central

Lacarrubba, Francesco; Verzì, Anna Elisa; Chosidow, Olivier; Schwartz, Robert A.

2016-01-01

Scabies is a common, highly contagious skin parasitosis caused by Sarcoptes scabiei var. hominis. Early identification and prompt treatment of infested subjects is essential, as missed diagnosis may result in outbreaks, considerable morbidity, and significantly increased economic burden. The standard diagnostic technique consists of mites’ identification by microscopic examination of scales obtained by skin scraping. This is a time-consuming and risk-associated procedure that is also not suitable to a busy practice. In recent years, some advanced and noninvasive techniques such as videodermatoscopy, dermatoscopy, reflectance confocal microscopy, and optical coherence tomography have demonstrated improved efficacy in the diagnosis of scabies. Their advantages include rapid, noninvasive mass screening and post-therapeutic follow-up, with no physical risk. A greater knowledge of these techniques among general practitioners and other specialists involved in the intake care of overcrowded populations vulnerable to scabies infestations is now viewed as urgent and important in the management of outbreaks, as well as in consideration of the recent growing inflow of migrants in Europe from North Africa. PMID:27311065

Project TEAMS (Techniques and Education for Achieving Management Skills): Business and Industrial Supervisors.

ERIC Educational Resources Information Center

Platte Technical Community Coll., Columbus, NE.

These Project TEAMS (Techniques and Education for Achieving Management Skills) instructional materials consist of five units for use in training business and industrial supervisors. Unit 1 is designed to help managers in business or industry increase management skills in regard to leadership techniques, problem solving and decision making, and…

The interaction between biology and the management of aquatic macrophytes

USGS Publications Warehouse

Nichols, S.A.

1991-01-01

'Management' refers to controlling nuisance aquatic species and to restoring or restructing aquatic plant communities. Producing stable, diverse, aquatic plant communities containing a high percentage of desirable species is a primary management goal. There are a variety of techniques including harvesting, herbicides, water-level fluctuation, sediment alteration, nutrient limitation, light alteration, and biological controls which can be used for managing macrophytes. These techniques are briefly reviewed along with discussions of biological considerations important to the efficacy of the technique and the environmental impacts of the technique. There is a growing interest in restoring and restructing aquatic plant communities. Techniques for community restoration are discussed as are emerging management technologies using growth regulators and bioengineering. New management technologies will probably be limited by costs and environmental impacts. In the near future, better macrophyte management will come through better planning and more effective use of present technology. The challenge is to make current planning and management techniques more effective through increased biological inputs. The potential for biological input ranges from subcellular biology to species biology, to community and ecosystem biology. Some information needs are identified. ?? 1991.

The role of genetics in fisheries management under the E.U. common fisheries policy.

PubMed

Casey, J; Jardim, E; Martinsohn, J Th

2016-12-01

Exploitation of fish and shellfish stocks by the European Union fishing fleet is managed under the Common Fisheries Policy (CFP), which aims to ensure that fishing and aquaculture are environmentally, economically and socially sustainable and that they provide a source of healthy food for E.U. citizens. A notable feature of the CFP is its legally enshrined requirement for sound scientific advice to underpin its objectives. The CFP was first conceived in 1970 when it formed part of the Common Agricultural Policy. Its formal inception as a stand-alone regulation occurred in 1983 and since that time, the CFP has undergone reforms in 1992, 2002 and 2013, each time bringing additional challenges to the scientific advisory process as the scope of the advice increased in response to changing objectives arising from E.U. regulations and commitments to international agreements. This paper reviews the influence that genetics has had on fish stock assessments and the provision of management advice for European fisheries under successive reforms of the CFP. The developments in genetics since the inception of the CFP have given rise to a diverse and versatile set of genetic techniques that have the potential to provide significant added value to fisheries assessments and the scientific advisory process. While in some cases, notably Pacific salmon Oncorhynchus spp., genetics appear to be very well integrated into existing management schemes, it seems that for marine fishes, discussions on the use of genetics and genomics for fisheries management are often driven by the remarkable technological progress in this field, rather than imminent needs emerging from policy frameworks. An example is the recent suggestion to use environmental (e)DNA for monitoring purposes. While there is no denying that state-of-the-art genetic and genomic approaches can and will be of value to address a number of issues relevant for the management and conservation of marine renewable natural resources, a focus on technology rather than policy and management needs is prone to widen the gap between science and policy, governance and management, thereby further impeding the effective integration of genetic and genomic information into the fisheries management decision making process. Hence, rather than focusing on what is technically achievable, this review outlines suggestions as to which modern genetic and genomic approaches are likely to help address some of the most pressing fisheries management challenges under the CFP. © 2016 The Authors. Journal of Fish Biology published by John Wiley & Sons Ltd on behalf of The Fisheries Society of the British Isles.

Evolution of the operative management of colon trauma

PubMed Central

Sharpe, John P; Magnotti, Louis J; Fabian, Timothy C; Croce, Martin A

2017-01-01

For any trauma surgeon, colon wounds remain a relatively common, yet sometimes challenging, clinical problem. Evolution in operative technique and improvements in antimicrobial therapy during the past two centuries have brought remarkable improvements in both morbidity and mortality after injury to the colon. Much of the early progress in management and patient survival after colon trauma evolved from wartime experience. Multiple evidence-based studies during the last several decades have allowed for more aggressive management, with most wounds undergoing primary repair or resection and anastomosis with an acceptably low suture line failure rate. Despite the abundance of quality evidence regarding management of colon trauma obtained from both military and civilian experience, there remains some debate among institutions regarding management of specific injuries. This is especially true with respect to destructive wounds, injuries to the left colon, blunt colon trauma and those wounds requiring colonic discontinuity during an abbreviated laparotomy. Some programs have developed data-driven protocols that have simplified management of destructive colon wounds, clearly identifying those high-risk patients who should undergo diversion, regardless of mechanism or anatomic location. This update will describe the progression in the approach to colon injuries through history while providing a current review of the literature regarding management of the more controversial wounds.

Evolution of the operative management of colon trauma.

PubMed

Sharpe, John P; Magnotti, Louis J; Fabian, Timothy C; Croce, Martin A

2017-01-01

For any trauma surgeon, colon wounds remain a relatively common, yet sometimes challenging, clinical problem. Evolution in operative technique and improvements in antimicrobial therapy during the past two centuries have brought remarkable improvements in both morbidity and mortality after injury to the colon. Much of the early progress in management and patient survival after colon trauma evolved from wartime experience. Multiple evidence-based studies during the last several decades have allowed for more aggressive management, with most wounds undergoing primary repair or resection and anastomosis with an acceptably low suture line failure rate. Despite the abundance of quality evidence regarding management of colon trauma obtained from both military and civilian experience, there remains some debate among institutions regarding management of specific injuries. This is especially true with respect to destructive wounds, injuries to the left colon, blunt colon trauma and those wounds requiring colonic discontinuity during an abbreviated laparotomy. Some programs have developed data-driven protocols that have simplified management of destructive colon wounds, clearly identifying those high-risk patients who should undergo diversion, regardless of mechanism or anatomic location. This update will describe the progression in the approach to colon injuries through history while providing a current review of the literature regarding management of the more controversial wounds.

Management of Postembolization Syndrome Following Hepatic Transarterial Chemoembolization for Primary or Metastatic Liver Cancer.

PubMed

Blackburn, Helen; West, Sandra

2016-01-01

Transarterial chemoembolization (TACE) is an established treatment in managing liver primary neoplasms or liver metastases. Postembolization syndrome (PES) is a common adverse event defined as fever without associated sepsis, pain in the right upper quadrant, and nausea and/or vomiting. This integrative review aims to identify effective management strategies for PES or one of its characterizing symptoms (fever, pain, and nausea and/or vomiting). Searches of electronic databases MEDLINE, EMBASE, and CINAHL were conducted. Fifteen articles were identified for inclusion. Seven addressed all symptoms of PES, and 8 studies focused on individual symptoms of PES. Interventions identified are intra-arterial lidocaine, oral and intravenous analgesics, steroids, wrist-ankle acupuncture, antibiotics, and 5-HT3 receptor antagonists. Findings are explicated according to individual symptoms of PES. Intra-arterial lidocaine, steroids, and a 5-HT3 receptor antagonist are found to offer potential benefit in the management of PES symptoms. A number of interventions have shown potential benefit in the management of PES. A systemic approach using combination therapy is necessary to effectively manage characterizing symptoms. Further research is needed to determine the impact of primary disease site, TACE technique, and chemotherapeutic agent on PES. Oncology nurses are uniquely placed to undertake thorough patient assessment after TACE and implement early intervention to effectively manage PES.

Medication therapy management: its relationship to patient counseling, disease management, and pharmaceutical care.

PubMed

McGivney, Melissa Somma; Meyer, Susan M; Duncan-Hewitt, Wendy; Hall, Deanne L; Goode, Jean-Venable R; Smith, Randall B

2007-01-01

To delineate the relationship, including similarities and differences, between medication therapy management (MTM) and contemporary pharmacist-provided services, including patient counseling, disease management, and pharmaceutical care, to facilitate the continued evolution of commonly used language and a standard of practice across geographic areas and practice environments. Incorporation of MTM services into the array of Medicare-funded services affords an opportunity for pharmacists to develop direct patient care services in the community. Defining the role of MTM within the scope of pharmacist-provided patient care activities, including patient counseling, disease management, and all currently provided pharmacy services is essential to the delineation of a viable and sustainable practice model for pharmacists. The definitions of each of these services are offered, as well as comparisons and contrasts of the individual services. In addition to Medicare-eligible patients, MTM services are appropriate for anyone with medication-related needs. MTM is offered as an all-encompassing model that incorporates the philosophy of pharmaceutical care, techniques of patient counseling, and disease management in an environment that facilitates the direct collaboration of patients, pharmacists, and other health professionals. Defining the role of MTM within the current patient care models, including patient counseling, disease management, and all who provide pharmacy services, is essential in delineating a viable and sustainable practice model for pharmacists.

Results of an International Survey on the Investigation and Endovascular Management of Cerebral Vasospasm and Delayed Cerebral Ischemia.

PubMed

Hollingworth, Milo; Chen, Peng Roc; Goddard, Antony J P; Coulthard, Alan; Söderman, Michael; Bulsara, Ketan R

2015-06-01

Delayed cerebral ischemia (DCI) is a major cause of morbidity and mortality in aneurysmal subarachnoid hemorrhage. Endovascular management of this condition offers a new hope in preventing adverse outcome; however, a uniform standard of practice is lacking owing to a paucity of clinical trials. We conducted an international survey on the use of investigative and endovascular techniques in the treatment of DCI to assess the variability of current practice. Neurovascular neurosurgeons and neuroradiologists were contacted through professional societies from America, United Kingdom, Europe, and Australasia. Members were invited to complete a 13-item questionnaire regarding screening techniques, first-line and second-line therapies in endovascular intervention, and the role of angioplasty. Answers were compared using χ(2) testing for nonparametric data. Data from 344 respondents from 32 countries were analyzed: 167 non-United States and 177 U.S. More than half of all clinicians had 10+ years of experience in units with a mixture of higher and lower case volumes. Daily transcranial Doppler ultrasonography was the most commonly used screening technique by both U.S. (70%) and non-U.S. (53%) practitioners. Verapamil was the most common first-line therapy in the United States, whereas nimodipine was most popular in non-U.S. countries. Angioplasty was performed by 83% of non-U.S. and 91% of U.S. clinicians in the treatment of vasospasm; however, more U.S. clinicians reported using angioplasty for distal vasospasm. Treatment practices for DCI vary considerably, with the greatest variability in the choice of agent for intra-arterial therapy. Our data demonstrate the wide variation of approaches in use at present. However, without further clinical trials and development of a uniform standard of best practice, variability in treatment and outcome for DCI is likely to continue. Copyright © 2015 Elsevier Inc. All rights reserved.

Systematic reviews of bladder training and voiding programmes in adults: a synopsis of findings from data analysis and outcomes using metastudy techniques.

PubMed

Roe, Brenda; Ostaszkiewicz, Joan; Milne, Jill; Wallace, Sheila

2007-01-01

This paper reports a comparison of the data analysis and outcomes from four Cochrane systematic reviews on bladder training and voiding programmes for the management of urinary incontinence using metastudy descriptive techniques to inform clinical practice, generate new ideas and identify future research directions. Bladder training is used for cognitively and physically able adults to regain continence by increasing the time interval between voids. Prompted voiding, habit retraining and timed voiding, collectively known as voiding programmes, are generally used for people with cognitive and physical impairments in institutional settings. Bladder training and voiding programmes feature as common clinical practice for the management of urinary incontinence. A synopsis of four Cochrane systematic reviews that included randomized controlled trials on bladder training, prompted voiding, habit retraining and timed voiding was undertaken using metastudy techniques for the synthesis of qualitative research, and has provided a discursive comparison and contrast of the meta-data analysis and outcomes of these reviews. Frequency of incontinence was the most common and constant outcome measure of effectiveness in the reviews. Limited data were available on other health outcomes, change in dependency status, quality of life and cost-effectiveness. The systematic review on bladder training included different types of urinary incontinence, whereas those on voiding programmes did not differentiate the type of incontinence. There is evidence on the effectiveness of bladder training but long-term follow up studies are needed. Evidence on the effectiveness of voiding programmes is limited and not available for many outcomes. Future research needs to consider the theory underpinning interventions for bladder training and voiding programmes for urinary incontinence and should incorporate recognized 'quality' research designs, established outcomes and long-term follow up. It is unclear whether health outcomes for people with comorbidities, cognitive and physical impairments will improve if extensive diagnostic and assessment investigations are undertaken.

Influence of Rotator Cuff Tear Size and Repair Technique on the Creation and Management of Dog Ear Deformities in a Transosseous-Equivalent Rotator Cuff Repair Model

PubMed Central

Redler, Lauren H.; Byram, Ian R.; Luchetti, Timothy J.; Tsui, Ying Lai; Moen, Todd C.; Gardner, Thomas R.; Ahmad, Christopher S.

2014-01-01

Background: Redundancies in the rotator cuff tissue, commonly referred to as “dog ear” deformities, are frequently encountered during rotator cuff repair. Knowledge of how these deformities are created and their impact on rotator cuff footprint restoration is limited. Purpose: The goals of this study were to assess the impact of tear size and repair method on the creation and management of dog ear deformities in a human cadaveric model. Study Design: Controlled laboratory study. Methods: Crescent-shaped tears were systematically created in the supraspinatus tendon of 7 cadaveric shoulders with increasing medial to lateral widths (0.5, 1.0, and 1.5 cm). Repair of the 1.5-cm tear was performed on each shoulder with 3 methods in a randomized order: suture bridge, double-row repair with 2-mm fiber tape, and fiber tape with peripheral No. 2 nonabsorbable looped sutures. Resulting dog ear deformities were injected with an acrylic resin mixture, digitized 3-dimensionally (3D), and photographed perpendicular to the footprint with calibration. The volume, height, and width of the rotator cuff tissue not in contact with the greater tuberosity footprint were calculated using the volume injected, 3D reconstructions, and calibrated photographs. Comparisons were made between tear size, dog ear measurement technique, and repair method utilizing 2-way analysis of variance and Student-Newman-Keuls multiple-comparison tests. Results: Utilizing 3D digitized and injection-derived volumes and dimensions, anterior dog ear volume, height, and width were significantly smaller for rotator cuff repair with peripheral looped sutures compared with a suture bridge (P < .05) or double-row repair with 2-mm fiber tape alone (P < .05). Similarly, posterior height and width were significantly smaller for repair with looped peripheral sutures compared with a suture bridge (P < .05). Dog ear volumes and heights trended larger for the 1.5-cm tear, but this was not statistically significant. Conclusion: When combined with a standard transosseous-equivalent repair technique, peripheral No. 2 nonabsorbable looped sutures significantly decreased the volume, height, and width of dog ear deformities, better restoring the anatomic footprint of the rotator cuff. Clinical Relevance: Dog ear deformities are commonly encountered during rotator cuff repair. Knowledge of a repair technique that reliably decreases their size, and thus increases contact at the anatomic footprint of the rotator cuff, will aid sports medicine surgeons in the management of these deformities. PMID:26535317

Rainwater harvesting and management in rainfed agricultural systems in sub-Saharan Africa - A review

NASA Astrophysics Data System (ADS)

Biazin, Birhanu; Sterk, Geert; Temesgen, Melesse; Abdulkedir, Abdu; Stroosnijder, Leo

Agricultural water scarcity in the predominantly rainfed agricultural system of sub-Saharan Africa (SSA) is more related to the variability of rainfall and excessive non-productive losses, than the total annual precipitation in the growing season. Less than 15% of the terrestrial precipitation takes the form of productive ‘green’ transpiration. Hence, rainwater harvesting and management (RWHM) technologies hold a significant potential for improving rainwater-use efficiency and sustaining rainfed agriculture in the region. This paper outlines the various RWHM techniques being practiced in SSA, and reviews recent research results on the performance of selected practices. So far, micro-catchment and in situ rainwater harvesting techniques are more common than rainwater irrigation techniques from macro-catchment systems. Depending on rainfall patterns and local soil characteristics, appropriate application of in situ and micro-catchment techniques could improve the soil water content of the rooting zone by up to 30%. Up to sixfold crop yields have been obtained through combinations of rainwater harvesting and fertiliser use, as compared to traditional practices. Supplemental irrigation of rainfed agriculture through rainwater harvesting not only reduces the risk of total crop failure due to dry spells, but also substantially improves water and crop productivity. Depending on the type of crop and the seasonal rainfall pattern, the application of RWHM techniques makes net profits more possible, compared to the meagre profit or net loss of existing systems. Implementation of rainwater harvesting may allow cereal-based smallholder farmers to shift to diversified crops, hence improving household food security, dietary status, and economic return. The much needed green revolution and adaptations to climate change in SSA should blend rainwater harvesting ideals with agronomic principles. More efforts are needed to improve the indigenous practices, and to disseminate best practices on a wider scale.

A critical analysis of the surgical outcomes for the treatment of Peyronie’s disease

PubMed Central

Mandava, Sree H.; Trost, Landon W.; Hellstrom, Wayne J.G.

2013-01-01

Peyronie’s disease (PD) is a relatively common condition, which can impair sexual function and result in emotional and psychological distress. Despite an abundance of minimally invasive treatments, few have confirmed efficacy for improving penile curvature and function. Surgical therapies include many different techniques and are reserved for patients with stable disease of ⩾12 months’ duration. We searched PubMed for all articles from 1990 to the present relating to the surgical management of PD. Preference was given to recent articles, larger series, and those comparing various techniques and/or materials. Outcomes were subsequently analysed and organised by surgical technique and the graft material used. Available surgical techniques include plication/corporoplasty procedures, incision and grafting (I&G), and placing a penile prosthesis with or without adjunctive procedures. Although several surgical algorithms have been reported, in general, plication/corporoplasty procedures are reserved for patients with adequate erectile function, simple curvatures of <60°, and with no deformities (hour-glass, hinge). I&G are reserved for complex curvatures of >60° and those with deformities. Penile prostheses are indicated for combined erectile dysfunction and PD. Overall outcomes show high rates of improved curvature and patient satisfaction, with mildly decreased erectile function with both plication and the I&G procedure (I&G >plication) and decreases in penile length (plication >I&G). Surgical management of PD remains an excellent treatment option for patients with penile curvature precluding or impairing sexual activity. Surgical algorithms are available to assist treating clinicians in appropriately stratifying surgical candidates. Additional research is needed to identify optimal surgical techniques and materials based on patient and disease characteristics. PMID:26558094

Laparoscopy-like operative vaginoscopy: a new approach to manage mesh erosions.

PubMed

Billone, Valentina; Amorim-Costa, Célia; Campos, Sara; Rabischong, Benoĭt; Bourdel, Nicolas; Canis, Michel; Botchorishvili, Revaz

2015-01-01

Mesh erosion through the vagina is the most common complication of synthetic mesh used for pelvic organ prolapse repair. However, conventional transvaginal mesh excision has many technical limitations. We aimed at creating and describing a new surgical technique for transvaginal removal of exposed mesh that would enable better exposition and access, thus facilitating optimal treatment. A step-by-step video showing the technique. A university tertiary care hospital. Five patients previously submitted to pelvic organ prolapse repair using synthetic mesh, presenting mesh erosion through the vagina. Mesh excision using a laparoscopy-like operative vaginoscopy in which standard laparoscopic instruments are used through a single-incision laparoscopic surgery port device placed in the vagina. In all cases, a very good exposure of the mesh was achieved, a minimal tissue traction was required, and the procedures were performed in a very ergonomic way. All the patients were discharged on the same day of the surgery and had a painless postoperative course. So far, there have been no cases of relapse. This seems to be a simple, cheap, and valuable minimally invasive technique with many advantages in comparison with the conventional approach. More cases and time are necessary to access its long-term efficacy. It may possibly be used for the management of other conditions. Copyright © 2015 AAGL. Published by Elsevier Inc. All rights reserved.

Pheromone-assisted techniques to improve the efficacy of insecticide sprays against Linepithema humile (Hymenoptera: Formicidae).

PubMed

Choe, Dong-Hwan; Tsai, Kasumi; Lopez, Carlos M; Campbell, Kathleen

2014-02-01

Outdoor residual sprays are among the most common methods for targeting pestiferous ants in urban pest management programs. If impervious surfaces such as concrete are treated with these insecticides, the active ingredients can be washed from the surface by rain or irrigation. As a result, residual sprays with fipronil and pyrethroids are found in urban waterways and aquatic sediments. Given the amount of insecticides applied to urban settings for ant control and their possible impact on urban waterways, the development of alternative strategies is critical to decrease the overall amounts of insecticides applied, while still achieving effective control of target ant species. Herein we report a "pheromone-assisted technique" as an economically viable approach to maximize the efficacy of conventional sprays targeting the Argentine ant. By applying insecticide sprays supplemented with an attractive pheromone compound, (Z)-9-hexadecenal, Argentine ants were diverted from nearby trails and nest entrances and subsequently exposed to insecticide residues. Laboratory experiments with fipronil and bifenthrin sprays indicated that the overall kill of the insecticides on Argentine ant colonies was significantly improved (57-142% increase) by incorporating (Z)-9-hexadecenal in the insecticide sprays. This technique, once it is successfully implemented in practical pest management programs, has the potential of providing maximum control efficacy with reduced amount of insecticides applied in the environment.

Prevalence, causes and management outcome of intestinal obstruction in Adama Hospital, Ethiopia.

PubMed

Soressa, Urgessa; Mamo, Abebe; Hiko, Desta; Fentahun, Netsanet

2016-06-04

In Africa, acute intestinal obstruction accounts for a great proportion of morbidity and mortality. Ethiopia is one of the countries where intestinal obstruction is a major cause of morbidity and mortality. This study aims to determine prevalence, causes and management outcome of intestinal obstruction in Adama Hospital in Oromia region, Ethiopia. A hospital based cross-sectional study design was used. Data covering the past three years were collected from hospital medical records of sampled patients. The collected data were checked for any inconsistency, coded and entered into SPSS version 16.0 for data processing and analysis. Descriptive and logistic regression analyses were used. Statistical significance was based on confidence interval (CI) of 95 % at a p-value of < 0.05. 262 patients were admitted with intestinal obstruction. The prevalence of intestinal obstruction was 21.8 % and 4.8 % among patients admitted for acute abdomen surgery and total surgical admissions, respectively. The mortality rate was 2.5 % (6 of 262). The most common cause of small bowel obstruction was intussusceptions in 48 patients (30.9 %), followed by small bowel volvulus in 47 patients (30.3 %). Large bowel obstruction was caused by sigmoid volvulus in 60 patients (69.0 %) followed by colonic tumor in 12 patients (13.8 %). After controlling for possible confounding factors, the major predictors of management outcome of intestinal obstruction were: duration of illness before surgical intervention (adjusted odds ratio (AOR) = 0.49, 95 % CI: 0.25-0.97); intra-operative findings [Viable small bowel volvulus (SBV) (AOR = 0.08, 95 % CI: 0.01-0.95) and viable (AOR = 0.17, 95 % CI: 0.03-0.88)]; completion of intra-operative procedures (bowel resection & anastomosis (AOR = 3.05, 95 % CI: 1.04-8.94); and length of hospital stay (AOR = 0.05, 95 % CI: 0.01-0.16). Small bowel obstruction was more prevalent than large bowel obstruction. Intussusceptions and sigmoid volvulus were the leading causes of small and large bowel obstruction. Laparotomy was the most common methods of intestinal obstruction management. Bowel resection and anastomosis was the commonest intra-operative procedure done and is associated with postoperative complications. Wound infection in the affected area should be improved because it is the most common postoperative complication. This can be decreased by appropriate surgical technique and wound care with sterile techniques.

Choice and explanation in medical management: a multiattribute model of artificial intelligence approaches.

PubMed

Rennels, G D; Shortliffe, E H; Miller, P L

1987-01-01

This paper explores a model of choice and explanation in medical management and makes clear its advantages and limitations. The model is based on multiattribute decision making (MADM) and consists of four distinct strategies for choice and explanation, plus combinations of these four. Each strategy is a restricted form of the general MADM approach, and each makes restrictive assumptions about the nature of the domain. The advantage of tailoring a restricted form of a general technique to a particular domain is that such efforts may better capture the character of the domain and allow choice and explanation to be more naturally modelled. The uses of the strategies for both choice and explanation are illustrated with analyses of several existing medical management artificial intelligence (AI) systems, and also with examples from the management of primary breast cancer. Using the model it is possible to identify common underlying features of these AI systems, since each employs portions of this model in different ways. Thus the model enables better understanding and characterization of the seemingly ad hoc decision making of previous systems.

Endoscopic features of gastro-intestinal lymphomas: From diagnosis to follow-up

PubMed Central

Vetro, Calogero; Romano, Alessandra; Amico, Irene; Conticello, Concetta; Motta, Giovanna; Figuera, Amalia; Chiarenza, Annalisa; Di Raimondo, Cosimo; Giulietti, Giorgio; Bonanno, Giacomo; Palumbo, Giuseppe Alberto; Di Raimondo, Francesco

2014-01-01

Many progresses have been done in the management of gastrointestinal (GI) lymphomas during last decades, especially after the discovery of Helicobacter pylori-dependent lymphoma development. The stepwise implementation of new endoscopic techniques, by means of echoendoscopy or double-balloon enteroscopy, enabled us to more precisely describe the endoscopic features of GI lymphomas with substantial contribution in patient management and in tailoring the treatment strategy with organ preserving approaches. In this review, we describe the recent progresses in GI lymphoma management from disease diagnosis to follow-up with a specific focus on the endoscopic presentation according to the involved site and the lymphoma subtype. Additionally, new or emerging endoscopic technologies that have an impact on the management of gastrointestinal lymphomas are reported. We here discuss the two most common subtypes of GI lymphomas: the mucosa-associated lymphoid tissue and the diffuse large B cell lymphoma. A general outline on the state-of-the-art of the disease and on the role of endoscopy in both diagnosis and follow-up will be performed. PMID:25278693

Current management of oral cancer. A multidisciplinary approach.

PubMed

Ord, R A; Blanchaert, R H

2001-11-01

Recent basic science discoveries have contributed to our understanding of the etiology of oral cancer and allowed us to consider innovative approaches to therapy. The authors evaluated and summarized current approaches to the management of oral cancer, emphasizing the multidisciplinary team approach to coordinate surgery, radiation therapy and chemotherapy. Current concepts in management, including complications of therapy, are described. State-of-the-art surgical techniques can spare patients with oral cancer from much of the morbidity and complications common in the past. The refinement of treatment strategies reduces complications and improves efficacy. Many exciting new clinical trials in the areas of gene therapy and immunomodulation are showing promise. Management of oral cancer has undergone radical change in the past 10 years and continues to evolve rapidly. Discoveries in molecular biology, diagnosis, surgery, radiation therapy and medical oncology have altered many traditional concepts and practices. General dental practitioners need to understand current treatment modalities for oral and pharyngeal cancers to determine to whom they should refer patients for the most appropriate treatment, and to make recommendations regarding complications associated with these cancers.

Designing a more efficient, effective and safe Medical Emergency Team (MET) service using data analysis

PubMed Central

Bilgrami, Irma; Bain, Christopher; Webb, Geoffrey I.; Orosz, Judit; Pilcher, David

2017-01-01

Introduction Hospitals have seen a rise in Medical Emergency Team (MET) reviews. We hypothesised that the commonest MET calls result in similar treatments. Our aim was to design a pre-emptive management algorithm that allowed direct institution of treatment to patients without having to wait for attendance of the MET team and to model its potential impact on MET call incidence and patient outcomes. Methods Data was extracted for all MET calls from the hospital database. Association rule data mining techniques were used to identify the most common combinations of MET call causes, outcomes and therapies. Results There were 13,656 MET calls during the 34-month study period in 7936 patients. The most common MET call was for hypotension [31%, (2459/7936)]. These MET calls were strongly associated with the immediate administration of intra-venous fluid (70% [1714/2459] v 13% [739/5477] p<0.001), unless the patient was located on a respiratory ward (adjusted OR 0.41 [95%CI 0.25–0.67] p<0.001), had a cardiac cause for admission (adjusted OR 0.61 [95%CI 0.50–0.75] p<0.001) or was under the care of the heart failure team (adjusted OR 0.29 [95%CI 0.19–0.42] p<0.001). Modelling the effect of a pre-emptive management algorithm for immediate fluid administration without MET activation on data from a test period of 24 months following the study period, suggested it would lead to a 68.7% (2541/3697) reduction in MET calls for hypotension and a 19.6% (2541/12938) reduction in total METs without adverse effects on patients. Conclusion Routinely collected data and analytic techniques can be used to develop a pre-emptive management algorithm to administer intravenous fluid therapy to a specific group of hypotensive patients without the need to initiate a MET call. This could both lead to earlier treatment for the patient and less total MET calls. PMID:29281665

Management Techniques for Librarians.

ERIC Educational Resources Information Center

Evans, G. Edward

This textbook on library management techniques is concerned with basic management problems. Examples of problems in planning, organization, and coordination are drawn from situations in libraries or information centers. After an introduction to library management, the history of management is covered. Several styles of management and organization…

Economic Techniques of Occupational Health and Safety Management

NASA Astrophysics Data System (ADS)

Sidorov, Aleksandr I.; Beregovaya, Irina B.; Khanzhina, Olga A.

2016-10-01

The article deals with the issues on economic techniques of occupational health and safety management. Authors’ definition of safety management is given. It is represented as a task-oriented process to identify, establish and maintain such a state of work environment in which there are no possible effects of hazardous and harmful factors, or their influence does not go beyond certain limits. It was noted that management techniques that are the part of the control mechanism, are divided into administrative, organizational and administrative, social and psychological and economic. The economic management techniques are proposed to be classified depending on the management subject, management object, in relation to an enterprise environment, depending on a control action. Technoeconomic study, feasibility study, planning, financial incentives, preferential crediting of enterprises, pricing, profit sharing and equity, preferential tax treatment for enterprises, economic regulations and standards setting have been distinguished as economic techniques.

Elucidating early CT after pancreatico-duodenectomy: a primer for radiologists.

PubMed

Tonolini, Massimo; Ierardi, Anna Maria; Carrafiello, Gianpaolo

2018-04-13

Pancreatico-duodenectomy (PD) represents the standard surgical treatment for resectable malignancies of the pancreatic head, distal common bile duct, periampullary region and duodenum, and is also performed to manage selected benign tumours and refractory chronic pancreatitis. Despite improved surgical techniques and acceptable mortality, PD remains a technically demanding, high-risk operation burdened with high morbidity (complication rates 40-50% of patients). Multidetector computed tomography (CT) represents the mainstay modality to rapidly investigate the postoperative abdomen, and to provide a consistent basis for an appropriate choice between conservative, interventional or surgical treatment. However, radiologists require familiarity with the surgically altered anatomy, awareness of expected imaging appearances and possible complications to correctly interpret early post-PD CT studies. This paper provides an overview of surgical indications and techniques, discusses risk factors and clinical manifestations of the usual postsurgical complications, and suggests appropriate techniques and indications for early postoperative CT imaging. Afterwards, the usual, normal early post-PD CT findings are presented, including transient fluid, pneumobilia, delayed gastric emptying, identification of pancreatic gland remnant and of surgical anastomoses. Finally, several imaging examples review the most common and some unusual complications such as pancreatic fistula, bile leaks, abscesses, intraluminal and extraluminal haemorrhage, and acute pancreatitis. • Pancreatico-duodenectomy (PD) is a technically demanding surgery burdened with high morbidity (40-50%). • Multidetector CT is the mainstay technique to investigate suspected complications following PD. • Interpreting post-PD CT requires knowledge of surgically altered anatomy and expected findings. • CT showing collection at surgical site supports clinico-biological diagnosis of pancreatic fistula. • Other complications include biliary leaks, haemorrhage, abscesses and venous thrombosis.

Chronic subdural hematoma: Surgical management and outcome in 986 cases: A classification and regression tree approach

PubMed Central

Rovlias, Aristedis; Theodoropoulos, Spyridon; Papoutsakis, Dimitrios

2015-01-01

Background: Chronic subdural hematoma (CSDH) is one of the most common clinical entities in daily neurosurgical practice which carries a most favorable prognosis. However, because of the advanced age and medical problems of patients, surgical therapy is frequently associated with various complications. This study evaluated the clinical features, radiological findings, and neurological outcome in a large series of patients with CSDH. Methods: A classification and regression tree (CART) technique was employed in the analysis of data from 986 patients who were operated at Asclepeion General Hospital of Athens from January 1986 to December 2011. Burr holes evacuation with closed system drainage has been the operative technique of first choice at our institution for 29 consecutive years. A total of 27 prognostic factors were examined to predict the outcome at 3-month postoperatively. Results: Our results indicated that neurological status on admission was the best predictor of outcome. With regard to the other data, age, brain atrophy, thickness and density of hematoma, subdural accumulation of air, and antiplatelet and anticoagulant therapy were found to correlate significantly with prognosis. The overall cross-validated predictive accuracy of CART model was 85.34%, with a cross-validated relative error of 0.326. Conclusions: Methodologically, CART technique is quite different from the more commonly used methods, with the primary benefit of illustrating the important prognostic variables as related to outcome. Since, the ideal therapy for the treatment of CSDH is still under debate, this technique may prove useful in developing new therapeutic strategies and approaches for patients with CSDH. PMID:26257985

Diagnosis and Management of Behavioral Variant Frontotemporal Dementia

PubMed Central

Pressman, Peter; Miller, Bruce L

2014-01-01

Frontotemporal dementia (FTD) was documented over a century ago. The last decade, however, has seen substantial changes in our conceptions of this increasingly recognized disorder. Different clinical variants have been delineated, the most common of which is the behavioral variant (bvFTD). Updated diagnostic criteria have been established. New histopathological findings and genetic etiologies have been discovered. Research continues to uncover molecular mechanisms by which abnormal proteins accumulate in degenerating brain tissue. Novel neuroimaging techniques suggest that functional networks are diminished in bvFTD that may be relevant to empathy and social behavior. Despite rapid advances in our understanding of bvFTD, the disease is still under-recognized and commonly misdiagnosed. The result is inappropriate patient care. Recognizing the various presentations of bvFTD and its histological and genetic subtypes may further diagnosis, treatment and research. PMID:24315411

Summary of nondestructive testing theory and practice

NASA Technical Reports Server (NTRS)

Meister, R. P.; Randall, M. D.; Mitchell, D. K.; Williams, L. P.; Pattee, H. E.

1972-01-01

The ability to fabricate design critical and man-rated aerospace structures using materials near the limits of their capabilities requires a comprehensive and dependable assurance program. The quality assurance program must rely heavily on nondestructive testing methods for thorough inspection to assess properties and quality of hardware items. A survey of nondestructive testing methods is presented to provide space program managers, supervisors and engineers who are unfamiliar with this technical area with appropriate insight into the commonly accepted nondestructive testing methods available, their interrelationships, used, advantages and limitations. Primary emphasis is placed on the most common methods: liquid penetrant, magnetic particle, radiography, ultrasonics and eddy current. A number of the newer test techniques including thermal, acoustic emission, holography, microwaves, eddy-sonic and exo-electron emission, which are beginning to be used in applications of interest to NASA, are also discussed briefly.

Treatments for Common Psychiatric Conditions Among Children and Adolescents During Acute Rehabilitation and Reintegration Phases of Burn Injury

PubMed Central

Arceneaux, Lisa L.; Meyer, Walter J.

2016-01-01

Advances in critical care and surgical management during the last 20 years have decreased mortality rates among children with severe burn injuries. This improved survival rate has prompted researchers to study the psychological aspects of recovering from a burn injury. Initially, research focused primarily on epidemiology, prevention and descriptions of the psychological phenomenon experienced by the children and adolescents. Whereas, previously, interventions were often utilized during the acute phases of burn injury without knowledge of the long-term effects, more recently, priorities have shifted to include long-term treatment outcome studies. The purpose of this paper is to review and discuss the current evidenced-based techniques and their efficacy in the treatment of common psychological and psychiatric conditions among children and adolescents during the 3 major phases of burn injury. PMID:19919208

MDCT evaluation of acute aortic syndrome (AAS)

PubMed Central

Rossi, Giovanni; Lassandro, Francesco; Rea, Gaetano; Marino, Maurizio; Muto, Maurizio; Molino, Antonio; Scaglione, Mariano

2016-01-01

Non-traumatic acute thoracic aortic syndromes (AAS) describe a spectrum of life-threatening aortic pathologies with significant implications on diagnosis, therapy and management. There is a common pathway for the various manifestations of AAS that eventually leads to a breakdown of the aortic intima and media. Improvements in biology and health policy and diffusion of technology into the community resulted in an associated decrease in mortality and morbidity related to aortic therapeutic interventions. Hybrid procedures, branched and fenestrated endografts, and percutaneous aortic valves have emerged as potent and viable alternatives to traditional surgeries. In this context, current state-of-the art multidetector CT (MDCT) is actually the gold standard in the emergency setting because of its intrinsic diagnostic value. Management of acute aortic disease has changed with the increasing realization that endovascular therapies may offer distinct advantages in these situations. This article provides a summary of AAS, focusing especially on the MDCT technique, typical and atypical findings and common pitfalls of AAS, as well as recent concepts regarding the subtypes of AAS, consisting of aortic dissection, intramural haematoma, penetrating atherosclerotic ulcer and unstable aortic aneurysm or contained aortic rupture. MDCT findings will be related to pathophysiology, timing and management options to achieve a definite and timely diagnostic and therapeutic definition. In the present article, we review the aetiology, pathophysiology, clinical presentation, outcomes and therapeutic approaches to acute aortic syndromes. PMID:27033344

Apical/Retrograde Periimplantitis/Implant Periapical Lesion: Etiology, Risk Factors, and Treatment Options: A Systematic Review.

PubMed

Ramanauskaite, Ausra; Juodzbalys, Gintaras; Tözüm, Tolga F

2016-10-01

To review the literature on retrograde periimplantitis symptoms, risk factors, and treatment methods and to propose a decision-making tree of retrograde periimplantitis management. An electronic literature search was conducted on the MEDLINE and EMBASE databases for articles published between 1990 and 2015. Clinical human studies in the English language were included. The search resulted in 44 case reports published by 27 authors. The average time of the diagnosis of the pathology was found to be 26.07 weeks after implant placement (SD ± 39.7). Fistula formation was found to be the most common clinical symptom, statistically significantly more often occurring in the maxilla (P = 0.04). A negative correlation was found between pain and the adjacent tooth with incomplete endodontic treatment/endodontic pathology (r = -0.4; P = 0.009) and a positive correlation between the later risk factor and implant removal (r = 0.3; P = 0.028). Regenerative treatment (45.2% of the cases) or implant removal (35.7% of the cases) was the most common treatment techniques used. A decision-making tree of retrograde periimplantitis management is suggested. The etiology of retrograde periimplantitis is most often infectious. A decision-making tree aimed at managing patients with retrograde periimplantitis according to the possible etiology and symptoms of the disease can be a useful tool in the treatment of the pathology.

Efficacy of Complementary Therapies in the Quality of Life of Breast Cancer Survivors

PubMed Central

Zaidi, Sahar; Hussain, Showket; Verma, Shalini; Veqar, Zubia; Khan, Asiya; Nazir, Sheeraz Un; Singh, Neha; Moiz, Jamal Ali; Tanwar, Pranay; Srivastava, Anurag; Rath, G. K.; Mehrotra, Ravi

2018-01-01

Breast cancer (BC) is the most common cancer diagnosed in women and the second most common cancer overall, ranking as the fifth cause of death from cancer. The chronicity of the disease produces long-term physiological and psychological manifestations, which adversely affect the quality of life of the individual. The primary treatment while managing cancer presents with various debilitating side effects. With the recent advances in treatment techniques that have improved the survival rate, patients suffer from continuing posttreatment complications. Patients seem to cope well with the stress of treatment of BC and sustain a normal life; however, the deterioration in physical well-being makes the patient functionally inefficient. Exercise has been proven to be an effective, safe, and feasible tool in combating the adverse effects of treatment, prevents complications and decreases the risk of BC-specific mortality. This review briefly presents an overview of the burden of the disease and its management strategies. Owing to the heterogeneity of the population and the multitude of therapies they receive, the response of each patient to treatment is different and so is the magnitude of adverse effects. The review discusses the late sequelae following treatment and evidence supporting the role of physical activity in their management. In conclusion, there is a need for personalized physical activity plans to be developed to suit the individual and their circumstances. PMID:29376027

Managing a Common Pool Resource: Real Time Decision-Making in a Groundwater Aquifer

NASA Astrophysics Data System (ADS)

Sahu, R.; McLaughlin, D.

2017-12-01

In a Common Pool Resource (CPR) such as a groundwater aquifer, multiple landowners (agents) are competing for a limited resource of water. Landowners pump out the water to grow their own crops. Such problems can be posed as differential games, with agents all trying to control the behavior of the shared dynamic system. Each agent aims to maximize his/her own personal objective like agriculture yield, being aware that the action of every other agent collectively influences the behavior of the shared aquifer. The agents therefore choose a subgame perfect Nash equilibrium strategy that derives an optimal action for each agent based on the current state of the aquifer and assumes perfect information of every other agents' objective function. Furthermore, using an Iterated Best Response approach and interpolating techniques, an optimal pumping strategy can be computed for a more-realistic description of the groundwater model under certain assumptions. The numerical implementation of dynamic optimization techniques for a relevant description of the physical system yields results qualitatively different from the previous solutions obtained from simple abstractions.This work aims to bridge the gap between extensive modeling approaches in hydrology and competitive solution strategies in differential game theory.

Managing Documents in the Wider Area: Intelligent Document Management.

ERIC Educational Resources Information Center

Bittleston, Richard

1995-01-01

Discusses techniques for managing documents in wide area networks, reviews technique limitations, and offers recommendations to database designers. Presented techniques include: increasing bandwidth, reducing data traffic, synchronizing documentation, partial synchronization, audit trials, navigation, and distribution control and security. Two…

A Study of the Applicability of Scientific Management Techniques for the Administration of Small, Private Church-Related Colleges.

ERIC Educational Resources Information Center

Ferguson, Albert S.

Experiences with various modern management techniques and practices in selected small, private church-related colleges were studied. For comparative purposes, practices in public colleges and universities were also assessed. Management techniques used in small companies were identified through review of the literature and the management seminars…

Extracorporeal membrane oxygenation: current clinical practice, coding, and reimbursement.

PubMed

Schuerer, Douglas J E; Kolovos, Nikoleta S; Boyd, Kayla V; Coopersmith, Craig M

2008-07-01

Extracorporeal membrane oxygenation (ECMO) is a technique for providing life support for patients experiencing both pulmonary and cardiac failure by maintaining oxygenation and perfusion until native organ function is restored. ECMO is used routinely at many specialized hospitals for infants and less commonly for children with respiratory or cardiac failure from a variety of causes. Its usage is more controversial in adults, but select medical centers have reported favorable findings in patients with ARDS and other causes of severe pulmonary failure. ECMO is also rarely used as a rescue therapy in a small subset of adult patients with cardiac failure. This article will review the current uses and techniques of ECMO in the critical care setting as well as the evidence supporting its usage. In addition, current practice management related to coding and reimbursement for this intensive therapy will be discussed.